CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 CALUB
NAME EXTENSION (JR., SR) N/A
FIRST NAME EDELYN
MIDDLE NAME DELA CRUZ
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 01/26/1976 Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH TACLOBAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS PH.2 BLK.6 LOT 25&26 MACOPA ST.
Widowed Separated House/Block/Lot No. Street

Other/s:
KUALA LUMPUR SUBDIVISION 26
Subdivision/Village Barangay

7. HEIGHT (m) 1.49 TACLOBAN CITY LEYTE

City/Municipality Province
8. WEIGHT (kg) 80 ZIP CODE 6500
9. BLOOD TYPE B+ 18. PERMANENT ADDRESS LORENZO COMPOUND PUROK MACOPA
House/Block/Lot No. Street

10. GSIS ID NO. 2004114126 BARAS SUBDIVISION SAN FERNANDO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1010-0259-0026 PALO LEYTE

City/Municipality Province

12. PHILHEALTH NO. 19-090394926-2 ZIP CODE 6501

13. SSS NO. 06-1695226-2 19. TELEPHONE NO. N/A
14. TIN NO. 903-653-626 20. MOBILE NO. 09606655126
15. AGENCY EMPLOYEE NO. 6294226 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CALUB 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME GREGORIO NAME EXTENSION (JR., SR) N/A ZOE PACANAN CALUB 06/12/2004
MIDDLE NAME AUTOR ***NOTHING FOLLOWS***
OCCUPATION GOVERNMENT EMPLOYEE
EMPLOYER/BUSINESS NAME DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES

BUSINESS ADDRESS STO. NIÑO EXTENSION, TACLOBAN CITY

TELEPHONE NO. (053) 832-0026
24. FATHER'S SURNAME DELA CRUZ
NAME EXTENSION (JR., SR) N/A
FIRST NAME PEDRO
MIDDLE NAME ABARSOZA
25. MOTHER'S MAIDEN NAME EVELITA VERUTIAO CHAVEZ
SURNAME DELA CRUZ
FIRST NAME EVELIA
MIDDLE NAME CHAVEZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY V&G ELEMENTARY SCHOOL ELEMENTARY 1983 1989 GRADUATED 1989 N/A

SECONDARY LEYTE NATIONAL HIGH SCHOOL HIGH SCHOOL 1989 1993 GRADUATED 1993 N/A
VOCATIONAL / Technical Education And Skills COMPUTER HARDWARE COMPLETE
2013 2014 2014 N/A
TRADE COURSE Development Authority SERVICING D
BACHELOR OF SCIENCE IN BUSINESS
COLLEGE AMA COMPUTER UNIVERSITY ADMINISTATION MAJOR IN MANAGEMENT 1993 1994 51 UNITS N/A N/A
INFORMATION SYSTEM

BACHELOR OF SCIENCE IN BUSINESS CUM

COLLEGE MANILA CENTRAL UNIVERSITY 1997 2000 GRADUATED 2000
ADMINISTATION MAJOR IN MANAGEMENT LAUDE

PHILIPPINE SCHOOL OF MASTERS IN BUSINESS ADMINISTRATION

GRADUATE STUDIES 2010 2013 GRADUATED 2013 N/A
BUSINESS ADMINISTRATION MAJOR IN FISCAL ADMINISTRATION

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE EXAMINATION FOR TEACHERS 75.78% 05/26/2019 CEBU CITY 1751126 01/26/2026

BARANGAY OFFICIAL ELIGIBILITY GRANTED 04/20/2015 CIVIL SERVICE COMMISSION RO8 202002000 N/A

PD-907 HONOR GRADUATE GRANTED 04/20/2000 CIVIL SERVICE COMMISSION RO8 101001000 N/A

CSC MC 11, s. 1996 (DATA ENCODER) 83.78% 11/20/1998 TACLOBAN CITY N/A N/A

***NOTHING FOLLOWS***

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
applicable)& STEP
STATUS OF
SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
From To INCREMENT

