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. (D

I. PERSONAL INFORMATION
2. SURNAME CABOCAN

FIRST NAME JUPE N/A

MIDDLE NAME JUMAWAN

3. DATE OF BIRTH
(mm/dd/yyyy) 08/05/1987 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth ✘ b

4. PLACE OF BIRTH TAGUM,DAVAO DEL NORTE If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK 1

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
Other/s: I
Subdivision/Village B
LAAK COMPOSTELLA
7. HEIGHT (m) 1.56 M
City/Municipality P
8. WEIGHT (kg) 60KGS ZIP CODE 8810
18. PERMANENT ADDRESS PUROK 1
9. BLOOD TYPE "O"
House/Block/Lot No.
I
10. GSIS ID NO. 0203851203811310
Subdivision/Village B
LAAK COMPOSTELLA
11. PAG-IBIG ID NO. N/A
City/Municipality P

12. PHILHEALTH NO. 16-0000796082 ZIP CODE 8810

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 436-685-643 20. MOBILE NO. 09156867258/ 09489661717

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
7413740 21. E-MAIL ADDRESS (if any) jupe_jumawan@yahoo.com
CABOCAN 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
ANTHONY

MIDDLE NAME IQUIN JIA ANTHONETTE JUMAWAN CABOCAN

OCCUPATION SOLDIER

EMPLOYER/BUSINESS NAME PHILIPPINE ARMY

BUSINESS ADDRESS NOLI, BAYUGAN CITY PHILIPPINES

TELEPHONE NO. N/A

24. FATHER'S SURNAME JUMAWAN

NAME EXTENSION (JR., SR)
FIRST NAME PEDRO
 MIDDLE NAME LINA

25. MOTHER'S MAIDEN NAME

SURNAME BIÑALES

FIRST NAME JUDYFLOR

MIDDLE NAME ESCANDALLO (Continue on separate sheet if necessar

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

SANTA MARIA SEVENTH DAY ADVENTIST

ELEMENTARY
ELEMENTARY SCHOOL
PRIMARY EDUCATION 1995 2000 GRADUATED

SECONDARY /
VOCATIONAL NORTHERN DAVAO ACADEMY HIGHSCHOOL 2000 2004 GRADUATED

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

TRADE
AGUSAN DEL SUR STATE COLLEGE OF BACHELOR OF ELEMENTARY EDUCATION -
COURSE
COLLEGE
AGRICULTURE AND TECHNOLOGY GENERAL
2005 2009 GRADUATED

GRADUATE STUDIES N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUS

CS FOR
L DATA SHEET
ience 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)

Dual Citizenship
✘ by naturalization

Pls. indicate country:

Street
ILPAPA
Barangay
COMPOSTELLA, VALLEY PROVINCE
Province

Street
ILPAPA
Barangay
COMPOSTELLA, VALLEY PROVINCE
Province

N/A

09156867258/ 09489661717

jupe_jumawan@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

03/10/1988

07/20/2017

07/18/1959
 09/26/1954

(Continue on separate sheet if necessary)

YEAR SCHOLARSHIP/
GRADUATED ACADEMIC
HONORS RECEIVED

WITH
2000
HONORS
GOVERNOR'
2004
S SCHOLAR

N/A N/A

2009 N/A

N/A N/A
parate sheet if necessary)

AUGUST 13,2019
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

TEODORO PALMA GIL ELEMENTARY

LICENSURE EXAMINATION FOR TEACHERS 78% 4/18/2010
SCHOOL,DAVAO CITY

(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
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

01/01/2019 PRESENT TEACHER I IL PAPA ELEMENTARY SCHOOL 21047.00 11-2

07/21/2018 12/31/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

07/20/2018 07/20/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

02/27/2018 07/19/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

02/26/2018 02/26/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

01/26/2018 02/25/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

01/25/2018 01/25/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

01/24/2018 01/24/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

01/23/2018 TEACHER I IL PAPA ELEMENTARY SCHOOL 20437.00 11-2

1/1/2018
11/16/2017 12/31/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

11/14/2017 11/15/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

09/30/2017 11/13/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

09/28/17 0929/17 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

19/16/2017 09/27/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

09/09/2017 09/15/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

09/08/2017 09/08/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

07/10/2017 09/07/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

06/17/2017 07/09/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

06/16/2017 06/16/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

03/03/2017 06/15/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

03/01/2017 03/02/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

02/01/2017 02/28/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

01/31/2017 01/31/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

01/01/2017 01/30/2017 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

05/15/2016 10/25/2016 TEACHER I IL PAPA ELEMENTARY SCHOOL 19853.00 11-2

01/01/2016 05/14/2016 TEACHER I IL PAPA ELEMENTARY SCHOOL 19077.00 11-1

05/15/2013 12/31/2015 TEACHER I IL PAPA ELEMENTARY SCHOOL 18549.00 11-1

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 13,2019

CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

1064449 8/5/2020

ue on separate sheet if necessary)

n of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES
 PERMANENT YES

PERMANENT YES

PERMANENT YES

PERMANENT YES

ue on separate sheet if necessary)

