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 SENOBAGO
NAME EXTENSION (JR., SR) N/A
FIRST NAME ROSE ANN
MIDDLE NAME MERTALLA
3. DATE OF BIRTH
(mm/dd/yyyy) 05/10/1990 16. CITIZENSHIP
✘

4. PLACE OF BIRTH GENERAL SANTOS CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘

✘ 17. RESIDENTIAL ADDRESS BLOCK 1

6 CIVIL STATUS
House/Block/Lot No. Street
TEACHER'S VILLAGE BARANGAY CALUMPANG
Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
7. HEIGHT (m) 1.57m
City/Municipality Province
8. WEIGHT (kg) 52kg ZIP CODE 9500

18. PERMANENT ADDRESS BLOCK 1

9. BLOOD TYPE AB
House/Block/Lot No. Street
TEACHER'S VILLAGE BARANGAY CALUMPANG
10. GSIS ID NO. 2005105918
Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
11. PAG-IBIG ID NO. 1212-7307-3051
City/Municipality Province

12. PHILHEALTH NO. 170253606390 ZIP CODE 9500

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

14. TIN NO. 406-815-652-000 20. MOBILE NO. 0932 573 8627

15. AGENCY EMPLOYEE NO. 5604040 21. E-MAIL ADDRESS (if any)
roseann.senobago@deped.gov.ph
II. FAMILY BACKGROUND
DATE OF BIRTH (mm/dd/yyyy)
22. SPOUSE'S SURNAME SENOBAGO 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR., SR) AMOR SEAN M. SENOBAGO

FIRST NAME AMOR BENEDICT 07/28/2012

BEA TRIZIA MARIE M. SENOBAGO

MIDDLE NAME DAYAP 02/07/2016

ZION BENEDICT D. SENOBAGO

OCCUPATION PROFESSIONAL TEACHER 01/22/2018

EMPLOYER/BUSINESS NAME DEPARTMENT OF EDUCATION

BUSINESS ADDRESS GENERAL SANTOS CITY

TELEPHONE NO. N/A

24. FATHER'S SURNAME MERTALLA

FIRST NAME RICARDO NAME EXTENSION (JR., SR)

MIDDLE NAME TABARES

25. MOTHER'S MAIDEN NAME

SURNAME BARBANTE

FIRST NAME MARGIE

MIDDLE NAME SIERRA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST LEVEL/ SCHOLARSHIP/

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

ELEMENTARY FVR ELEMENTARY SCHOOL ELEMENTARY 1996 2002 GRADUATED 2002 N/A

SECONDARY FATIMA NATIONAL HIGH SCHOOL SECONDARY 2002 2006 GRADUATED 2006 N/A

MINDANAO STATE UNIVERSITY BACHELOR OF ARTS IN POLITICAL SCIENCE 2006 2010 GRADUATED 2010 N/A
COLLEGE
STRATFORD INTERNATIONAL INC. BACHELOR OF SECONDARY EDUCATION 2018 2019 18 UNITS 2019 N/A

POST GRADUATE MINDANAO STATE UNIVERSITY MASTERS IN PUBLIC ADMINISTRATION 2022 2024 GRADUATED 2024 N/A

DOCTOR OF PHILOSOPHY IN EDUCATIONAL

POST GRADUATE MINDANAO STATE UNIVERSITY MANAGEMENT 2024 PRESENT 18 UNITS

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 84% 9/29/2019 GENERAL SANTOS CITY 1877130 5/10/2026

(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)

1/1/2025 PRESENT TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱30,308.00 SG11-2 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

1/1/2024 12/31/2024 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱30,024.00 SG 11-2 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

1/1/2024 12/31/2024 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱27,000.00 SG 11-2 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

1/1/2023 12/31/2023 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱26,012.00 SG 11-2 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

1/1/2022 12/31/2022 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱26,012.00 SG 11-2 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

1/1/2021 12/31/2021 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱23,877.00 SG 11-1 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

