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

MIDDLE NAME MALISE

3. DATE OF BIRTH
7/4/1998 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
DAVAO GENERAL HOSPITAL birth naturalization
4. PLACE OF BIRTH COOPERATIVE, BONIFACIO STREET, If holder of dual citizenship, Pls. indicate country:
TAGUM CITY, DAVAO
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS ✘ Single 17. RESIDENTIAL ADDRESS BLOCK 11, LOT 12 N/A
Married
Widowe Separat House/Block/Lot No. Street
ERLYNVILLE SAN MIGUEL
d ed
Other/s: Subdivision/Village Barangay
7. HEIGHT (m) 1.60 TAGUM DAVAO DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 8100

9. BLOOD TYPE N/A

18. PERMANENT ADDRESS BLOCK 11, LOT 12 N/A
House/Block/Lot No. Street
10. GSIS ID NO. N/A ERLYNVILLE SAN MIGUEL
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-5521-7972 TAGUM DAVAO DEL NORTE

City/Municipality Province

12. PHILHEALTH NO. 1625-2180-3436 ZIP CODE 8100

13. SSS NO. 09-463095-80 19. TELEPHONE NO. N/A

14. TIN NO. 731-267-815 20. MOBILE NO. 09385517818 / 09918131550

15. AGENCY EMPLOYEE NO. N/A 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)
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ESOLAN

NAME EXTENSION (JR., SR)
FIRST NAME ROMEO SR.
MIDDLE NAME PALMA

25. MOTHER'S MAIDEN NAME

SURNAME MALISE

FIRST NAME ROSALINA

MIDDLE NAME CANOY (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

MAGUGPO PILOT CENTRAL ELEMENTARY MERITORIOUS

ELEMENTARY ELEMENTARY 2004 2010 GRADUATED 2010
SCHOOL AWARDEE
5TH
TAGUM CITY NATIONAL COMPREHENSIVE HONORABLE
SECONDARY HIGH SCHOOL 2010 2014 GRADUATED 2014
VOCATIONAL / HIGH SCHOOL MENTION

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

TRADE ACADEMIC &
COURSE CHED SCHOLAR
BACHELOR OF SECONDARY EDUCATION LATIN
COLLEGE UM TAGUM COLLEGE 2014 2018 GRADUATED 2018
MAJOR IN MATHEMATICS HONOR

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 90.4 03/24/2019 HOLY CROSS, DAVAO CITY 1794240 04/072025

(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)
DEPED TAGUM CITY DIVISION - TAGUM
PRESENT TEACHER I CITY REGIONAL ACADEMY FOR SENIOR P 27 000 11-1 PERMANENT YES
HIGH SCHOOL
ARRIESGADO COLLEGE FOUNDATION REGULAR
7/6/2019 03/14/2024 SENIOR HIGH SCHOOL TEACHER P 15 306 N/A NO
INCORPORATED PERMANENT

(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

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

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

ARRIESGADO COLLEGE FOUNDATION,

FUTURE THINKING: EDUCATION BEYOND PANDEMIC 3/3/2023 3/3/2023 4.0 TECHNICAL
INCORPORATED - QUIPPER

INTEGRATING TECHNOLOGY BY DESIGN: KEY INGREDIENTS FOR AN EFFECTIVE USE OF ARRIESGADO COLLEGE FOUNDATION,
1/3/2023 1/3/2023 4.0 TECHNICAL
TECHNOLOGY IN THE TEACHING AND LEARNING PROCESS INCORPORATED - QUIPPER
ARRIESGADO COLLEGE FOUNDATION,
INNOVATIVE TEACHING STRATEGIES THAT DEVELOP 21ST CENTURY SKILLS 02/22/2023 02/22/2023 4.0 TECHNICAL
INCORPORATED - QUIPPER

ARRIESGADO COLLEGE FOUNDATION,

SEMINAR - WORKSHOP ON TEACHING STRATEGIES 11/25/2022 11/26/2022 16.0 TECHNICAL
INCORPORATED

ARRIESGADO COLLEGE FOUNDATION,

TEACHER ENHANCEMENT PROGRAM ON VIDEO EDITING 4/11/2021 4/11/2021 8.0 TECHNICAL
INCORPORATED

ARRIESGADO COLLEGE FOUNDATION,

PLATFORM TRAINING: EXPLORING QUIPPER LINK, CREATE, AND ESSAYS 3/9/2021 3/9/2021 8.0 TECHNICAL
INCORPORATED - QUIPPER

ARRIESGADO COLLEGE FOUNDATION,

TEACHER INDUCTION PROGRAM 08/24/2021 08/25/2021 16.0 TECHNICAL
INCORPORATED

(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)

MS Office Literate (Word, Excel and PowerPoint

N/A N/A
Presentation)
Mathematics Software Oriented (SPSS, Geogebra
and Algebrator)
Creating and Designing Reycle Notebooks

Learning Management Oriented (Quipper and

Activeminds Brightspace)

Learning Information System Oriented (enrolling

learners to Deped L.I.S and doing school forms)

(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
YES ✘ NO
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 phased If YES, give details:
out (abolition) in the public or private sector? Resignation
________________________________
________________________________
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
BERMUDEZ PLAINS, APOKON, TAGUM the last 6 months
ENGR. AMBROSIO D. AYUBAN JR., MAEM CITY
0910-609-5302
4.5 cm. X 3.5 cm
(passport size)
HANNAH GILLIENE R. ARAIZ, LPT PUROK CEBOLE, APOKON, TAGUM CITY 0953-421-7651
Computer generated
SISON SUBDIVISION, MAGUGPO SOUTH, or photocopied picture
VIRGINIA S. MANINGO, MAED TAGUM CITY
0976-265-7622 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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.: 1794240

Signature (Sign inside the box)

Date/Place of Issuance: 07/12/2019 - PRC TAGUM

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