AUGUST 13,2019

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

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

DISTRICT SPORTS CLINIC 10/06/2018 10/08/2018 24 TECHNICAL DEP

THREE-DAY DISTRICT ROLL-OUT SEMINAR-WORKSHOP ON RPMS,PPST,COT AND

08/23/2018 08/25/2018 24 CURRICULAR DEP
SAT

MID-YEAR PERFORMANCES REVIEW AND EVALUATION(MPRE) 10/23/2017 10/24/2017 16 TECHNICAL DEP

SPORTS CLINIC FOR TECHNICAL OFFICIALS AND COACHES 10/06/2017 10/08/2017 24 TECHNICAL DEP

ONE HOPE PHILIPPINES LAUNCHING 09/04/2017 09/04/2017 8 TECHNICAL DEP

MID-YEAR PERFORMANCE REVIEW AND EVALUATION(MPRE) 10/24/2016 10/28/2016 40 SUPERVISORY DEP

THREE DAY SCIENCE CURRICULUM ENHANCEMENT SEMINAR-WORKSHOP FOR

09/30/2016 10/02/2016 24 TECHNICAL DEP
GRADE 3-11 TEACHERS TEACHING SCIENCE
DISTRICT TRAINING OF TEACHER'S IN MUSIC WITH KODALY METHOD AND
11/29/2015 11/19/2015 8 TECHNICAL DEP
MUSIC SOFTWARE APPLICTION

MID-YEAR PERFORMANCE REVIEW AND EVALUATION 10/26/2015 10/30/2015 40 TECHNICAL DEP

TWO-DAY TRAINING WORKSHOP FOR ALL SCHOOL MATH COORDINATORS AND

09/24/2015 09/25/2015 16 TECHNICAL DEP
TEACHERS IN LAAK NORTH DISTRICT ABOUT THE RUBRICS CUBE GAMES
DISTRICT TRAINING ON PROCESS SKILLS TEST CONSTRUCTION WITH TABLE OF
08/17/2015 08/17/2015 8 TECHNICAL DEP
SPECIFICATIONS FOR SCIENCE ELEMENTARY
THREE DAY CLUSTER SCHOOL-BASED LIVE-IN TRAINING WORKSHOP ON
07/23/2015 07/25/2015 24 TECHNICAL DEP
INFORMATION AND COMPUTER
TWO-DAY 2015 DRRM TRAINING FOR SCHOOL DRRM FOCAL PERSON AND
03/16/2015 03/17/2015 16 TECHNICAL DEP
ADMINISTRATION IN DISASTER RISK REDUCTION MANAGEMENT
REGIONAL MASS TRAINING FOR GRADE 3 TEACHERS IN THE K TO 12
05/19/2014 05/23/2014 40 TECHNICAL DEP
ENHANCED BASIC EDUCATION CURRICULUM

SCI-DAMA REFRESHER COURSE 08/30/2013 08/30/2013 8 TECHNICAL DEP

TRAINING OF MOTHER-TONGUE BASED MULTILINGUAL EDUCATION 05/28/2012 05/30/2012 24 TECHNICAL DEP

DISTRICT ENHANCEMENT SEMINAR FOR ALL TEACHERS TEACHING SCIENCE 3-5 01/30/2012 01/30/2012 8 TECHNICAL DEP

KINDERGARTEN CURRICULUM 12/01/2011 12/02/2011 16 TECHNICAL DEP

THREE DAY LIVE IN SEMINAR WORKSHOP ON MAKING INSTRUCTIONAL

07/15/2011 07/17/2011 24 TECHNICAL DEP
MATERIALS AND LEARNING PLAN

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

SINGING N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION
 DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

DEPARTMENT OF EDUCATION

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

eparate sheet if necessary)

AUGUST 13,2019
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 ✘ 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
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
ILPAPA, LAAK, COMPOSTELLA the last 6 months
MELCHOR C. TISBE VALLEY
N/A 3.5 cm. X 4.5 cm
(passport size)
ILPAPA, LAAK, COMPOSTELLA
FLORDELIZA M. GUIBAO VALLEY
N/A With full and handwritten
name tag and signature over
printed name
ILPAPA, LAAK, COMPOSTELLA
JOSEFA C. VERANO VALLEY
N/A
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 COMISSION

ID/License/Passport No.: 1064449

Signature (Sign inside the box)
AUGUST 13,2019
Date/Place of Issuance: 12/10/2010/DAVAO 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