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 aga
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

I. PERSONAL INFORMATION
2. SURNAME ENRIQUEZ
NAME EXTENSION (JR., SR)
FIRST NAME PAULO

MIDDLE NAME VALDEZ

3. DATE OF BIRTH
(mm/dd/yyyy) 11/18/1998 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth

4. PLACE OF BIRTH Candaba, Pampanga If holder of dual citizenship, Pls. indicate countr
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS #18 Purok Ros

6 CIVIL STATUS
Widowed Separated
House/Block/Lot No. Street
N/A Bantog
Other/s:
Subdivision/Village Barangay
Victoria Tarlac
7. HEIGHT (m) 1.80m
City/Municipality Province
8. WEIGHT (kg) 82kg ZIP CODE 3100
18. PERMANENT ADDRESS #18 Purok Ros
9. BLOOD TYPE B+
House/Block/Lot No. Street
N/A Bantog
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Victoria
11. PAG-IBIG ID NO. 1212-4874-7819
City/Municipality Province
12. PHILHEALTH NO. 21-025644871-2 ZIP CODE 2313

13. SSS NO. 02-4451613-9 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 0949-593-8535

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)
NAME EXTENSION (JR., SR) N/A
FIRST NAME 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 ENRIQUEZ

NAME EXTENSION (JR., SR)
FIRST NAME LEOPOLDO

MIDDLE NAME MANGULABNAN

25. MOTHER'S MAIDEN NAME

SURNAME VALDEZ

FIRST NAME LUZ

 MIDDLE NAME RUFINO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

BASIC EDUCATION
ELEMENTARY SAN AGUSTIN ELEMENTARY SCHOOL 2005 2011 N/A

BASIC EDUCATION
SECONDARY VICTORIA NATIONAL HIGH SCHOOL 2011 2015 N/A
VOCATIONAL /

NATIONAL CERTIFICATE III EVENTS MANAGEMENT 2020 2021 N/A

TRADE
BACHELOR OF SECONDARY EDUCATION
COLLEGE
COURSE CENTRAL LUZON STATE UNIVERSITY
MAJOR IN FILIPINO
2015 2019 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revis
minal case/s against the

(Do not fill up. For CSC use only)

TENSION (JR., SR)

nship
birth by naturalization

s. indicate country:

Purok Rose
Street
Bantog
Barangay
Tarlac
Province

Purok Rose
Street
Bantog
Barangay
Tarlac
Province

gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A
ecessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2011 N/A

2015 N/A

2021 N/A

2019 N/A

N/A N/A

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
81.80% September 29, 2019 Baguio City 1840115 11/18/23
PROFESSIONAL TEACHERS

(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/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
June, 2019 April, 2020 INSTRUCTOR I GOOD SAMARITAN COLLEGES P 12, 000 N/A CONTRACTUAL N/A

May, 2020 April, 2021 LEARNING FACILITATOR GOOD SAMARITAN COLLEGES P 12, 000 N/A CONTRACTUAL

(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

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

Embracing Educational Reforms Through January 30, 2021 January 30, 2021 Hee Ning Education Center
Enhanced Teaching Skills

Facilitating Learning for More Effective Teaching January 24, 2021 January 24, 2021 Hee Ning Education Center
Transforming Leadership Potentials to Teaching
January 23, 2021 January 23, 2021 Hee Ning Education Center
Excellence
Designing Instructional Materials Using TV and Radio as
June 26, 2020 June 26, 2020 Vibal Group
Platforms in Teaching
Curriculum Primer for Parents: A Guide in Using Online
June 26, 2020 June 26, 2020 Vibal Group
Platforms for Home Learning
Use of Educational Television and Radio Shows in
June 24, 2020 June 24, 2020 Vibal Group
Teaching
Guiding Young Learners to Online Distance Learning June 23, 2020 June 23, 2020 Vibal Group
Conceptualizing, Use and Creation of Self-made Videos
June 23, 2020 June 23, 2020 Vibal Group
for Online Learning
Utilizing Local and Government TV and Radio
June 22, 2020 June 22, 2020 Vibal Group
Broadcasting in Enhancing Students' Competencies
Rizal 2.0 Teknolohiya sa Pagtuturo ng Buhay at Mga
June 19, 2020 June 19, 2020 Vibal Group
Gawa ni Dr. Jose P. Rizal
Muling Sulyap sa mga Piling Simbolismo sa Dalawang
June 19, 2020 June 19, 2020 Vibal Group
Imortal na Nobela ni Dr. Jose P. Rizal
2020 Whole Child Education Road Show: Supporting & Resuorce for Educators and Academic
February 8, 2020 February 8, 2020 8 hrs
Engaging The Filipino Whole Child Professionals
2019 Summer In-Service Training (INSET) for Junior
April 29, 2019 May 1, 2019 Private Education Assistance Committee
High School Teachers -

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
Sirkulo ng mga Nagdadalubhasa sa Filipino, Pangulo, OSA Philippine Association For Teachers &
Dancing CLSU 2018-2019 Educators, Inc.
Organizing Events CLSU Alumni Association, Inc.
Sirkulo ng mga Nagdadalubhasa sa
Sewing
Filipino, CLSU

(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
YES ✘ NO
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, ✘ YES NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If
phased out (abolition) in the public or private sector? YES END OF CONTRACT
,
38. a. Have you ever been a candidate in a national or local election held within the last year
give YES ✘ NO
(except Barangay election)?
detaiIf YES, give details:
ls:
b. Have you resigned from the government service during the three (3)-month period before ____ YES ✘ NO
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? ____ 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
a.
items: ____
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
Angelito Magat Tarlac City 09385120233 3.5 cm. X 4.5 cm
(passport size)

Rowena Guiam Bulo, Victoria, Tarlac 09204021492 With full and handwritten
name tag and signature over
printed name
Shasta Croissan Quilala Cabanatuan City, Nueva Ecija 09972432040
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 PHOTO
filing of 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

ID/License/Passport No.: 1840115

Signature (Sign inside the box)

Date/Place of Issuance: 01/09/2020

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