CS Form No.

212
Revised 2017 Unique Appli
PERSONAL DATA SHEET T1528

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 LAMYONGAN
NAME EXTENSION (JR., SR
FIRST NAME MACRINA

MIDDLE NAME PANAS

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 3/15/1997 ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH Bolagabog, Ballay, Kabayan, Benguet If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
B
Other/s:
Subdivision/Village Ba
Kabayan Be
7. HEIGHT (m) 4'14
City/Municipality Pr
8. WEIGHT (kg) 45 ZIP CODE 2606

18. PERMANENT ADDRESS

9. BLOOD TYPE "o"
House/Block/Lot No. S
B
10. GSIS ID NO. None
Subdivision/Village Ba
Kabayan
11. PAG-IBIG ID NO. None
City/Municipality Pr

12. PHILHEALTH NO. 04-22-4253796-8 ZIP CODE 2606

13. SSS NO. None 19. TELEPHONE NO. None

14. TIN NO. None 20. MOBILE NO. 09469403563

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
None 21. E-MAIL ADDRESS (if any) lamyonganmacrina@gmail.com
Lamyongan 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
Marfo Desirie Lamyongan

MIDDLE NAME Dampilag

OCCUPATION Farming

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME Panas

NAME EXTENSION (JR., SR)
FIRST NAME Sario
 MIDDLE NAME Sagamla

25. MOTHER'S MAIDEN NAME

SURNAME Cawa-ing

FIRST NAME Delina

MIDDLE NAME Lacaden (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 Ballay Elementary School Primary School 6/5/2005 4/5/2009 Graduated

SECONDARY /
VOCATIONAL Kamora National High School High School 6/7/2009 4/10/2013 Graduated

None None None None None

TRADE
COURSE
COLLEGE Benguet State University-Buguias Campus Bachelor of Elementary Education 6/4/2013 7/9/2017 Graduated

GRADUATE STUDIES None None None None None

(Continue on separate sheet if necessary)

SIGNATURE DATE
MACRINA P. LAMYONGAN
CS FORM
 Unique Applicant Number
L DATA SHEET T15281558

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:

Street
Ballay
Barangay
Benguet
Province
2606

Street
Ballay
Barangay
Benguet
Province

None

09469403563

lamyonganmacrina@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

11/6/2015
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2009 None

2013 None

None None

ESGP-PA
2017
grant

None None
parate 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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

Licensure Examination for teachers 77.2 27/09/2017 Baguio city 1560743

(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

2/1/2018 4/5/2018 Teacher Ballay Elementary School 3000.00 MSB

 (Continue on separate sheet if necessary)

SIGNATURE DATE
MACRINA P. LAMYONGAN
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

3/15/2020

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Yes
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

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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
District training of teachers on ENABLING WRITERS' TRAINING WORKSHOP ON
5/25/2018 5/27/2018 24.0 DepEd
DEVELOPING SMALL BOOK IN KALANGUYA using Bloom software
Devision Training of teachers on basic concepts and fundamentals in teaching dances
5/28/2017 5/31/2017 24.0
and performance standards, elementary and secondary, Buguias Benguet DepEd
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Playing volleyball,badminton & table tennis None

(Continue on separate sheet if necessary)

SIGNATURE DATE
MACRINA P. LAMYONGAN
/ 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)

DepEd
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

None

eparate sheet if necessary)

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: Kalanguya
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
Mrs. Bertha Antonio Ballay,Kabayan,Benguet 9 3.5 cm. X 4.5 cm
(passport size)

Mr. Felino Bugnay Ballay Kabayan Benguet With full and handwritten
name tag and signature over
printed name

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
MACRINA P. LAMYONGAN
ID/License/Passport No.: 1560743
Signature (Sign inside the box)

Date/Place of Issuance: 12/08/2017/ Baguio 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