VICKY Q.CS Form No. 212 Revised Personal Data 2019

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 aga
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 CARAMAT
NAME EXTENSION (JR., SR
FIRST NAME VICTORIA N/A
MIDDLE NAME GARCIA
3. DATE OF BIRTH
(mm/dd/yyyy) 3/6/1963 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH DAGUPAN CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 174

Widowed Separated House/Block/Lot No.
N/A
Other/s:
Subdivision/Village B
7. HEIGHT (m) 1.8 m MANGALDAN PANG
City/Municipality P
8. WEIGHT (kg) 52 kgs. ZIP CODE 2432
9. BLOOD TYPE B+
18. PERMANENT ADDRESS 174
House/Block/Lot No.
N/A
10. GSIS ID NO. 63030602325
Subdivision/Village B
11. PAG-IBIG ID NO. 1280-0046-6649 MANGALDAN PANG

City/Municipality P
12. PHILHEALTH NO. 05-000052405-8 ZIP CODE 2432
13. SSS NO. NONE 19. TELEPHONE NO. 540-9145
14. TIN NO. 189-091-791 20. MOBILE NO. 0948 454 6639
15. AGENCY EMPLOYEE NO. 4108859 21. E-MAIL ADDRESS (if any) V_Caramat@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CARAMAT 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME ROMEO N/A JOHN PHILIP G. CARAMAT
MIDDLE NAME BAGBAGAY EZEKIEL G. CARAMAT
OCCUPATION EMPLOYEE N/A
EMPLOYER/BUSINESS NAME LOS PEDRITOS BAKESHOP AND RESTAURANT N/A
BUSINESS ADDRESS TAPUAC DISTRICT, DAGUPAN CITY N/A
TELEPHONE NO. N/A N/A
24. FATHER'S SURNAME GARCIA N/A

FIRST NAME JUAN SR. N/A
MIDDLE NAME SOROTEN N/A
25. MOTHER'S MAIDEN NAME LYDIA GAPASEN RAPOTE N/A
SURNAME RAPOTE N/A
FIRST NAME LYDIA N/A
MIDDLE NAME GAPASEN (Continue on separate sheet if necessa
III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
LEVEL (Write in EARNED
(Write in full)
full) (if not graduated)
From To
MALABAGO ELEMENTARY SCHOOL,

ELEMENTARY
MALABAGO, MANGALDAN, PANGASINAN ELEMENTARY EDUCATION 1970 1976 GRADUATED
MANGALDAN NATIONAL HIGH SCHOOL,

SECONDARY
MANGALDAN, PANGASINAN SECONDARY EDUCATION 1976 1981 GRADUATED
VOCATIONAL /
N/A N/A N/A N/A N/A

TRADE BACHELOR OF SCIENCE IN COMMERCE 1982 1986 GRADUATED
COURSE
COLLEGE LUZON COLLEGES BACHELOR OF ELEMENTARY EDUCATION
1987 1990 60 UNITS
42 UNITS FINISHED
GRADUATE STUDIES TARLAC COLLEGE OF AGRICULTURE MASTER OF ARTS IN EDUCATION 1989 1995 ACADEMIC REQUIREMENTS
(Continue on separate sheet if necessary)

SIGNATURE DATE JANUA
CS FO
L DATA SHEET
ence Sheet shall cause the filing of administrative/criminal case/s against the person
FORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

N/A
Dual Citizenship
by naturalization
Pls. indicate country:
N/A
Street
BARI
Barangay
PANGASINAN
Province
N/A
Street
BARI
Barangay
PANGASINAN
Province
V_Caramat@yahoo.com
DATE OF BIRTH (mm/dd/yyyy)
7/8/2001
8/19/2003
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
1976 N/A
1981 N/A
N/A N/A
1986
NA N/A
N/A N/A
parate sheet if necessary)
JANUARY 10, 2019
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
CSC CAREER SERVICE PROFESSIONAL
70.74 7/26/1987 DAGUPAN CITY
EXAMINATION
PROFESSIONAL BOARD EXAMINATION FOR
72.3 11/22/1987 DAGUPAN CITY 0104804 8/25/1997
TEACHERS
N/A N/A N/A N/A N/A N/A