ADMINISTRATIVE ASSISTANT II (DATA

01/01/2022 PRESENT DEPARTMENT OF EDUCATION-LEYTE DIVISION 19,170.00 08/2 PERMANENT Y
ENCODER)
ADMINISTRATIVE ASSISTANT II (DATA
01/01/2021 12/31/2021 DEPARTMENT OF EDUCATION-LEYTE DIVISION 18,251.00 08/2 PERMANENT Y
ENCODER)
ADMINISTRATIVE ASSISTANT II (DATA
01/01/2020 12/31/2020 DEPARTMENT OF EDUCATION-LEYTE DIVISION 17,663.00 08/2 PERMANENT Y
ENCODER)
ADMINISTRATIVE ASSISTANT II (DATA
01/01/2019 12/31/2019 DEPARTMENT OF EDUCATION-LEYTE DIVISION 16,758.00 08/1 PERMANENT Y
ENCODER)
ADMINISTRATIVE ASSISTANT II (DATA
01/01/2018 12/31/2018 DEPARTMENT OF EDUCATION-LEYTE DIVISION 16,282.00 08/1 PERMANENT Y
ENCODER)
ADMINISTRATIVE ASSISTANT II (DATA DEPARTMENT OF EDUCATION-LEYTE DIVISION
02/01/2017 12/31/2017 15,818.00 08/1 PERMANENT Y
ENCODER) (San Miguel National High School)
DEPARTMENT OF SOCIAL WELFARE AND CONTRACT OF
01/08/2015 01/31/2017 ADMINISTRATIVE ASSISTANT III 16,512.00 09/1 N
DEVELOPMENT SERVICE
04/11/2011 07/03/2011 CASH CLERK IV PAG-IBIG FUND - TACLOBAN BRANCH 17,447.00 10/1 PERMANENT Y

DEVELOPMENT BANK OF THE PHILIPPINES SERVICE

CONTRACT OF
09/15/2006 04/10/2011 HUMAN RESOURCE MANAGEMENT OFFICER I CORPORATION (PAG-IBIG FUND TACLOBAN 8,400.00 N/A N
BRANCH) SERVICE
DEVELOPMENT BANK OF THE PHILIPPINES SERVICE
CONTRACT OF
02/28/2003 09/14/2006 LOANS ASSISTANT CORPORATION (PAG-IBIG FUND TACLOBAN 6,504.00 N/A N
BRANCH) SERVICE
DEVELOPMENT BANK OF THE PHILIPPINES SERVICE
CONTRACT OF
07/10/2000 02/27/2002 CLERK CORPORATION (PAG-IBIG FUND TACLOBAN 6,504.00 N/A N
BRANCH) SERVICE

***NOTHING FOLLOWS***

(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

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 Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
THREE-DAY CAPACITY BLDG. WORKSHOP ON PERSONNEL ADMINISTRATION,PROPERTY
Department of Education-Leyte Division, The Oriental
CUSTODIANSHIP,GEN. ADMINISTRATIVE SUPPORT AND FINANCIAL MANAGEMENT TO ALL 11/23/2021 11/25/2021 24.0 TECHNICAL Hotel, Palo, Leyte
ADMINISTRATIVE OFFICER II IN LEYTE DIVISION
3-DAY ENHANCE CAPACITY BUILDING FOR ADMINISTRATIVE PERSONNEL IN THE Department of Education-Leyte Division, Summit Hotel
11/15/2021 11/17/2021 24.0 TECHNICAL Tacloban City
ADMINISTRATIVE SERVICES

2020 REGIONAL CONGRESS FOR HUMAN RESOURCE MANAGEMENT PRACTISIONERS 2/26/2020 2/27/2020 16.0 TECHNICAL CSC RO8 Summit Hotel Tacloban City

