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 MONARES
NAME EXTENSION (JR., SR)
FIRST NAME BEATRIZ N/A

MIDDLE NAME N/A

3. DATE OF BIRTH
3/13/1993 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH KANANGA, LEYTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS SIKIT

Widowe House/Block/Lot No. Street

Separat
DATAG MARIBAGO
d ed
Other/s: Subdivision/Village Barangay
LAPU-LAPU CEBU
7. HEIGHT (m) 1.59
City/Municipality Province
8. WEIGHT (kg) 44 ZIP CODE 6015

18. PERMANENT ADDRESS SIKIT

9. BLOOD TYPE O+
House/Block/Lot No. Street
DATAG MARIBAGO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LAPU-LAPU CEBU
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 120513442152 ZIP CODE 6015

13. SSS NO. 06-3552770-9 19. TELEPHONE NO. N/A

14. TIN NO. 454-179-905-000 20. MOBILE NO. 0954 - 094 - 8160

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

NAME EXTENSION (JR., SR) JEMIMA KEZIAH M. PAQUIBOT

FIRST NAME JUN JUN 7/18/2016
PRINCESS SOPHIA M. PAQUIBOT
MIDDLE NAME 5/6/2020
PRINCE DAVID M. PAQUIBOT
OCCUPATION PRIVATE SCHOOL TEACHER 9/14/2022

EMPLOYER/BUSINESS NAME EINSTEIN SCHOOL CEBU

BUSINESS ADDRESS ABUNO PAJAC, LAPU-LAPU CITY

TELEPHONE NO. 9950111772

24. FATHER'S SURNAME N/A

NAME EXTENSION (JR., SR)
FIRST NAME N/A

MIDDLE NAME N/A

25. MOTHER'S MAIDEN NAME LEONILA PAJARON MONARES

SURNAME MONARES

FIRST NAME LEONILA

MIDDLE NAME PAJARON (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY MONTEBELLO ELEMENTARY SCHOOL PRIMARY EDUCATION 2003 2009 N/A 2009 N/A

SECONDARY /
VOCATIONAL MARIBAGO HIGH SCHOOL SECONDARY SCHOOL 2009 2013 N/A 2013 N/A

LOGIC GATE TECHNOLOGY INSTITUTE NATIONAL CERTIFICATE II 2023 2023 N/A 2023 N/A
TRADE
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE UNIVERSITY OF CEBU LAPU-LAPU AND MANDAUE
MAJOR IN MATHEMATICS 2013 2022 N/A 2022 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)
SIGNATURE DATE
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 81.6 3/19/2022 CEBU CITY, CEBU 2126827 3/13/2027

(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 SALARY/ JOB/ PAY SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
ENGLISH AS A SECOND LANGUAGE
4/24/2023 12/29/2023 CEBU INTERNATION ACADEMY 14500.00 N/A PROBATIONARY N
TEACHER

(Continue on separate sheet if necessary)

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

(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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

DANCING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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 regulation
by any court or tribunal?
YES ✘ NO
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 phased If YES, give details:
out (abolition) in the public or private sector? I render my resignation to the company.
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
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 items:
a. 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
SIKIT, DATAG MARIBAGO, LAPU-LAPU the last 6 months
SANIE VILLA CATULINAN CITY
9655378842 3.5 cm. X 4.5 cm
(passport size)

JESSICA DANO CORDOVA, CEBU 9989619556 With full and handwritten

name tag and signature over
printed name
MARIBAGO, LAPU-LAPU CITY 9262343829
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 filing of PHOTO
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 LICENSE

ID/License/Passport No.: 2126827

Signature (Sign inside the box)

Date/Place of Issuance: 01/02/2024 CEBU CITY

Date Accomplished Right Thumbmark

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

Person Administering Oath

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