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 DADIA
NAME EXTENSION (JR., SR)
FIRST NAME BRYAN N/A
MIDDLE NAME HIPOLITO
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
01/30/1998 ✘ Filipino Dual Citizenship

4. PLACE OF BIRTH ALLEN, NORTHERN SAMAR If holder of dual citizenship,

✘ byindicate
Pls. birth country:
by naturalization

please indicate the details.

5. SEX
✘ Male Female
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLOCK 4 LOT 1 N/A
✘ Single Married House/Block/Lot No. Street
Widowed Separate N/A SAN ANTONIO DE PADUA 1
Other/s: d Subdivision/Village Barangay

7. HEIGHT (cm) 172.72 cm DASMARIÑAS CITY CAVITE

City/Municipality Province
8. WEIGHT (kg) 57 kg ZIP CODE 4114

9. BLOOD TYPE A+ 18. PERMANENT ADDRESS BLOCK 4 LOT 1 N/A

House/Block/Lot No. Street

10. GSIS ID NO. N/A N/A SAN ANTONIO DE PADUA 1

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-2490-6389 DASMARIÑAS CITY CAVITE

City/Municipality Province

12. PHILHEALTH NO. 13-025502223-8 ZIP CODE 4114

13. SSS NO. 06-41221189-2 19. TELEPHONE NO. N/A

14. TIN NO. 729-493-557-000 20. MOBILE NO. +63 961 770 3091

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)
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 DADIA
NAME EXTENSION (JR., SR)
FIRST NAME JULIO N/A
MIDDLE NAME RAPSING
25. MOTHER'S MAIDEN NAME

SURNAME HIPOLITO
FIRST NAME MEA
MIDDLE NAME JARALES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY
ALLEN CENTRAL ELEMENTARY PRIMARY EDUCATION 2004 2010 N/A 2010 WITH
SCHOOL HONORS

SECONDARY ALLEN NATIONAL HIGH SCHOOL HIGH SCHOOL 2010 2014 N/A 2014 SERVICE
VOCATIONAL / AWARDEE
BALICUATRO COLLEGE OF ARTS TRAINER'S METHODOLOGY NC 2019 2020 N/A 2020 N/A
AND TRADES LEVEL I
TRADE
COURSE UNIVERSITY OF EASTERN BACHELOR OF TECHNICIAN TEACHER SERVICE
COLLEGE
PHILIPPINES
EDUCATION MAJOR IN TECHNOLOGY AND 2014 2018 N/A 2018 AWARDEE
LIVELIHOOD EDUCATION

GRADUATE STUDIES
PHILIPPINE CRISTIAN UNIVERSITY - MASTER OF ARTS IN EDUCATION MAJOR IN
N/A N/A N/A N/A N/A
DASMARIÑAS EDUCATIONAL ADMINISTRATION
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity
LICENSURE EXAMINATION FOR PROFESSIONAL 81.60% 01/30/2022 CATARMAN, NORTHERN SAMAR 1915234 01/30/2025
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/ PAY SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)

10/14/2024 Present JUNIOR HIGH SCHOOL TEACHER FRANCISCO E. BARZAGA INTEGRATED 30,024.00 11-1 PERMANENT Y
HIGH SCHOOL
01/23/2023 05/11/2024 CLERK FRANCISCO E. BARZAGA INTEGRATED 23,226.00 9-1 PERMANENT Y
HIGH SCHOOL
01/23/2023 05/11/2024 SENIOR HIGH SCHOOL TEACHER FEAPITSAT COLLEGE OF DASMARIÑAS 14,000.00 11-1 CONTRACTUAL N

03/28/2022 05/20/2022 CUSTOMER SERVICE REPRESENTATIVE /

CALL CENTER AGENT INSPIRO RELIA, INC. 19,000.00 11-1 CONTRACTUAL N
SERVICE REPRESENTATIVE / IQOR PHILIPPINES (RMS COLLECT PHILS.,
07/22/2021 12/10/2021 CUSTOMER
CALL CENTER AGENT INC.) 21,500.00 11-1 CONTRACTUAL N

09/01/2020 09/30/2020 ENUMERATOR PHILIPPINE STATISTICS AUTHORITY 17,000.00 11-1 CONTRACTUAL Y

09/28/2018 11/10/2019 FRONTLINER CELL CITY 10,000.00 11-1 CONTRACTUAL N

06/02/2014 03/30/2018 ADMINISTRATIVE ASSISTANT BALICUATRO COLLEGE OF ARTS AND 15,000.00 11-1 CONTRACTUAL N
TRADES / REGISTRAR'S OFFICE

(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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

GAWAD KALINGA: BAYANI CHALLENGE 2017 05/22/2017 05/26/2017 60 HRS. VOLUNTEER

(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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
DEVELOP TRAINING CURRICULUM LEADING TO TRAINERS 10/01/2024 10/05/2024 40 HRS. FOUNDATION TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
METHODOLOGY LEVEL II NATIONAL TVET TRAINERS ACADEMY, TAGUIG CITY, MANILA

