Sei sulla pagina 1di 5

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 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 PERALTA
NAME EXTENSION (JR., SR)
FIRST NAME RAMIRO

MIDDLE NAME PARILLA


3. DATE OF BIRTH
(mm/dd/yyyy) 02/15/1968 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH JOSE PANGANIBAN, CAMARINES NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS UNIT 205 2F RPEC CONDOMINIUM MULAWINAN STREET
6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
LAWANG BATO
Other/s:
Subdivision/Village Barangay
VALENZUELA CITY NCR
7. HEIGHT (m) 1.64 METERS
City/Municipality Province
8. WEIGHT (kg) 60KG ZIP CODE 1447

18. PERMANENT ADDRESS 025 RIZAL STREET


9. BLOOD TYPE B
House/Block/Lot No. Street
SOUTH POBLACION
10. GSIS ID NO. BPN 2004981850
Subdivision/Village Barangay
JOSE PANGANIBAN CAMARINES NORTE
11. PAG-IBIG ID NO. 1060-0135-4601
City/Municipality Province

12. PHILHEALTH NO. 10-050038597-3 ZIP CODE 4606

13. SSS NO. 05-0522482-8 19. TELEPHONE NO.

14. TIN NO. 913-376-850 20. MOBILE NO. 0919-532-7707

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) ramiropperalta@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BRIGUERA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) PRINZE ANDREI BRIGUERA PERALTA
FIRST NAME MYRA 02/29/2008

MIDDLE NAME TRIA

OCCUPATION DEPED JUNIOR HIGH TEACHER

EMPLOYER/BUSINESS NAME DEPED VALENZUELA

BUSINESS ADDRESS PIO VALENZUELA ST., MARULAS, VALENZUELA CITY

TELEPHONE NO. 0908-343-4102

24. FATHER'S SURNAME PERALTA

FIRST NAME TOBIAS SR

MIDDLE NAME REQUIJO

25. MOTHER'S MAIDEN NAME

SURNAME PARILLA

FIRST NAME LORETA

MIDDLE NAME LAUDES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


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

ELEMENTARY JOSE PANGANIBAN CENTRAL SCHOOL 1974 1980 1980

SECONDARY JOSE PANGANIBAN NATIONAL HIGH SCHOOL 1980 1984 1984

COLLEGE HOLY ROSARY SEMINARY AB PHILOSOPHY 1985 1989 1989

COLLEGE HOLY ROSARY MAJOR SEMINARY AB THEOLOGY 1989 1994 1994

HOLY ROSARY MAJOR SEMINARY GRADUATE


MA IN THEOLOGY MAJOR IN BIBLICAL
GRADUATE STUDIES SCHOOL OF THEOLOGY (AFFILIATED WITH
STUDIES
1998 2000 36
UNIVERSITY OF SANTO TOMAS)

MA IN EDUCATION MAJOR IN EDUCATIONAL


GRADUATE STUDIES PAMANTASAN NG LUNGSOD NG VALENZUELA
MANAGEMENT
2011 2012 18

(Continue on separate sheet if necessary)

SIGNATURE DATE May 7, 2018

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
06/23/2015
03/29/2015/06/28/2 CENTRAL COLLEGE OF THE PHILIPPINES, QUEZON
LICENSURE EXAMINATIONS FOR TEACHERS 82.20 015 CITY/CUNETA ASTRODOME, PASAY CITY, MM
1371696 -
02/15/2018

(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) STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
N)
SENIOR HIGH SCHOOL/DIVISION OF CITY SCHOOLS-
05/23/2016 PRESENT TEACHER II VALENZUELA/BIGNAY NATIONAL HIGH 20,651.00 SG - 12-1 PERMANENT Y
SCHOOL/DEPARTMENT OF EDUCATION