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) 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)
SDO PANGASINAN DIVISION II MANGALDAN
TEACHER III DISTRICT II MALABAGO ELEMENTARY SCHOOL 13-5 PERMANENT YES

11/07/18 PRESENT TEACHER III DISTRICT II MALABAGO ELEMENTARY SCHOOL
P25,387 13-5 PERMANENT YES

01/01/2018 11/6/2018 TEACHER III DISTRICT II MALABAGO ELEMENTARY SCHOOL

01/01/2017 12/31/2017 TEACHER III DISTRICT II MALABAGO ELEMENTARY SCHOOL 13-3 PERMANENT YES










02/02/2004 11/17/2005 TEACHER I DISTRICT II MALABAGO ELEMENTARY SCHOOL

09/29/2003 11/11/2003 CLASSROOM TEACHER DISTRICT II MALABAGO ELEMENTARY SCHOOL
P10,200 N/A SUBSTITUTE YES

P3,000 N/A CONTRACTUAL YES

P9,000 N/A SUBSTITUTE YES

P3,000 N/A CONTRACTUAL YES
06/04/2001 03/31/2002 CLASSROOM TEACHER P4,500 N/A PERMANENT NO
06/05/2000 03/30/2001 CLASSROOM TEACHER P4,100 N/A TEMPORARY NO
N/A N/A N/A N/A N/A N/A N/A N/A
SIGNATURE DATE JANUARY 10, 2019

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 N
N/A N/A N/A N/A N
N/A N/A N/A N/A N
N/A N/A N/A N/A N
N/A N/A N/A N/A N
N/A N/A N/A N/A N
N/A N/A N/A N/A N

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/ SP
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
DISTRICT ECHO-SEMINAR WORKSHOP ON GUIDANCE CURRICULUM DEPARTMENT
10/08/2016 10/ 15-16/2016 24 HOURS TECHNICAL
DEVELOPMENT for K TO 12, CAREER GUIDANCE and COUNSELING
DISTRIC ECHO-TRAINING on the PHYSICAL FITNESS TEST (PFT) DEPARTMENT
07/23-24/2016 07/30/2016 24 HOURS TECHNICAL
and SCHOOL FITNESS PROGRAM (SFP)
DEPARTMENT
MASS TRAINING OF TEACHERS IN GRADE 5 FOR THE K TO 12 PROGRAM 05/17/2016 05/23/2016 56 HOURS TECHNICAL
INTERN
INTERNATIONAL MIND EDUCATION SPECIALIST TRAINING 12/11/2015 12/13/2015 24 HOURS TECHNICAL
DISTRICT ECHO SEMINAR ON THE IMPLEMENTATION OF DEPED DEPARTMENT

05/28/2015 05/30/2015 24 HOURS TECHNICAL
RATIONALIZATION PROGRAM, RPMS, AND CITIZENS CHARTER
09/13/2014 09/14/2014 16 HOURS TECHNICAL GIRL SCO
09/06/2014 09/07/2014 16 HOURS TECHNICAL GIRL SCO
DEPARTMENT
06/25/2014 06/27/2014 24 HOURS TECHNICAL
DEPARTMENT
DIVISION RE-ECHO TRAINING ON PHYSICAL FITNEST TEST 12/6/2013 12/8/2013 24 HOURS TECHNICAL
DIVISION TRAINING ON GENDER AND DEVELOPMENT FOCUSED ON ETHICAL DEPARTMENT

STANDARDS FOR PUBLIC SCHOOL TEACHER & DEPED CHILD PROTECTION POLICY
07/29/2013 07/31/2013 24 HOURS TECHNICAL
DEPARTMENT
REGIONAL TRAINING ON ENGLISH LANGUAGE AND READING PROFICIENCY 02/02/2011 02/04/2011 24 HOURS TECHNICAL
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A
VIII. OTHER INFORMATION

MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
PHILIPPINE PUB
N/A TEACHERS AS
N/A TEACHERS ASS
N/A N/A MANGALDAN II
N/A N/A
N/A N/A
N/A N/A
SIGNATURE DATE J
/ VOLUNTARY ORGANIZATION/S
POSITION / NATURE OF WORK
N/A
N/A
N/A
N/A
N/A
N/A
N/A
if necessary)
S ATTENDED
s for Division Chief/Executive/Managerial positions)
CONDUCTED/ SPONSORED BY
(Write in full)
DEPARTMENT OF EDUCATION
MANGALDAN II
MANGALDAN II
PANGASINAN II
INTERNATIONAL MIND EDUCATION
INSTITUTE
MANGALDAN II
GIRL SCOUTS OF THE PHILIPPINES
GIRL SCOUTS OF THE PHILIPPINES
PANGASINAN II
PANGASINAN II
PANGASINAN II
REGION I
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
PHILIPPINE PUBLIC SCHOOL
TEACHERS ASSOCIATION
TEACHERS ASSOCIATION OF PANGASINAN
MANGALDAN II TEACHERS CLUB
N/A
N/A
N/A
if necessary)
JANUARY 07, 2019
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
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
________________________________
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?
________________________________
________________________________
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)?
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
the last 6 months
LUZ G. ARGUILLA, Ph. D. MANGALDAN, PANGASINAN 9256309043 3.5 cm. X 4.5 cm
(passport size)
LEO E. BLAQUIR, Ed. D. MANGALDAN, PANGASINAN 9257465766 With full and handwritten
name tag and signature over
printed name
MARIETTA O. MAURE, Ph.D. MANGALDAN, PANGASINAN 9434121345
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: PROFESSIONAL REGULATION COMMISSION
ID/License/Passport No.:
Signature (Sign inside the box)
JANUARY 07, 2019
Date/Place of Issuance: / BAGUIO CITY Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this 7TH DAY OF JANUARY, 2019 , affiant exhibiting his/her validly issued government ID as indicated above.
LUZ G. ARGUILLA, Ph.D.

Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

VICKY Q.CS Form No. 212 Revised Personal Data 2019

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CS Form No.

PERSONAL DATA SHEET

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 174

11. PAG-IBIG ID NO. 1280-0046-6649 MANGALDAN PANG

12. PHILHEALTH NO. 05-000052405-8 ZIP CODE 2432

13. SSS NO. NONE 19. TELEPHONE NO. 540-9145

MIDDLE NAME BAGBAGAY EZEKIEL G. CARAMAT

OCCUPATION EMPLOYEE N/A

EMPLOYER/BUSINESS NAME LOS PEDRITOS BAKESHOP AND RESTAURANT N/A

BUSINESS ADDRESS TAPUAC DISTRICT, DAGUPAN CITY N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME GARCIA N/A

MIDDLE NAME SOROTEN N/A

25. MOTHER'S MAIDEN NAME LYDIA GAPASEN RAPOTE N/A

SURNAME RAPOTE N/A

FIRST NAME LYDIA N/A

MIDDLE NAME GAPASEN (Continue on separate sheet if necessa

III. EDUCATIONAL BACKGROUND

MALABAGO ELEMENTARY SCHOOL,

MANGALDAN NATIONAL HIGH SCHOOL,

N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

FORE ACCOMPLISHING THE PDS FORM.

NAME EXTENSION (JR., SR)

Pls. indicate country:

DATE OF BIRTH (mm/dd/yyyy)

(Continue on separate sheet if necessary)

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

SDO PANGASINAN DIVISION II MANGALDAN

06/04/2001 03/31/2002 CLASSROOM TEACHER P4,500 N/A PERMANENT NO

06/05/2000 03/30/2001 CLASSROOM TEACHER P4,100 N/A TEMPORARY NO

06/07/1999 03/31/2000 CLASSROOM TEACHER P3,600 N/A TEMPORARY NO

06/01/1998 03/31/1999 CLASSROOM TEACHER P3,300 N/A TEMPORARY NO

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 10, 2019

N/A N/A N/A N/A N