ADMINISTRATIVE MANAGEMENT 09/22/2024 09/22/2024 4 HRS. FOUNDATION THE KOM ACADEMY (KNIGHTS OF ONLINE MARKETERS)
- DAVAO CITY

CIVIC EDUCATORS AND TEACHERS' SUMMIT 2024 08/31/2024 08/31/2024 8 HRS. FOUNDATION PHILIPPINE NORMAL UNIVERSITY-MANILA - TAFT AVE., ERMITA,
METRO MANILA

CYBERSECURITY PROFICIENCY IMPROVEMENT TRAINING 08/28/2024 08/28/2024 4 HRS. FOUNDATION DEPARTMENT OF INFORMATION AND COMMUNICATIONS
TECHNOLOGY (DICT) - CAVITE

EFFECTIVE OFFICE ADMINISTRATION 08/14/2024 08/14/2024 8 HRS. FOUNDATION THE KOM ACADEMY (KNIGHTS OF ONLINE MARKETERS)
- DAVAO CITY

EVENTS MANAGEMENT SERVICES NC III 06/27/2024 07/13/2024 108 HRS. FOUNDATION TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
C & C ACADEMY INC. - CITY OF DASMARIÑAS, CAVITE

2023 IN-SERVICE TRAINING FOR SENIOR HIGH SCHOOL TEACHERS 06/23/2023 06/25/2023 24 HRS. FOUNDATION PRIVATE EDUCATION ASSISTANCE COMMITTEE - LYCEUM OF
THE PHILIPPINES UNIVERSITY, CALAMBA CITY, LAGUNA

TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -

TRAINER'S METHODOLOGY NC LEVEL 1 11/11/2019 01/17/2020 262 HRS. FOUNDATION BALICUATRO
SAMAR
COLLEGE OF ARTS AND TRADES, ALLEN, N.

TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -

TILE SETTING NC II 04/16/2018 04/30/2018 82 HRS. FOUNDATION BALICUATRO COLLEGE OF ARTS AND TRADES, ALLEN, N.
SAMAR

COOKERY NC II 08/08/2017 11/26/2017 316 HRS. FOUNDATION BARAYONG GYMNASIUM, ALLEN, N. SAMAR
RURAL IMPACT SOURCING WORKSHOP: PROMOTING ONLINE JOBS IN 07/21/2017 07/21/2017 10 HRS. TECHNICAL
TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
BALICUATRO COLLEGE OF ARTS AND TRADES, ALLEN, N.
THE COUNTRYSIDE SAMAR
TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
PERFORM FOOT SPA (LEADING TO BEAUTY CARE NC II) 06/20/2017 07/10/2017 120 HRS. TECHNICAL BALICUATRO COLLEGE OF ARTS AND TRADES, ALLEN, N.
SAMAR
TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
COMPUTER LITERACY 09/12/2016 09/30/2016 120 HRS. TECHNICAL BALICUATRO COLLEGE OF ARTS AND TRADES, ALLEN, N.
SAMAR
TECHNICAL EDUCATION & SKILLS DEVELOPMENT AUTHORITY -
BASIC ENGLISH LANGUAGE PROFICIENCY 08/19/2016 09/03/2016 100 HRS. TECHNICAL BALICUATRO COLLEGE OF ARTS AND TRADES, ALLEN, N.
SAMAR

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

PROFICIENT IN MICROSOFT OFFICE (WORD, N/A SANGGUNIANG KABATAAN (SK) COUNCILOR

EXCEL, AND POWERPOINT)

EVENT STAGE DESIGNING/DECORATING

FASHION DESIGNING

(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:
________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense?
YES ✘ NO
If YES, give details:
________________________________
N/A
________________________________

b. Have you been criminally charged before any court? YES ✘ NO

If YES, give details:
________________________________
N/A
Date Filed:
________________________________
Status of Case/s: N/A

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:
________________________________
N/A
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
N/A
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
If YES, give details: N/A
b. Have you resigned from the government service during the three (3)-month period before the last YES
election to promote/actively campaign for a national or local candidate? ✘ NO
If YES, give details: N/A

39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability?
YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent?
YES ✘ NO
If YES, please specify ID No: N/A

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
IVY JOY D. PELAYO SILANG, CAVITE 9175881983 3.5 cm. X 4.5 cm
(passport size)

ANNE KIMBERLY S. DELA TORRE DASMARIÑAS CITY, CAVITE 9351701841 With full and handwritten
name tag and signature over
printed name
MARIA PAMELA C. SANTIAGO DASMARIÑAS CITY, CAVITE 9434338361
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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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
administrative/criminal case/s against me. PHOTO

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 LICENSE ID
ID/License/Passport No.: 1915256 Signature (Sign inside the box)

Date/Place of Issuance: 05/23/2022 / PRC ROBINSON,

DASMARIÑAS CITY, CAVITE Date Accomplished Right Thumbmark

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

HON. JEFFREY N. FRANI

PUNONG BARANGAY
Person Administering Oath

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