JUNIOR HIGH SCHOOL/VALUES EDUCATION


10/6/2013 03/31/2014 TEACHER DEPARTMENT/ST. JOSEPH SCHOOL, NAGA CITY
12,000.00 N/A PART-TIME N

COLLEGE OF ARTS AND SCIENCES/PAMANTASAN NG


3/6/2010 10/30/2012 INSTRUCTOR LUNGSOD NG VALENZUELA
18,000.00 N/A PART-TIME Y

COLLEGE OF ARTS AND SCIENCES/OUR LADY OF


11/6/2007 10/30/2009 FACULTY MEMBER FATIMA UNIVERSITY, VALENZUELA CITY
18,000.00 N/A PART-TIME N

CAMPUS MINISTRY/ATENEO DE NAGA UNIVERSITY,


7/11/2001 05/31/2002 MUSIC TRAINER NAGA CITY
2,500.00 N/A CONTRACTUAL N

COLLEGE OF ARTS AND SCIENCES/ATENEO DE NAGA


5/11/2001 03/28/2003 FACULTY MEMBER UNIVERSITY, NAGA CITY
18,000.00 N/A PART-TIME N

COLLEGE OF ARTS AND SCIENCES/UNIVERSIDAD DE


06/15/1998 10/15/2001 ASSISTANT PROFESSOR SANTA ISABEL, NAGA CITY
15,000.00 N/A PART-TIME N

BASIC EDUCATION CAMPUS MINISTRY/UNIVERSIDAD


06/15/1998 10/15/2001 BASIC EDUCATION CAMPUS MINISTER DE SANTA ISABEL, NAGA CITY N/A FULL-TIME N

(Continue on separate sheet if necessary)


SIGNATURE DATE MAY 7, 2018

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

PASKA (PAMBIKARYANG SAMAHAN NG KATEKISTA) 1/6/2015 3/3/2016 3,150 VICE-PRESIDENT/CATECHESIS

PARISH COMMISSION ON YOUTH 02/15/2016 05/30/2016 30 CHAIRMAN/PARISH YOUTH ACTIVITIES

PPCRV (PARISH PASTORAL COUNCIL FOR RESPONSIBLE VOTING 04/27/2016 9/5/2016 40 OVERALL PARISH COORDINATOR

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
SENIOR HIGH SCHOOL DEPARTMENT, BIGNAY
OUTREACH PROGRAM 12/19/2017 12/19/2017 4 HOURS
NATIONAL HIGH SCHOOL

MASS TRAINING OF CAREER ADVOCATES FOR GRADE 12 CAREER GUIDANCE DEPARTMENT OF EDUCATION, NATIONAL
12/14/2017 12/16/2017 3 DAYS
PROGRAM IMPLEMENTATION CAPITAL REGION

IN-SERVICE TRAINING PROGRAM FOR TEACHERS OF BIGNAY NATIONAL HIGH


10/23/2017 10/27/2017 5 DAYS BIGNAY NATIONAL HIGH SCHOOL
SCHOOL

HUMAN RESOURCE DEVELOPMENT


SHS GRADE 11 MASS TRAINING WORKSHOP ON COMMON/GENERAL TOPICS 10/25/2016 10/28/2016 96 HOURS (4 DAYS) DIVISION/NATIONAL EDUCATORS ACADEMY
OF THE PHILIPPINES

REGIONAL MASS TRAINING OF SENIOR HIGH SCHOOL TEACHERS ON THE DEPARTMENT OF EDUCATION, NATIONAL
05/26/2016 12/6/2016 144 HOURS (18 DAYS)
ACADEMIC TRACK (HUMMS STRAND) CAPITAL REGION

DEPARTMENT OF EDUCATION, NATIONAL


REGIONAL DEMONSTRATION SHS TEACHER 12/6/2016
CAPITAL REGION

DEPATMENT OF EDUCATION, VALENZUELA


TAGASANAY SA 2016 PANSANGAY NA PALIGSAHAN NG O.P.M. 08/17/2016
DIVISION

MAPEH DEPARTMENT, BIGNAY NATIONAL


SERVICE AWARD AS SCHOOL CHOIR CONDUCTOR 6/4/2017
HIGH SCHOOL, VALENZUELA CITY

(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
(Write in full)
in full)

BIGNAY NATIONAL HIGH SCHOOL FACULTY


CHORAL TRAINING AND CONDUCTING ASSOCIATION

MARRIAGE ENCOUNTER ALAGAD NG DIYOS


SINGING CHARISMATIC GROUP

COMPOSING LITURGICAL SONGS

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 7,2018

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 ✘
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
YES ✘ NO
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? ________________________________
________________________________
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
POLO NATIONAL HIGH SCHOOL, VALENZUELA the last 6 months
MR. CESAR C. VILLAREAL, ED.D. CITY 3.5 cm. X 4.5 cm
(passport size)
MOST HOLY ROSARY PARISH, JOSE
REV. FR. JOEL C. VILLANIA, PARISH PRIEST PANGANIBAN, CAM. NORTE 0919-213-4060 With full and handwritten
name tag and signature over
ST. BERNADETTE COLLEGE OF printed name
MR. JESUS T. BERNAL VALENZUELA 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
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:

ID/License/Passport No.: PRC


Signature (Sign inside the box)

Date/Place of Issuance: 06/10/2015/MANILA


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