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. (Do

I. PERSONAL INFORMATION
2. SURNAME CAHANAP
NAME EXTENSION (JR., SR
FIRST NAME ARLYN
MIDDLE NAME GUMAHAD
3. DATE OF BIRTH
(mm/dd/yyyy) 8/29/1989 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH BALIANGAO, MISAMIS OCCIDENTAL 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
PUROK 4 PUNTA
Other/s:
Subdivision/Village Ba
BALIANGAO MISAMIS
7. HEIGHT (m) 160 METERS
City/Municipality Pr
8. WEIGHT (kg) 52 KILOS ZIP CODE 7211

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. S
PUROK 4 PUNTA
10. GSIS ID NO. 2005133145
Subdivision/Village Ba
BALIANGAO
11. PAG-IBIG ID NO. 121152599345
City/Municipality Pr

12. PHILHEALTH NO. 030508520499 ZIP CODE 7211

13. SSS NO. 06-3104681-5 19. TELEPHONE NO. N/A

14. TIN NO. 322-932-960-0000 20. MOBILE NO. 09556714170

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) arlyncahanap@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N/A CLENT C. MABIDA
MIDDLE NAME N/A PRINCESS CRYSTAL C. COMA
OCCUPATION N/A BELLA CHRYZTYL C. COMA
EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME CAHANAP

NAME EXTENSION (JR., SR) JR
FIRST NAME
HERMOGENES
MIDDLE NAME PAGLINAWAN

25. MOTHER'S MAIDEN NAME

SURNAME GUMAHAD

FIRST NAME APOLONIA

MIDDLE NAME NANO (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 Timoteo T. Su Elementary School N/A N/A N/A GRADUATED

SECONDARY /
Roque L. Su Sr. Memorial N/A N/A N/A GRADUATED
VOCATIONAL
National High School
N/A N/A N/A N/A N/A
TRADE
COURSE
COLLEGE Sacred Heart College Bachelor in Secondary Education N/A N/A GRADUATED

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

(Continue on separate sheet if necessary)

SIGNATURE DATE Novem

CS FORM
L DATA SHEET
rience 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) N/A

Dual Citizenship

by naturalization

Pls. indicate country:

Street
PUNTA SULONG
Barangay
MISAMIS OCCIDENTAL
Province
7211

Street
PUNTA SULONG
Barangay
MISAMIS OCCIDENTAL
Province

N/A

09556714170

arlyncahanap@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

9/19/2011

4/22/2016

2/25/2018

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

VALEDICTO-
2002 RIAN
 VALEDICTO
2006
-RIAN

N/A N/A

ACADEMIC
2013
SCHOLAR

N/A N/A
parate sheet if necessary)

November 9, 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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LET ( LICENSURE EXAMINATION FOR

75.0 9/27/2015 CAGAYAN DE ORO CITY 1435037
TEACHERS)

(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

Aquino Integrated School, Plaridel,

7/9/2018 PRESENT TEACHER 1 20129.00 G-11 PERMANENT
Misamis Occidental
Tabo-o Integrated School, Jimenez, NON
1/16/2017 3/3/2017 SUBSTITUTE TEACHER 20129.00 G-11
Misamis Occidental PERMANENT
MADISON SHOPPING PLAZA INCORPORATION,
9/2/2015 1/25/2016 SALES CLERK SM CITY, CAGAYAN DE ORO CITY
8000.00 0-0 SEASONAL
PANASONIC COMPANY, TAGBILARAN
12/2/2010 2/2/2011 PROMODISER 9000.00 0-0 SEASONAL
CITY BOHOL
GRAB A CRAB AN COFFEE CLUB 101
7/19/2010 11/22/2010 CASHIER 9000.00 0-0 SEASONAL
GENERAL SANTOS CITY
 (Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMVER 9, 2018

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

8/29/2019

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

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

2018 MID-YEAR PERFORMANCE RENEW AND IN SERVICE TRAINING 10/22/2018 10/26/2018 40.0 TECHNICAL DEPARMENT O

FOSTERING GENDER RESPONSIVE WORKPLACE THROUGH HEALTH AND

8/21/2018 8/22/2018 16.0 TECHNICAL DEPARMENT O
WELLNESS TRAINING
RESULT-BASED PERFORMANCE MANAGEMENT SYSTEM-PHILIPPINE
7/13/2018 7/14/2018 16.0 TECHNICAL DEPARMENT O
PROFESSIONAL STANDARDS FOR TEACHERS (RPMS-PPST)
MICROSOFT OFFICE APPLICATION (WORD, EXCEL,POWER POINT
1/9/2018 1/29/2018 20.0 TECHNICAL TESDA
PRESENTATION)

FOOD AN BEVERAGE SERVICES NCII 7/1/2009 9/30/2009 365.0 TECHNICAL

TESDA

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE FIRST RUNNER-UP "PAGSALABOK QUEEN 2009", DIPOLOG CITY

SINGING MISS ECO-TOURISM MUTYA NG BALIANGAO 2005

DANCING DANCE SPORT CHAMPION "MENAJAK FESTIVAL 2010",

READING CALAMBA, MISAMIS OCCIDENTAL

(Continue on separate sheet if necessary)

SIGNATURE DATE N
PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

arate sheet if necessary)

OGRAMS ATTENDED
ve (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARMENT OF EDUCATION

DEPARMENT OF EDUCATION

DEPARMENT OF EDUCATION

TESDA

TESDA

arate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

arate sheet if necessary)

NOVEMBER 9, 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? ________________________________
FINISHED CONTRACT
________________________________
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
AQUINO, INTEGRATED SCHOOL, the last 6 months
MRS. BERSEFLOR D. CURAMBAO PLARIDEL, MISAMIS OCCIDENTAL
0917-744-0471 3.5 cm. X 4.5 cm
(passport size)
AQUINO, INTEGRATED SCHOOL,
MRS. DELIA S. ACAIN PLARIDEL, MISAMIS OCCIDENTAL
0930-682-7890 With full and handwritten
name tag and signature over
printed name
MR. HENRY KEN REGALADO OROQUIETA CITY 0949-862-5566
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 LICENSE

ID/License/Passport No.: 1435037

Signature (Sign inside the box)
NOVEMBER 9, 2018
Date/Place of Issuance: 03/31/2016 CAGAYAN DE ORO 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