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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 ag
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

I. PERSONAL INFORMATION
2. SURNAME LUMABE
NAME EXTENSION (JR., SR
FIRST NAME CHRISTINE

MIDDLE NAME ESTELLES


3. DATE OF BIRTH
(mm/dd/yyyy) SEPTEMBER 17, 1997 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH BICOL MEDICAL CENTER, NAGA 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 312 ZO
Widowed Separated House/Block/Lot No. S

Other/s:
LOURDE
Subdivision/Village Ba
7. HEIGHT (m) 1.61 NABUA CAMAR
City/Municipality Pr
8. WEIGHT (kg) 53 ZIP CODE 4434

9. BLOOD TYPE B+
18. PERMANENT ADDRESS 312 ZO
House/Block/Lot No. S

10. GSIS ID NO. NONE LOURDE


Subdivision/Village Ba

11. PAG-IBIG ID NO.


NABUA CAMAR
City/Municipality Pr

12. PHILHEALTH NO. ZIP CODE 4434

13. SSS NO. 19. TELEPHONE NO. NONE

14. TIN NO. 20. MOBILE NO. 09381996361

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) christine_lumabe@yahoo.co

II. FAMILY BACKGROUND


22. SPOUSE'S SURNAME NONE 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) NONE
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME LUMABE


NAME EXTENSION (JR., SR)
FIRST NAME EDUARDO
MIDDLE NAME LAURENTE

25. MOTHER'S MAIDEN NAME

SURNAME ESTELLES

FIRST NAME AURORA

MIDDLE NAME REGALA (Continue on separate sheet if necessary

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

ELEMENTARY HOLY CROSS PAROCHIAL SCHOOL ELEMENTARY 2004 2010 GRADUATED

SECONDARY /
VOCATIONAL NABUA NATIONAL HIGH SCHOOL SECONDARY 2010 2014 GRADUATED

NONE
TRADE
CAMARINES SUR POLYTECHNIC BTTE MAJOR IN FOOD SERVICE
COURSE
COLLEGE 2014 2018 GRADUATED
COLLEGES MANAGEMENT

GRADUATE STUDIES NONE


(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMB


CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

ZONE 3
Street
LOURDES YOUNG
Barangay
CAMARINES SUR
Province
4434
ZONE 3
Street
LOURDES YOUNG
Barangay
CAMARINES SUR
Province

NONE

09381996361

christine_lumabe@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)


(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2010 N/A

2014 N/A

2018 N/A

parate sheet if necessary)

SEPTEMBER 11, 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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

SEPTEMBER 30,
LICENSURE EXAMINATION FOR TEACHERS 78.6 2018
LEGAZPI CITY 1687150

(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
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

OCTOBER 1, JULY 31,


2018 2019
VOLUNTEER TEACHER DEPARTMENT OF EDUCATION N/A N/A VOLUNTEER
(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 11, 2019


CS FORM 212 (Revised 20
LICENSE (if applicable)

Date of
Validity

9/17/2021

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y
arate sheet if necessary)

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 /
From To

SAN JOSE INTEGRATED SCHOOL - SAN JOSE, NABUA, CAMARINES SUR OCT. 1, 2018 JULY 31, 2019 VOLUNT

(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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
WORL
ENGLISH SKILLS AND EMPLOYABILITY SKILLS TRAINING PROGRAM 4/9/2017 6/9/2017

NATIONAL CERTIFICATE IN BREAD AND PASTRY PRODUCTION TECHNIC


(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

BAKING N/A

COMPUTER LITERATE

SINGING

(Continue on separate sheet if necessary)

SIGNATURE DATE S
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

VOLUNTEER TEACHER

eparate sheet if necessary)


ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

WORLD WIDE LINK EDUCATIONAL


DEVELOPMENT INC.

TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY


eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

eparate sheet if necessary)

SEPTEMBER 11, 2019


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? ________________________________
VOLUNTEER: OCT. 1, 2018 -JULY 31, 2019
________________________________
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
LOURDES YOUNG, NABUA, the last 6 months
HON. EDISON REDONDO CAMARINES SUR
9295196518 3.5 cm. X 4.5 cm
(passport size)
STA. ELENA BARAS, NABUA, CAM
MARICEL T. ABALA SUR
9306538281 With full and handwritten
name tag and signature over
printed name
MARY JEAN P. UVERO SAN JOSE, NABUA, CAMARINES SUR 9482810412
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: PRC ID

ID/License/Passport No.: 1687150


Signature (Sign inside the box)
SEPTEMBER 11, 2019
Date/Place of Issuance: 12/21/2018 - NAGA CITY
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 o


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

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