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 LLORCA
NAME EXTENSION (JR., SR) N/A
FIRST NAME ALMA GAY

MIDDLE NAME BALIGUAT

3. DATE OF BIRTH
(mm/dd/yyyy) 5/21/1981 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH ODIONGAN, ROMBLON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street
Dapawan
Other/s:
Subdivision/Village Barangay
Odiongan Romblon
7. HEIGHT (m) 1.53
City/Municipality Province
8. WEIGHT (kg) 65 kgs ZIP CODE 5505

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
Dapawan
10. GSIS ID NO. 2004356731
Subdivision/Village Barangay
Odiongan Romblon
11. PAG-IBIG ID NO. 108002399842
City/Municipality Province

12. PHILHEALTH NO. 03-050454118-1 ZIP CODE 5505

13. SSS NO. 04-1339650-5 19. TELEPHONE NO. NONE

14. TIN NO. 940-937-335 20. MOBILE NO. 09478026250

15. AGENCY EMPLOYEE NO. 4640147 21. E-MAIL ADDRESS (if any) [email protected]/ [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME LLORCA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A Alyzza Kareen Gail B. Llorca
FIRST NAME ANGELO 11/10/2002
Althea Grace B. Llorca
MIDDLE NAME PASTOR 5/5/2013

OCCUPATION Police Officer

EMPLOYER/BUSINESS NAME Philippine National Police

BUSINESS ADDRESS Tablas Airport Station, Tugdan, Alcantara, Romblon

TELEPHONE NO. NONE

24. FATHER'S SURNAME Baliguat

NAME EXTENSION (JR., SR)
FIRST NAME Oral Robert

MIDDLE NAME Fontabla

25. MOTHER'S MAIDEN NAME

SURNAME Fabito

FIRST NAME Jocelyn

MIDDLE NAME Fradejas (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

Odiongan Seventh Day Adventist Elementary

ELEMENTARY
School
Elementary 1988 1994 Graduated 1994 N/A

SECONDARY /
VOCATIONAL Romblon State University Secondary 1994 1998 Graduated 1998 N/A

N/A N/A N/A N/A N/A N/A N/A

TRADE
COURSE Romblon State University Bachelor of Arts in Political Science 1998 2002 Graduated 2002 N/A
COLLEGE
Romblon State University Bachelor of Science in Secondary Education 2006 2008 36 units N/A

GRADUATE STUDIES Romblon State University Master of Arts in Education major in English 2011 2020 Graduated 2020 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE August 10, 2023

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 Teachers 75.00% 9/29/2012 Arellano University, Manila 1159320 12/17/2012

(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)
Department of EducationOdiongan National
01/01/23 Present Teacher III P31, 949 13-2 Permanent YES
High School
Department of EducationOdiongan National
01/01/22 12/31/22 Teacher III P30, 427 13-2 Permanent YES
High School
Department of EducationOdiongan National
1/1/2021 12/31/21 Teacher III P28,859 13-1 Permanent YES
High School
Department of EducationOdiongan National
1/1/2020 12/31/2020 Teacher III P28567 13-1 Permanent YES
High School
Department of EducationOdiongan National
05/27/2019 12/31/2019 Teacher III P25225 13-1 Permanent YES
High School
Department of EducationOdiongan National
1/1/2019 05/26/2019 Teacher III P24224 13-1 Permanent YES
High School
Department of EducationOdiongan National
1/1/2018 12/31/2018 Teacher III P24224 13-1 Permanent YES
High School
Department of EducationOdiongan National
1/1/2017 12/31/2017 Teacher III P23257 13-1 Permanent YES
High School
Department of Education Odiongan National
16/13/2017 12/31/2016 Teacher III P22328 13-1 Permanent YES
High School
Department of EducationOdiongan National
6/3/2016 6/12/2016 Teacher I P19286 11-1 Permanent YES
High School
Department of EducationOdiongan National
1/1/2016 6/2/2016 Teacher I P19077 11-1 Permanent YES
High School
Department of EducationOdiongan National
6/3/2013 12/31/2015 Teacher I P18549 11-1 Permanent YES
High School
6/13/2011 4/30/2013 College Instructor Erhard Systems Technological Institute P8500 N/A Contractual NO

7/30/2010 5/20/2011 Customer Service Representative ePerformax BPO Center P15000 N/A Regular NO

5/5/2008 7/15/2010 Customer Service Representative SITEL Phils. P12000 N/A Permanent NO

11/3/2006 3/31/2008 College Instructor Erhard Systems Technological Institute P5000 N/A Contractual NO

