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 AMORES
NAME EXTENSION (JR., SR)
FIRST NAME ABEGAIL
MIDDLE NAME DAÑO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/20/1996 ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH LAPU-LAPU CITY, CEBU If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS DATAG
Widowed Separated House/Block/Lot No. Street
MARIBAGO
Other/s:
Subdivision/Village Barangay
LAPU-LAPU CITY CEBU
7. HEIGHT (m) 5'2
City/Municipality Province
8. WEIGHT (kg) 46 ZIP CODE 6015
18. PERMANENT ADDRESS DATAG
9. BLOOD TYPE 0+
House/Block/Lot No. Street
MARIBAGO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LAPU-LAPU CITY CEBU
11. PAG-IBIG ID NO. 1211-9701-9614
City/Municipality Province
12. PHILHEALTH NO. 12-025715157-9 ZIP CODE 6015
13. SSS NO. 06-3958512-9 19. TELEPHONE NO. N/A
14. TIN NO. 336-756-966-000 20. MOBILE NO. 09612034791
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) abegailamores30@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AMORES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) THEO NATHAN D. AMORES
FIRST NAME JHUNREY 6/30/2018
MIDDLE NAME LUMBA
OCCUPATION PHILIPPINE NATIONAL POLICE
EMPLOYER/BUSINESS NAME GOVERNMENT
BUSINESS ADDRESS REGION VII
TELEPHONE NO.
24. FATHER'S SURNAME DAÑO
NAME EXTENSION (JR., SR)
FIRST NAME JAIME
MIDDLE NAME TABERA
25. MOTHER'S MAIDEN NAME JESSICA P. MONARES
SURNAME MONARES
FIRST NAME JESSICA
MIDDLE NAME PAJARON (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To
ELEMENTARY MARIBAGO ELEMENTARY SCHOOL 6/1/2003 3/1/2009 2009 N.A
SECONDARY /
VOCATIONAL MARIBAGO HIGH SCHOOL 6/1/2009 3/1/2013 2013 N.A
MARIBAGO SKILLS DEVELOPMENT TRAINING &
ASSESSMENT CENTER
HOUSEKEEPING 10/26/2018 1/8/2019 2019 N.A
TRADE
COURSE
COLLEGE UNIVERSITY OF CEBU LAPU-LAPU & MANDAUE7 BACHELOR OF SECONDARY EDUCATION 6/1/2013 3/16/2017 2017 N.A
GRADUATE STUDIES 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
RA 1080 (BOARD EXAMINATION) BLEPT 83.4 9/24/2017 SOUTH WESTERN UNIVERSITY 1615404 12/20/2024
DRIVER'S LICENSE (NON-PROFESSIONAL) 35.0 1/17/2020 ISLAND CENTRAL, LAPU-LAPU CITY G21-20-000513 12/20/2024
(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)
5/16/2019 PRESENT PRIVATE SCHOOL TEACHER RIZWOODS COLLEGES 10000.00 CONTRACT NO
HOME-BASED ONLINE ENGLISH
9/26/2018 4/28/2019 ACADSOC 18000.00 PROBATIONARY NO
TEACHER
ENGLISH AS SECONDARY LANGUAGE
11/13/2017 3/2/2016 CEBU BLUE OCEAN ACADEMY 10000.00 CONTRACT NO
TEACHER
ENGLISH AS SECONDARY LANGUAGE
8/10/2017 9/10/2017 PREMIER ENGLISH 10000.00 CONTRACT NO
TEACHER
4/20/2017 6/25/2017 QUALITY INSURANCE INSPECTOR TOA KIKO (MEPZA) 10000.00 CONTRACT NO
(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
(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
COMPUTER SKILLS: MS OFFICE APPLICATION & OPERATING SYSTEMS INSTALLATION 6/8/2019 7/7/2019 80.0 MR. RENATO N. CAPUNO JR.
TEACHING EMPOWERMENT PROGRAM FOR ENGLISH EDUCATOR (TEPEE) 10/2/2017 10/13/2017 72.0 JUNAIDA OBRA
(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 LAKAMBINI NG WIKA 2016 N.A
MAKE UP SEARCH FOR CTE MS INTRAMURALS 2016 - 1ST RUNNER UP
COMPUTER LITERATE MARIBAGO BASKET BALL LEAGUE MUSE 2016
(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? end of contract
________________________________
________________________________
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
the last 6 months
LOIDA C. ARAGON DATAG, MARIBAGO LAPU-LAPU CITY 9069129874 3.5 cm. X 4.5 cm
(passport size)
ROCHELLE M. TAGHOY LAPU-LAPU CITY 9273965685 With full and handwritten
name tag and signature over
printed name
GERARDO M. AUGUSTO DATAG, MARIBAGO LAPU-LAPU CITY 9152123765
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.: 1615404
Signature (Sign inside the box)
Date/Place of Issuance: 1/19/2018
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
