CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the
person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME CAWIGAN
NAME EXTENSION (JR., SR)
FIRST NAME ALNAIR

MIDDLE NAME BRIONES

3. DATE OF BIRTH
(mm/dd/yyyy) 2/1/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH TARLAC CITY, TARLAC If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS Block 6
Widowed Separated House/Block/Lot No. Street
San Manuel
Other/s:
Subdivision/Village Barangay
Tarlac City Tarlac
7. HEIGHT (m) 1.58 m
City/Municipality Province
8. WEIGHT (kg) 58 kg ZIP CODE 2300
18. PERMANENT ADDRESS Block 6
9. BLOOD TYPE O+
House/Block/Lot No. Street
San Manuel
10. GSIS ID NO. 021-1865-8952-5
Subdivision/Village Barangay
Tarlac City Tarlac
11. PAG-IBIG ID NO. 121144243803
City/Municipality Province
12. PHILHEALTH NO. ZIP CODE 2300

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 468-590-124-00 20. MOBILE NO. +639087384573

15. AGENCY EMPLOYEE NO. 5378424 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CAWIGAN

NAME EXTENSION (JR., SR)
FIRST NAME ZOILO

MIDDLE NAME GARCIA

25. MOTHER'S MAIDEN NAME

SURNAME BRIONES

FIRST NAME REMILYN

MIDDLE NAME CUNANAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
UNITS ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From To
graduated)
ELEMENTARY MALIWALO ELEMENTARY SCHOOL ELEMENTARY 2001 2007 2007
VOCATIONAL /
SECONDARY MALIWALO NATIONAL HIGH SCHOOL HIGH SCHOOL 2007 2011 2011

BACHELOR OF SECONDARY EDUCATION

COLLEGE TRADE TARLAC STATE UNIVERSITY 2011 2015 2015
COURSE MAJOR IN MAPEH
MASTER OF ARTS IN EDUCATION MAJOR IN
GRADUATE STUDIES ARAULLO UNIVERSITY
PHYSICAL EDUCATION
2018 PRESENT 30 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2020

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

LICENSURE EXAMINATION FOR TEACHERS 78.20 8/27/2015 BAGUIO CITY 1404907 12/12/2015

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
GOV'T
28. INCLUSIVE DATES SERVICE
SALARY/ JOB/
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
MONTHLY STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)

10/9/2019 To Date Teacher II DepEd Tarlac City P22,938 12-1 Permanent Y

10/10/2016 9/9/2019 Teacher I DepEd Tarlac City P20,651 11-1 Permanent Y

1/6/2015 3/31/2016 MAPEH Teacher Ecumenical Christian College P10,000 Contractual N

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2020

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

N/A

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)
INCLUSIVE DATES OF
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

Webinar or Gender and Development: "TCSD WAVE through

Mental Health Awareness and Resiliency"
11/9/2020 11/9/2020 8.0 Technical DepEd Tarlac City
Division Online Training-Workshop on the preparation of
08/19/2020 08/21/2020 24.0 Technical DepEd Tarlac City
Learning Activity Sheets (LAS)
Online Training on remote learning using Microsoft
3/8/2020 7/8/2020 24.0 Technical DepEd Tarlac City
Teams and Office 365
Teach On: Keeping the Passion Alive 2/4/2020 5/6/2020 40.0 Technical SEAMEO INNOTECH
Division Enhancement Training in Coaching and Officiating in the
different School-Based Sports Discipline
11/9/2019 9/13/2019 24.0 Technical DepEd Tarlac City
Division Training-Workshop on the Development and Evaluation
of Supplementary Learning Resources
10/29/2018 10/31/2018 24.0 Technical DepEd Tarlac City
Regional K-10 MTOT on Critical Content for Music and
5/16/2018 5/22/2018 56.0 Technical DepEd Region III
Arts Grade 7
RMTOT on Rondalla for Music Teachers 12/18/2018 12/20/2018 24.0 Technical DepEd Region III

Basic Training Course for Outfit Advisor 8/14/2015 8/16/2015 24.0 Technical DepEd Tarlac City

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
Photo Editing N/A N/A

Playing and Officiating Different Sports Discipline

Playing Musical Instruments

Dancing (Folk dance, Modern, Cheerleading)

Digital art

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2020

CS FORM 212 (Revised 2017), Page 3 of 4
 34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to
the
chief of bureau or office or to the person who has immediate supervision over you in the
Office,
Bureau or Department where you will be apppointed,
a. within the third degree? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or
YES ✘ NO
regulation by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year
YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons
(RA 7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following
a.
items:
Are you a member of any indigenous group? YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
JUVELYN L. ESTEBAN San Vicente, Tarlac City 639230900734 3.5 cm. X 4.5 cm
(passport size)

EMILIA B. TABU Maliwalo, Tarlac City 639958990113 With full and handwritten
name tag and signature over
printed name
JASPER JAY MENDOZA San Miguel, Tarlac City 639209452052
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated
herein. I agree that any misrepresentation made in this document and its attachments shall cause the PHOTO
filing of administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: PRC ID

ID/License/Passport No.: 1404907

Signature (Sign inside the box)
11/16/2020
Date/Place of Issuance: 12/12/2015 Baguio City
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

MA. CRISTINA A. ESPIRITU

AO IV/HRMO

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4