(Continue on separate sheet if necessary)

SIGNATURE DATE August 10, 2023

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

Foursquare Bible College- Romblon Campus 12/7/2022 3/24/2023 45.0 Volunteer Teacher

(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

Arts Academy- Framed Dances: Exploring Movement Narratives Through Lenses 7/16/2023 7/22/2023 60.0 TECHNICAL Cultural Center of the Philippines

Deparment of Information and Communications

Digital Literacy in Microsoft Office Productivity Tools 6/13/2023 6/16/2023 32 Technical
Technology

2022 Division Research Colloquium and Review and Evaluation of Research Proposals 2023 3/28/2023 3/31/2023 24 Technical Schools Division Office Romblon

Simplified Approach in Doing Research with SPSS Application: A Classroom Action Research
19/12/2023 9/23/2023 10 Technical Odiongan National High School
Perspective

In-Service Training for Teachers (INSET) 03/15/2021 03/17/2021 24.0 TECHNICAL DEPARTMENT OF EDUCATION

Virtual Planning Conference on the Development of Contextualized SLM for SHS 02/17/2021 02/17/2021 4 Technical Schools Division Office Romblon

Virtual Training on Crafting Contextualized Lesson Plan for Blended Learning 11/15/2021 11/15/2021 4 Technical Schools Division Office Romblon

Capability Building of Pool of Evaluators for Reclasification of Positions 10/20/2021 10/20/2021 12 Technical Schools Division Office Romblon

International Training on Action Research 6/4/2019 8/4/2019 16.0 TECHNICAL DEPARTMENT OF EDUCATION

Schools Division Office Romblon/ Odiongan National

Re-orientation on Results Based Performance Management System (RPMS) 05/27/2019 05/28/2019 `16 Technical
High School

Professional Corps of Test Administrators (PROCTAD) Training 3/13/2019 3/13/2019 8 Technical Civil Service Commision

SHAPE( Sexually Healthy And Professional Effective) Adolescents 10/25/2018 10/25/2018 8 Technical Odiongan National High School

Intramural Meet 2018 12/9/2018 09/14/2018 24 Technical Odiongan National High School

District Roll-out on Philippine Professional Standards for Teachers (PPST), Utilization of PPST Schools Division Office Romblon/ Odiongan National
08/13/2018 08/15/2018 24 Technical
Package and Orientation on Results- Based Performance Management Systems (RPMS) High School

Mass Training of Grade 11 Teachers on Academic Track 9/4/2016 9/11/2016 64 Technical Department of Education

St. Vincent Ferrer Parish Multi-Purpose Cooperative/

Aflatoun Child Social and Financial Education Teachers' Training 8/4/2016 8/6/2016 16 Technical
Department of Education- Romblon

Mass Training of Grade 11 Teachers- Phase I 6/27/2016 7/1/2016 40 Technical Department of Education

Mass Training of Grade 11 Teachers on Academic Track 6/1/2016 6/10/2016 80 Technical Department of Education

(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)
Odiongan National High School- Teachers and
hosting 2023 Most Outstanding Teacher III
Employees Organization
2022 Division Research Colloquium and Review and Evaluation of Research Proposals 2023
front office servicing Odiongan National High School Cooperative
(Presenter)
computer literate Foursquare Bible Quiz Competition 2022 (Grand Finals Host and Quiz Master) Boy Scout of the Philippines
Quality Assurance of Division- Developed SLMs for Q1 and Q2 in MAPEH (Grade 9) and Senior
baking Manila Teachers Mutual Aid System
High School (Evaluator)
Regional Mass Training for of Grade 10 Teachers on the Implementation of the K-12 Basic
Education Program (Demonstration Teacher)
DepEd Division-wide TV assisted instructional videos (Host)

Division Super Quiz Bee (Quizmaster)

(Continue on separate sheet if necessary)

SIGNATURE DATE August 10, 2023

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
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? ________________________________
________________________________
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: Bantoanon Tribe
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
Annalyn M. Formento, PhD. Mayha, Odiongan, Romblon 9985628906 3.5 cm. X 4.5 cm
(passport size)

Bebot F. Fetilo Gabawan, Odiongan, Odiongan, Romblon 9298065714 With full and handwritten
name tag and signature over
printed name
Amelyn F. Bantang Canduyong, Odiongan, Odiongan, Romblon 09298186506
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: Professional Regulation Commission

ID/License/Passport No.: 1159320

Signature (Sign inside the box)
August 10, 2023
Date/Place of Issuance: 03/22/2021/ Manila
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4