CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal cas
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.

I. PERSONAL INFORMATION
2. SURNAME PALAPAR

FIRST NAME JUDY

MIDDLE NAME ALFEREZ

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citi
(mm/dd/yyyy) 10/28/1968

4. PLACE OF BIRTH BANSALAN, DAVAO DEL SUR If holder of dual citizenship,

please indicate the details.

5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
JUANILLA VILLAGE
Other/s:
Subdivision/Village
VALENCIA CITY
7. HEIGHT (m) 1.5748m
City/Municipality
8. WEIGHT (kg) 71kg ZIP CODE 8709

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No.
JUANILLA VILLAGE
10. GSIS ID NO. B68VUJAPO15
Subdivision/Village
VALENCIA CITY
11. PAG-IBIG ID NO. 1094-8970-411
City/Municipality

12. PHILHEALTH NO. ZIP CODE 8709

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 933-281-324 20. MOBILE NO. 09272644381

15. AGENCY EMPLOYEE NO. 1530111 21. E-MAIL ADDRESS (if any) marialourdesruba@g
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME RUBA 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) JEWEILLE QLOUDETTE L. RUBA
FIRST NAME JOEL

MIDDLE NAME PODADOR

OCCUPATION TAILOR

EMPLOYER/BUSINESS NAME JOHNNAS TAILORAMA

BUSINESS ADDRESS ALKUINO EMPORIUM, POBLACION, VALENCIA CITY

TELEPHONE NO. N/A

24. FATHER'S SURNAME LOFRANCO

SR
FIRST NAME REMEGIO

MIDDLE NAME APARECE

25. MOTHER'S MAIDEN NAME

SURNAME GARA

FIRST NAME CLEOFE

MIDDLE NAME MUNALEM (Continue on separate sheet i

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY OUR LADY OF LOURDES ELEMENTARY SCHOOL 6/1/1989 3/31/1995

SECONDARY HOLY CROSS HIGH SCHOOL 6/1/1995 3/31/1999

VOCATIONAL /

NONE N/A N/A N/A

TRADE
COURSE
COLLEGE BUKIDNON STATE COLLEGE BACHELOR IN ELEMENTARY EDUCATION 6/1/1999 3/31/2003

MASTER OF ARTS IN EDUCATIONAL

GRADUATE STUDIES BUKIDNON STATE UNIVERSITY
ADMINISTRATION
11/5/2003 3/31/2009

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 18, 2017

AL DATA SHEET
Experience Sheet shall cause the filing of administrative/criminal case/s against the person

DS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Filipino Dual Citizenship

by birth by naturalization

Pls. indicate country:

PUROK 14
Street
BAGONTAAS
Barangay
BUKIDNON
Province
8709

PUROK 14
Street
BAGONTAAS
Barangay
BUKIDNON
Province

8709

NONE

09272644381

marialourdesruba@gmail.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

JEWEILLE QLOUDETTE L. RUBA 6/7/2011

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/

YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

N/A 1995 NONE

N/A 1999 NONE

 N/A N/A N/A

ACADEMIC
N/A 2003
SCHOLAR

CAR N/A N/A

ue on separate sheet if necessary)

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 84.0 AUGUST, 2003 CAGAYAN DE ORO CITY 0815763 6/15/2019

(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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

1/1/2017 PRESENT TEACHER III DEPARTMENT OF EDUCATION 23, 257.00 11-1 PERMANENT Y

1/1/2016 12/31/2016 TEACHER III DEPARTMENT OF EDUCATION 22, 328.00 11-1 PERMANENT Y

3/2/2015 12/31/2015 TEACHER III DEPARTMENT OF EDUCATION 21, 436.00 11-1 PERMANENT Y

8/9/2013 3/1/2015 TEACHER I DEPARTMENT OF EDUCATION 19, 111.OO 10-4 PERMANENT Y

6/1/2012 8/8/2013 TEACHER I DEPARTMENT OF EDUCATION 18, 922.00 10-3 PERMANENT Y

6/1/2011 5/31/2012 TEACHER I DEPARTMENT OF EDUCATION 17, 540.00 10-3 PERMANENT Y

8/9/2010 5/31/2011 TEACHER I DEPARTMENT OF EDUCATION 16, 157.00 10-3 PERMANENT Y

6/24/2010 8/8/2010 TEACHER I DEPARTMENT OF EDUCATION 15, 900.00 10-2 PERMANENT Y

7/1/2009 6/23/2010 TEACHER I DEPARTMENT OF EDUCATION 14, 438.00 10-2 PERMANENT Y

7/1/2008 6/30/2009 TEACHER I DEPARTMENT OF EDUCATION 12, 328.00 10-2 PERMANENT Y

8/9/2007 6/30/2008 TEACHER I DEPARTMENT OF EDUCATION 11, 207.00 10-2 PERMANENT Y

7/1/2007 8/8/2007 TEACHER I DEPARTMENT OF EDUCATION 10, 933.00 10-1 PERMANENT Y

8/9/2004 6/30/2007 TEACHER I DEPARTMENT OF EDUCATION 9, 939.00 10-1 PERMANENT Y

6/28/2004 8/5/2004 TEACHER I DEPARTMENT OF EDUCATION 9, 939.00 10-1 SUBSTITUE Y

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 18, 2017 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 / N
From To

