CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 Baimpal
NAME EXTENSION (JR., SR)
FIRST NAME Norminah

MIDDLE NAME Tomara

3. DATE OF BIRTH
16. CITIZENSHIP Dual Citizenship
(mm/dd/yyyy) 11/10/1995 / Filipino
/ by birth by naturalization

4. PLACE OF BIRTH Balindong Lanao del Sur If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male / Female

6 CIVIL STATUS Single / Married 17. RESIDENTIAL ADDRESS N/A

Widowed Separated House/Block/Lot No. Street

Other/s: Cadayonan
Subdivision/Village Barangay

7. HEIGHT (m) 1.45 Balindong Lanao Del Sur

City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 9318

9. BLOOD TYPE 18. PERMANENT ADDRESS n/a

O+
House/Block/Lot No. Street

10. GSIS ID NO. Cadayonan

N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. Balindong Lanao Del Sur

N/A
City/Municipality Province

12. PHILHEALTH NO. 202508972328 ZIP CODE 9318

13. SSS NO. N/A 19. TELEPHONE NO.

14. TIN NO. 749-253-752-000 20. MOBILE NO. 09977180191

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) norminabaimpal@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME Lala 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME Saidamen Samarah Afiyyah Baimpal Saidamen 3/5/2024

MIDDLE NAME Dimakuta

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO.

24. FATHER'S SURNAME Baimpal

NAME EXTENSION (JR., SR)
FIRST NAME Abdullah

MIDDLE NAME Mapupuno

25. MOTHER'S MAIDEN NAME

SURNAME Tomara

FIRST NAME Sobaida

MIDDLE NAME Marabong (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

Sogod Central Elementary School Primary Education N/A

ELEMENTARY 2003 2009 2009

Balindong National Elementary School High School N/A

SECONDARY 2009 2013 2013

VOCATIONAL / TESDA Masonry NC II N/A

TRADE COURSE 2020 2020 2020

Philippine Muslim Teachers' College Bachelor of Elementary Education N/A

COLLEGE 2015 2018 2018

GRADUATE STUDIES

(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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE EXAMINATION FOR TEACHERS

77.200 06-26-2022 Pagadian City 1952268 11/10/2025

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
From To INCREMENT

Subject Teacher Balindong Central Elementary School

06/19/19 03/03/20 1.00 Volunteer No

Grade 3 Adviser Magarang Elementary School

01/10/20 07/16/22 1.00 Volunteer 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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

Kabalikat Civicom 952 Watu Balindong Chapter

05/10/19 12/01/23 24 member

(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 Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
Lecture on Bill of Rights and Magna Carta for Students Technical Public Attorney's Office - Marawi District Office
01/30/15 01/30/15 8
Orientation of First Aid /CPR and Basic life Support Management Managerial Philippine Red Cross Lanao del Sur- Marawi City
06/03/15 06/03/15 8
Technical PMTC, Vice President. For Internal Affairs
3rd PMTC Mapeh Seminar Workshop 11/14/16 11/14/16 8
4th PMTC Mapeh Seminar Workshop Technical PMTC, Vice President. For Internal Affairs
01/07/17 01/07/17 8
7TH CONSULTATION ON LANAO YOUTH ENGAGEMENT IN PUBLIC AND CIVIC Technical National Youth Commission - Office of the Chairman
CONCERNS.
03/02/17 03/02/17 8 & the Lanao Youth Council
Basic Entrepreneurship Training Technical The Moropreneur Inc. (TMI), MBHTE TESD
09/30/21 10/02/21 24
3-day Training on Values Transformation for MBHTE TESD Technical Bangsamoro Development agency (BDA)
12/11/21 12/13/21 24
Plaster Concrete/ Masonry Surface (Leading to Masonry NC II) Technical MBHTE TESD, TESDA, AMIN T-A-C-I
09/18/21 10/18/21 8
Training On Communicating COVID-19 with Communities of Relief International Technical Country Director, Relief International Philippines and
08/23/22 08/23/22 8 Area Coordinator-BARMM
Red Cross 143 Volunteer Leadership and Management Training Of Trainers Managerial Philippine Red Cross, Manager, Volunteer Service
01/21/23 01/24/23 24 Officer and Chapter Administrator
Community Based Disaster Risk Reduction Training Technical Philippine Red Cross, Chapter Administrator
06/14/23 06/15/23 12
1 Day Emergency First Aid Training Technical Philippine Red Cross, Chapter Administrator
06/17/23 06/17/23 8
Intensifying Pedagogical Approaches on the Conduct Of 5Bs Catch-up Program Technical Ministry of basic, Higher and Technical Education,
07/16/23 07/16/23 8 Division of Lanao del Sur- I , School Division
Superintendent

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Cooking N/A Kabalikat Civicom

singing

Surfing Internet

(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 / 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 regulation by YES / NO
any court or tribunal?
If YES, give details:
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, YES / NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) If YES, give details:
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 (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
Ropaina P. Panggaga Dilausan Balindong Lanao del sur 09753084762 3.5 cm. X 4.5 cm
(passport size)

Benjamin M. Bagul Salipongan Balindong Lanao del Sur 09177162106 With full and handwritten
name tag and signature over
printed name
Soraifah M. Serad Salipongan Balindong Lanao del Sur 09394961634
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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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

Attachment to CS Form No. 212

WORK EXPERIENCE SHEET

Instructions: 1. Include only the work experiences relevant to the position being applied to.

2. The duration should include start and finish dates, if known, month in abbreviated form, if known, and year
in full. For the current position, use the word Present, e.g., 1998-Present. Work experience should be listed
from most recent first.

• Duration: January 10, 2020 - July 16, 2022

• Position: Grade 3 Adviser
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: Magarang Elementary School
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

• Duration: June 19, 2019 - March 03, 2020

• Position: Subject Teacher
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: Balindong Central Elementary School
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

Norminah T. Baimpal
(Signature over Printed Name of
Employee/Applicant)
Date: