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 CARUANA
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARIA CEILO

MIDDLE NAME PADILLO

3. DATE OF BIRTH
02/13/1990 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH CEBU CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
Male ✘

6 CIVIL STATUS Single ✘ Married

17. RESIDENTIAL ADDRESS ZONE 3 445 SAMBAG
House/Block/Lot No. Street
Widowed Separate
N/A LAGTANG
Other/s: d Subdivision/Village Barangay
7. HEIGHT (m) 1.549 TALISAY CEBU
City/Municipality Province
8. WEIGHT (kg) 51 ZIP CODE 6045

9. BLOOD TYPE B+
18. PERMANENT ADDRESS ZONE 3 445 SAMBAG
House/Block/Lot No. Street
10. GSIS ID NO. N/A N/A LAGTANG
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211-4280-1402 TALISAY CEBU

City/Municipality Province

12. PHILHEALTH NO. 12-051179973-8 ZIP CODE 6045

13. SSS NO. 06-3302232-9 19. TELEPHONE NO. 253 8838

14. TIN NO. 426-478-216 20. MOBILE NO. 0933 631 4302

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME CARUANA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) N/A

FIRST NAME DAVIDSON ZILDJIAN NICHOLAI PADILLO CARUANA 12/04/2013

MIDDLE NAME CORDOVA ZIAN KAEL PADILLO CARUANA 11/04/2013

OCCUPATION TECHNICIAN

EMPLOYER/BUSINESS NAME FIBERHOME PHILIPPINES INCORPORATED

QUIMONDA IT CENTER COMPLEX, SERGIO OSMEÑA JR BOULEVARD, CEBU
BUSINESS ADDRESS
CITY

TELEPHONE NO. 384 3124

24. FATHER'S SURNAME PADILLO

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

MIDDLE NAME BARLISO

25. MOTHER'S MAIDEN NAME

SURNAME LABRADOR

FIRST NAME IMELDA

MIDDLE NAME JUAREZ (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY LAGTANG ELEMENTARY SCHOOL ELEMENTARY 1997 2002 N/A 2002 WITH HONORS

SECONDARY SAINT SCHOLASTICA'S ACADEMY HIGH SCHOOL 2002 2007 N/A 2007 WITH HONORS
VOCATIONAL /

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

TRADE
COURSE
COLLEGE UNIVERSITY OF SAN JOSE-RECOLETOS BACHELOR OF SCIENCE IN TOURISM 2007 2012 N/A 2012 N/A

GRADUATE STUDIES DIPLOMA IN PROFESSIONAL EDUCATION PROFESSIONAL EDUCATION 06/28/2021 10/23/2021 18 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 02/08/2024

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 84% 03/19/2023 CEBU 2116727 02/13/2026

(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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)

Reservations and Ticketing, Airport Air Niugini Cebu/Funjet Travel Services x

02/01/2014 05/15/2020 18750 N/A Regular N
Operations Representative Destinations Specialists Cebu Incorporated

Manila Integrated Airport Services Corporation

08/01/2012 02/01/2014 Passenger Service Agent (MIASCOR) Ground Handling Corporation - 13000 N/A Regular N
Cebu

(Continue on separate sheet if necessary)

SIGNATURE DATE 02/08/2024

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
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
HANDA, TURO! - KEEPING A POSITIVE MINDSET USING GOKONGWEI BROTHERS FOUNDATION STEM
01/27/2024 01/27/2024 1.0
SOCIO-EMOTIONAL LEARNING COLLAB
GOKONGWEI BROTHERS FOUNDATION STEM
HANDA, TURO! - LEARNING DESIGN STRATEGIES FOR STUDENT MOTIVATION 02/03/2024 02/03/2024 2.0
COLLAB
BASIC COMPUTER LITERACY 01/27/2024 02/08/2024 80.0 ELTECH LEARNING HUB

(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)
THE PHILIPPINE ASSOCIATION FOR TEACHER
COMPUTER TECHNICAL SKILLS N/A
EDUCATION
CUSTOMER SERVICE

ADAPTABILITY

READING

(Continue on separate sheet if necessary)

SIGNATURE DATE 02/08/2024

 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 ✘

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

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,
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:
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
LIVELY AULBREE LUMAYAG LAPU-LAPU CITY, CEBU 0995 738 7354 4.5 cm. X 3.5 cm
(passport size)

CARLENE RODRIGUEZ MACINAS CEBU CITY 0966 248 1500

Computer generated
or photocopied picture
ROMEO BEJASA JR. TALISAY CITY, CEBU 0909 462 5432 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 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: PRC

ID/License/Passport No.: 2116727 Signature (Sign inside the box)

02/08/2024
Date/Place of Issuance: 10/03/2023, CEBU 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