CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misinterpretation 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 CLARIDO
NAME EXTENSION (JR., SR)
FIRST NAME ETHEL
MIDDLE NAME JIMENEZ
3. DATE OF BIRTH
(mm/dd/yyyy) 4/15/1978 16. CITIZENSHIP
✘ Filipino Dual Citizenship
4. PLACE OF BIRTH AMPENICAN, SALAY MIS. OR. If holder of dual citizenship, Pls. indicate country: by naturalization
by birth
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
Single ✘ Married House/Block/Lot No. Street
Widowed Separate PUROK 4 AMPENICAN
Other/s: d Subdivision/Village Barangay
SALAY MISAMIS ORIENTAL
7. HEIGHT (m) 4'11''
City/Municipality Province
8. WEIGHT (kg) 50 kls. ZIP CODE 9007
9. BLOOD TYPE O 18. PERMANENT ADDRESS
PUROK 4 AMPENICAN
10. GSIS ID NO. 2005-252-908
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 12-1110639235 SALAY MISAMIS ORIENTAL
City/Municipality Province
12. PHILHEALTH NO. 15-2015032809 ZIP CODE 9007
13. SSS NO. 08-2446620-2 19. TELEPHONE NO. NONE

14. TIN NO. 705-660-444 20. MOBILE NO. 0935-594-0036

15. AGENCY EMPLOYEE NO. 4991154 21. E-MAIL ADDRESS (if any) ethel.clarido@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CLARIDO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., JOSHUA J. CLARIDO
FIRST NAME JULIUS SR) 12/16/2006

MIDDLE NAME CANALES MYLES J. CLARIDO 1/14/2008

OCCUPATION SOLDIER
EMPLOYER/BUSINESS NAME PHILLIPINE ARMY

BUSINESS ADDRESS MANOLO FORTICH BUKIDNON

TELEPHONE NO. N/A N/A N/A
24. FATHER'S SURNAME JIMENEZ N/A N/A
FIRST NAME ELY NAME EXTENSION (JR., SR) N/A N/A
N/A
MIDDLE NAME LITERATO N/A

25. MOTHER'S MAIDEN NAME REDONDO N/A N/A

SURNAME JIMENEZ N/A N/A
FIRST NAME EFFEDA N/A N/A
MIDDLE NAME ABAO (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
LEVEL (Write BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
in full) EARNED
(if not graduated) RECEIVED
From To

ELEMENTARY AMPENICAN ELEMENTARY SCHOOL ELEMENTARY 6/8/1990 3/23/1994 N/A 1994 none
VOCATIONAL
SECONDARY / SALAY NATIONAL HIGH SCHOOL HIGH SCHOOL 6/7/1994 3/26/1997 N/A 1997 none
N/A N/A N/A N/A N/A
TRADE
COLLEGE
COURSE ST. PETER'S COLLEGE OF BALINGASAG BACHELOR OF SECONDARY EDUCATION 6/10/1998 3/28/2002 N/A 2002 NONE

GRADUATE STUDIES Cagayan Capitol University Master in Filipino (MAFIL) 6/20/2019 12/19/2020 30 Units
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/10/2022 CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity
LICENSURE EXAMINATION FOR TEACHERS 3/20/2016 CAGAYAN DE ORO CITY, PHILIPPINES 1457626 May 4, 2022
(LET)

(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
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)

1/1/2021 10/1/2022 Teacher I Department of Education 24,161 PERMANENT YES

1/1/2020 12/31/2021 Teacher I Department of Education 24,161 PERMANENT YES

1/1/2018 12/31/2019 Teacher I Department of Education 24,161 PERMANENT YES

8/1/2017 12/31/2018 Teacher I Department of Education 24,161 PERMANENT YES

1/6/2015 03/28/2016 Teacher I Philippine Integrated School 7,000 RENEWAL NO

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/10/2022 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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

10/05/2021 11/03/2021 80 hrs Technical DEPARTMENT OF EDUCATION -

Formative Assessment Training for (SLM) writer MIS. OR.
DEPARTMENT OF EDUCATION - MIS. OR.
In Service Training For Teachers 03/15/2021 03/19/2021 40 hrs. Technical

Virtual Year-End In-Service Training 12/14/2020 12/18/2020 40 hrs Technical DEPARTMENT OF EDUCATION - MIS. OR.

DEPARTMENT OF EDUCATION - MIS.

Learning Delivery Modalities for Teachers Course 2 09/21/2020 09/30/2020 80 hrs. Technical OR.
DEPARTMENT OF EDUCATION - MIS.
In- Service Training for Teacher 10/21/2019 10/22/2019 16 HOURS Technical OR.

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION 3

31. SPECIAL SKILLS and HOBBIES (Write in full) 3
.
Resource Speaker in Filipino In- Service Training
for Public Junior High School Teacher Oct. 21- Certificate of Recognition Balingasag North District
22,2019
First Place in 1st Reseach and Innovation Festival
2021(12/16/21) Certificate of Recognition Balingasag North District

Video Editor Pinaghandaang Talumpati (12/16/21) Certificate of Recognition Balingasag North District

Point Writer Filipino sa Piling Larang Certificate of Recognition Division of Cagayan de Oro

LDM2 Course for Teachers/ Outstanding

(10/30/21) Certificate of Recognition Balingasag North District

Filipino Phil Iri Reading Coordinator Certificate of Recognition San Isidro National High School
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/10/2022 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 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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except ________________________________
Barangay election)? YES ✘ NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the YES
last election to promote/actively campaign for a national or local candidate? ✘ NO
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 specify: ✘ NO
If YES, please
b. Are you a person with disability?
YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent?
YES specify ID
If YES, please ✘ NO
No:

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

NAME ADDRESS TEL. NO.

ID picture taken within
OPHELIA J. ANG BALINGASAG MISAMIS ORIENTAL 9177015840 the last 6 months
3.5 cm. X 4.5 cm
ROY ROSTATA DINAGSAAN, SALAY MIS. OR 9177131967 (passport size)

MA. CLARISSA Q. GONZALES SALAY MISAMIS ORIENTAL 9177015840 With full and handwritten
name tag and signature over
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete printed name
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 Computer generated
in this document and its attachments shall cause the filing of administrative/criminal case/s against me. or photocopied picture
is not acceptable
PHOTO

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/License/Passport No.: 1457626 Signature (Sign inside the box)
01/10/2022
Date/Place of Issuance: Cdo 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