12/8/2020 12/31/2020 TEACHER 1 DEPARTMENT OF EDUCATION- GENERAL ₱22,316.00 SG 11-1 PERMANENT Y

SANTOS CITY NATIONAL HIGH SCHOOL

(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
(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

01/30/2025 02/01/2025 24 HOURS INCLUSIVE DEPARTMENT OF EDUCATION DIVISION OF GENERAL

ORIENTATION ON POSITIVE DEISCIPLINE LEARNING ACTION CELL (LAC) SESSION GUIDES CUM EDUCATION SANTOS CITY
ORIENTATION ON SAFE SPACES ACT

12/13/2024 12/17/2024 32 HOURS FOUNDATION DEPARTMENT OF EDUCATION DIVISION OF GENERAL

DEVELOPMENT OF UNIFIED DIVISION ASSESSMENT TOOLS FOR GMRC/VALUES EDUCATION SANTOS CITY

11/05/2024 11/06/2024 16 HOURS RESEARCH DEPARTMENT OF EDUCATION DIVISION OF GENERAL

2024 DIVISION RESEARCH CONGRESS SANTOS CITY

10/24/2024 10/26/2024 24 HOURS FOUNDATION DEPARTMENT OF EDUCATION DIVISION OF GENERAL

DIGITIZATION OF E-LEARNING MODULE OF ESP GRADE 6 AND GRADE 10 SANTOS CITY

10/12/2024 10/12/2024 24 HOURS INCLUSIVE DEPARTMENT OF EDUCATION DIVISION OF GENERAL

TRAINING-WORKSHOP ON INCLUSIVE EDUCATION EDUCATION SANTOS CITY

07/14/2024 07/19/2024 5 days TECHNICAL DEPARTMENT OF EDUCATION DIVISION OF GENERAL

SCHOOL-BASED TRAINING OF TRAINERS FOR MATATAG CURRICULUM SANTOS CITY

ACTION RESEARCH TRAINING-WRITESHOP 11/04/2023 11/04/2023 8 HOURS RESEARCH DEPARTMENT OF EDUCATION DIVISION OF GENERAL
SANTOS CITY

SEMINAR WORKSHOP STRATEGIC AND OPERATIONAL PLANNING 06/02/2023 06/02/2023 8 HOURS STRATEGIC DEPARTMENT OF EDUCATION DIVISION OF GENERAL
DEVEOPMENT SANTOS CITY

POSITIVE DISCIPLINE ON EVERYDAY TEACHING 01/06/2023 01/06/2023 8 HOURS INCLUSIVE DEPARTMENT OF EDUCATION DIVISION OF GENERAL
EDUCATION SANTOS CITY

3-DAY DIVISION VIRTUAL SEMINAR WORKSHOP ON THE USE OF ICT IN CLASSROOM INSTRUCTIONS 08/16/2022 08/18/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION DIVISION OF GENERAL
FOR EPP/TLE/TVL. SANTOS CITY

GENDER AND DEVELOPMENT SEMINAR CUM SCHOOL YEAR-END PROGRAM IMPLEMENTATION 07/26/2022 07/27/2022 16 HOURS DIVERSITY & DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
REVIEW AND STRATEGIC PLANNING INCLUSION NATIONAL HIGH SCHOOL

CAPACITY DEVELOPMENT ON TRAUMA-INFORMED CARE 06/22/2022 06/22/2022 8 HOURS STRATEGIC DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
DEVEOPMENT NATIONAL HIGH SCHOOL

DIVISION-WIDE TRAINING ON MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT SERVICES FOR 06/16/2022 06/17/2022 16 HOURS SUPERVISORY DEPARTMENT OF EDUCATION DIVISION OF GENERAL
LEARNERS IN IMPLEMENTATION OF PROGRESSIVE FACE TO FACE CLASSES SANTOS CITY

WRITESHOP ON THE ENHANCEMENT OF CINTEXTUALIZED SSLM FOR IDENTIFIED EPP/TLE/TVL 05/17/2022 05/19/2022 24 HOURS FOUNDATION DEPARTMENT OF EDUCATION DIVISION OF GENERAL
SPECIALIZATION SANTOS CITY