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/ S
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

SCHOOL-BASED TRAINING PROGRAM ON TEST CONSTRUCTION AND TOS 10/26/2016 10/27/2016 16 BAGONTAAS

SCHOOL-BASED TRAINING PROGRAM ON DEVELOPMENT OF ASSESSMENT TOOLS 10/25/2016 10/25/2016 8 BAGONTAAS

2016 DIVISION ENHANCEMENT TRAINING FOR RSPC QUALIFIERS 9/11/2016 9/12/2016 16 DIVISION OF V

2016 REGIONAL TRAING IN JOURNALISM 8/24/2016 8/26/2016 24 DepEd REGIO

INTERNATIONAL SEMINAR-WORKSHOP ON SPECIAL EDUCATION FOR K-12 12/11/2015 12/13/2015 24

DEL CARMEN CO

2015 DIVISION ENHANCEMENT TRAINING IN JOURNALISM FOR RSPC QUALIFIERS 11/12/2015 11/13/2015 16 DIVISION OF V

TRAINING-WORKSHOP ON WRITING ACTION RESEARCH 9/10/2015 10/7/2015 32 DIVISION OF V

REORIENTATION ON RESULTS-BASED PERFORMANCE MANAGEMENT SYSTEM 6/8/2015 6/8/2015 8 DIVISION OF V

REGIONAL (DIVISION-BASED) MASS TRAINING OF GRADE 4 TEACHERS ON K TO 12

5/23/2015 5/29/2015 56 DIVISION OF V
CURRICULUM
SCHOOL-BASED SEMINAR-WORKSHOP ON MENTORING TEACHERS IN TEACHING
10/21/2015 10/22/2015 16 BAGONTAAS
FILIPINO, MATH, VALUES EDUCATION AND ARALING PANLIPUNAN
SEMINAR ON PREVENTING HIV/AIDS IN WORKPLACE AND IMPLEMENTATION OF "NO
12/4/2013 12/5/2013 16 DIVISION OF V
SMOKING POLICY" IN SCHOOLS
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

COMPUTER LITERATE (MS WORD, MSEXCEL, VALENCIA C

N/A E
MS POWERPOINT, LAY OUTING)
ASSOC
DANCING
EMPL
WRITING ARTICLES
(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 18, 2017

RGANIZATION/S

POSITION / NATURE OF WORK

N/A

ef/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

BAGONTAAS CENTRAL ELEMENTARY SCHOOL

BAGONTAAS CENTRAL ELEMENTARY SCHOOL

DIVISION OF VALENCIA CITY

DepEd REGION X

DEL CARMEN CONTINUING ED & SKILLS TRAINING

DIVISION OF VALENCIA CITY

DIVISION OF VALENCIA CITY

DIVISION OF VALENCIA CITY

DIVISION OF VALENCIA CITY

BAGONTAAS CENTRAL ELEMENTARY SCHOOL

DIVISION OF VALENCIA CITY

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

VALENCIA CITY PUBLIC SCHOOL TEACHERS AND

EMPLOYEES ASSOCIATION
ASSOCIATION OF VALENCIA TWO
EMPLOYEES INCORPORATED

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:
________________________________
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:
________________________________
N/A
________________________________
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? ________________________________
N/A
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except YES NO
Barangay election)? N/A
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: 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:
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 w
the last 6 mon
MERLIE S. ABECIA LUMBO, VALENCIA CITY 3.5 cm. X 4.5 c
(passport size

LINDA N. JUMANGITO LIBONA, BUKIDNON 9177189479 With full and hand

name tag and signat
printed name
FE L. RICARTE VALENCIA CITY, BUKIDNON 9778465745
Computer gener
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied pi
is not acceptab
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 administrative/criminal case/s PHOTO
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.: 0815763

Signature (Sign inside the box)
APRIL 18, 2017
Date/Place of Issuance: 8/1/2016/CAGAYAN DE ORO CITY
Date Accomplished Right Thumbma

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

Person Administering Oath

CS FORM 212 (Revised

 If YES, give details:
________________________________
N/A

If YES, give details:

________________________________
N/A
________________________________

If YES, give details:

________________________________
N/A
________________________________
N/A

If YES, give details:

________________________________
N/A
________________________________

If YES, give details:

________________________________
N/A
________________________________
NO
N/A

NO
N/A

NO
If YES, give details (country):
N/A

NO
N/A
NO
N/A
NO
N/A

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

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