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

MIDDLE NAME PALMERO

3. DATE OF BIRTH
16. CITIZENSHIP Dualby by
(mm/dd/yyyy) 04/04/1987 ✘ Filipino
Citizenship
birt naturalizati
Pls. indicate country:
4. PLACE OF BIRTH If holder of dual citizenship,
h on
please indicate the details.
5. SEX
Male ✘ Fema
6 CIVIL STATUS ✘ Singl le
Marri 17. RESIDENTIAL ADDRESS AURORA EXTENSION

Wido
e Sepa
ed
House/Block/Lot No.
PUROK MANSANITAS
Street
SAN MIGUEL
Other
wed rated Subdivision/Village Barangay
7. HEIGHT (m) 1.44 /s: DIGOS CITY
City/Municipality
DAVAO DEL SUR
Province
8. WEIGHT (kg) 44 ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
PUROK 6-B LELING
10. GSIS ID NO. N/A
Subdivision/Village Barangay
HAGONOY DAVAO DEL SUR
11. PAG-IBIG ID NO. 121272759527
City/Municipality Province

12. PHILHEALTH NO. 16-050488614-7 ZIP CODE

13. SSS NO. 0931408496 19. TELEPHONE NO. N/A

14. TIN NO. 280-690-522 20. MOBILE NO. 09501640897 / 09067618725

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) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A 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 VALE

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

MIDDLE NAME LAHOY

25. MOTHER'S MAIDEN NAME

SURNAME PALMERO

FIRST NAME EVANGELINE

MIDDLE NAME TAGOBA (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

SECOND
ELEMENTARY LELING ELEMENTARY SCHOOL ELEMENTARY 1994 2000 GRADUATED 2000
HONOR

SECONDARY /
VOCATIONAL DIGOS CITY NATIONAL HIGH SCHOOL HIGH SCHOOL 2000 2004 GRADUATED 2004 N/A

SECOND
SOUTHERN MINDANAO COMPUTER COLLEGE INFORMATION TECHNOLOGY SOFTWARE 2004 2007 GRADUATED 2007
HONOR
TRADE COMMISSION ON
COURSE
COLLEGE SOUTHEASTERN COLLEGE OF PADADA BACHELOR OF SECONDARY EDUCATION 2014 2018 GRADUATED 2018 HIGHER EDUCATION
SCHOLAR

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

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 29, 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 84.80% 09/29/2019 DAVAO CITY 1845300 04/04/2023

(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 EDUCATION- DIVISION
01/04/2023 PRESENT LEARNING SUPPORT AIDE 9,680.00 N/A CONTRACTUAL Y
OF DIGOS CITY
PROVINCIAL SCHOOL BOARD PROVINCIAL GOVERNMENT OFFICE- PADADA NATIONAL
04/05/2021 12/31/2022 HIGH SCHOOL
5,000.00 N/A CONTRACTUAL Y
TEACHER/VOLUNTEER TEACHER
09/01/2020 09/29/2020 ENUMERATOR PHILIPPINE STATISTICS AUTHORITY 11,000.00 N/A CONTRACTUAL Y

01/18/2019 03/20/2020 CLERK LE MONDE PRINTERS 6,000.00 N/A PERMANENT N

11/18/2018 01/17/2019 CALL CENTER AGENT EAV OUTSOURCING 10, 000.00 N/A PERMANENT N

03/10/2008 0715/2018 CLERK LE MONDE PRINTERS 6,000.00 N/A PERMANENT N

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 29, 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

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

BOOKKEEPING NC III 11/05/2022 02/13/2022 50.00 TECHNICAL SOUTHERN MINDANAO COMPUTER COLLEGE

(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)
PHILIPPINE ASSOCIATION FOR TEACHERS & EDUCATION,
TEACHING N/A INC

COMPUTER LITERATE N/A

BOOKKEEPING N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 29, 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 NO
YES ✘
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? ________________________________
RESIGNATION
________________________________
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: 112404000010-012
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
IDpicture
picturetaken
takenwithin
within
the
thelast
last 66months
months
MERILYN T. SALBORO TIGUMAN, DIGOS CITY 09468199041 3.5
4.5cm.
cm.XX4.5
3.5cm
cm
(passport
(passportsize)
size)

KARREN JOY P. SALES SAN MIGUEL, DIGOS CITY 09958456052 With full and handwritten
name tag and signature
Computer generatedover
printed name
or photocopied picture
RAYKI BUAT EMILY HOMES SUBDIVISION, DIGOS CITY 09471753992 is not acceptable
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: PRC- TEACHER'S LICENSE

ID/License/Passport No.: 1845300

Signature (Sign inside the box)
MAY 29, 2023
Date/Place of Issuance: 01/13/2020/DAVAO 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