WRITESHOP ON THE ENHANCEMENT OF CINTEXTUALIZED SSLM FOR IDENTIFIED EPP/TLE/TVL 05/17/2022 05/19/2022 24 HOURS FOUNDATION DEPARTMENT OF EDUCATION DIVISION OF GENERAL
SPECIALIZATION SANTOS CITY

VIRTUAL IN-SERVICE TRAINING (INSET) FOR TEACHERS 02/02/2022 02/05/2022 24 HOURS FOUNDATION DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

FACILITATING THE DEVELOPMENT OF 21ST CENTURY SKILLS FOR SOUTHERN ASIAN TEACHERS 10/20/2021 11/26/2022 60 HOURS TECHNICAL DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

THREE-DAY DIVISION ONLINE SEMINAR WORKSHOP ON THE ENHANCED TEACHERS VIA GOOGLE 08/24/2021 08/26/2021 24 HOURS FOUNDATION DEPARTMENT OF EDUCATION DIVISION OF GENERAL
MEET TECHNOLOGY PEDAGOGY AND CONTENT KNOWLEDGE FOR JHS TLE TEACHERS SANTOS CITY

LEARNING ACTION CELL 10/10/2020 06/16/2021 48 HOURS FOUNDATION DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

LEARNING ACTION CELL 08/7/2019 02/26/2020 48 HOURS FOUNDATION DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

IN-SERVICE TRAINING PROGRAM 03/15/2021 03/19/2021 40 HOURS TECHNICAL DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

IN-SERVICE TRAINING PROGRAM 12/14/2020 12/19/2020 24 HOURS MANAGERIAL DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
NATIONAL HIGH SCHOOL

THREE-DAY INDUCTION PROGRAM FOR NEWLY-HIRED TEACHING PERSONNEL OF DEPED 9/12/2020 11/12/2020 24 HOURS MANAGERIAL DEPARTMENT OF EDUCATION GENERAL SANTOS CITY
GENERAL SANTO CITY DIVISION DIVISION

NATIONAL CERTIFICATE III IN BOOKKEPPING 10/14/2019 11/17/2019 320 HOURS TECHNICAL TECHNICAL EDUCATION AND SKILL DEVELOPMENT
AUTHORITY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

EVENT ORGANIZING N/A PHILIPPINE ASSOCIATION FOR TEACHERS

AND EDUCATORS

OUTDOOR ACTIVITIES PHILIPPINE HUMAN RIGHTS SOCIETY-

MEMBER

COMMUNITY ENGAGEMENT JUNIOR PHILIPPINE POLITICAL SCIENCE

ASSOCIATION
INTERIOR DESIGNNING

POLICY DEVELOPMENT

RESEARCH AND ANALYSIS

(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? ✘

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

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense?
✘

If YES, give details:

________________________________
________________________________

b. Have you been criminally charged before any court? ✘

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? ✘
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 If YES, give details:
out (abolition) 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
Barangay election)? ✘
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last ✘
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?
✘
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?
✘
If YES, please specify:
b. Are you a person with disability? ✘
If YES, please specify ID No:
c. Are you a solo parent? ✘
If YES, please specify ID No:

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

NAME ADDRESS Contact No

ID picture taken within
the last 6 months
BARANGAY CALUMPANG,GENERAL SANTOS 3.5 cm. X 4.5 cm
HON. ARTHUR RYAN DUPALCO CITY 09097114519 (passport size)

With full and handwritten

name tag and signature over
RONALD S. RADIN BARANGAY FATIMA, GENERAL SANTOS CITY 09324582255 printed name

Computer generated
BARANGAY CALUMPANG,GENERAL SANTOS or photocopied picture
MATTY B. NAPOLES CITY 09332384101 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
administrative/criminal case/s against me.
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

ID/License/Passport No.: 1877130

Date/Place of Issuance: General Santos 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