SEMINAR WORKSHOP ON 2017 OMNIBUS RULES ON APPOINTMENTS AND OTHER

11/15/2018 11/16/2018 16.0 TECHNICAL CSC RO8 Human Resource Center, Palo, Leyte
HUMAN RESOURCE ACTIONS (REVISED JULY 2018)
CAPACITY-BUILDING CUM CRAFTING OF THE IPCRF OF THE NEWLY-HIRED ADMINISTRATIVE
1/4/2018 1/6/2018 24.0 TECHNICAL Department of Education-Leyte Division
OFFICER II, REGISTRAR I and ADMINISTRATIVE ASSISTANT II FOR THE SENIOR HIGH SCHOOL
Department of Social Welfare & Development-Field
GASSD EVALUATION & PLANNING CONFERENCE CUM STAFF DEVELOPMENT 11/19/2015 11/21/2015 24.0 TECHNICAL
Office 8
Department of Social Welfare & Development-Field
FINANCIAL MANAGEMENT TRAINING WORKSHOP ON ENGAS and EBUDGET 09/16/2015 09/19/2015 32.0 TECHNICAL
Office 8

REFRESHER COURSE FOR FRONTLINERS 04/26/2014 04/26/2014 4.0 TECHNICAL Pag-IBIG Fund Cebu City/DBP Service Corp.

GENDER SENSITIVITY TRAINING 11/13/2009 11/13/2009 8.0 TECHNICAL Civil Service Commission/Pag-IBIG Fund

FRONTLINING SEMINAR 11/24/1998 11/26/1998 23.2 TECHNICAL MindBroker / Pag-IBIG Fund Tacloban City

***NOTHING FOLLOWS***

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

PAG-IBIG FUND 10 YEARS SERVICE AWARD FOR LOYALTY AND UNSELFISH DEDICATION TO THE LEYTE NATIONAL HIGH SCHOOL BATCH 1993 - PUBLIC
COMPUTER LITERATE / ENCODING INFORMATION OFFICER
FUND
2nd PLACER SWIMMING FREESTYLE WOMEN-Pag-IBIG Fund 7th BICOL-VISAYAS SPORTSFEST
TYPING / FILING / CLERICAL WORKS ***NOTHING FOLLOWS***
1999
JUDGE during the AGRI-FAIR CONTEST of NUTRITION MONTH CELEBRATION with the theme
INTERNET SURFING
"HEALTHY DIET,GAWING HABIT for LIFE" on July 1-31, 2017.
RESOURCE SPEAKER in the ORIENTATION ON THE DISTRICT/SCHOOL COUNTERPART ON THE
TRAVELLING and SWIMMING
DIVISION EFFORT TO SIMPLIFY AND EXPEDITE THE PROCESS FLOW ON APPOINTMENTS
MEMBER, TECHNICAL WORKING GROUP FOR 2020 PERFORMANCE BASED BONUS (PBB)
***NOTHING FOLLOWS***
VALIDATION
CERTIFICATE OF APPRECIATION FOR THE TIRELESS EFFORTS AND CONSTANT SUPPORT TO THE PROGRAMS
OF THE CIVIL SERVICE COMMISSION AND THE OPERATIONS OF THE LEYTE FIELD OFFICE II

***NOTHING FOLLOWS***
(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 regulation by YES NO
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, YES NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in If YES, give details:
the public or private sector? RESIGNED
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
MA. NATIVIDAD L. COSTIBOLO CIVIL SERVICE COMMISSION RO8 0936-111-2222 the last 6 months
4.5 cm. X 3.5 cm
(passport size)
ENGR. VICENTE C. TOLOSA CIVIL SERVICE COMMISSION RO8 0917-333-4444

MIKO OLSEN DELA CRUZ DEPED LEYTE DIVISION 0908-555-6666 Computer generated
or photocopied picture
42. 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: BIR TIN CARD
ID/License/Passport No.: 926-626-626 Signature (Sign inside the box)

Date/Place of Issuance: 11/21/2008 / PALO, LEYTE 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