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 against the person
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 not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME SAYON
NAME EXTENSION (JR., SR)
FIRST NAME MARILYN

MIDDLE NAME MIRANDO

3. DATE OF BIRTH
10/14/1969 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH QUEZON CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS 713 DOÑA AURORA STREET

6 CIVIL STATUS
House/Block/Lot No. Street
Widowed Separated
SAN JUAN
Other/s: Subdivision/Village Barangay
IRIGA CITY CAMARINES SUR
7. HEIGHT (m) 1.79 m.
City/Municipality Province
8. WEIGHT (kg) 56kg ZIP CODE

18. PERMANENT ADDRESS 713 DOÑA AURORA STREET

9. BLOOD TYPE "A"
House/Block/Lot No. Street
SAN JUAN
10. GSIS ID NO. 200259869
Subdivision/Village Barangay
IRIGA CITY CAMARINES SUR
11. PAG-IBIG ID NO. 7630057880
City/Municipality Province

12. PHILHEALTH NO. 19=00369572-0 ZIP CODE 4431

13. SSS NO. n/a 19. TELEPHONE NO. 299-35-75

14. TIN NO. 175-977-439 20. MOBILE NO. 09471525076

15. AGENCY EMPLOYEE NO. 4515472 21. E-MAIL ADDRESS (if any) marilyn.sayon@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SAYON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JOANA MARIE M. SAYON
FIRST NAME DARIO 5/31/1999

MIDDLE NAME FAT MARK DARYL M. SAYON 11/12/1995

OCCUPATION DRIVER

EMPLOYER/BUSINESS NAME UV EXPRESS FILCAB

BUSINESS ADDRESS SAN JUAN. IRIGA CITY

TELEPHONE NO. 299-35-75

24. FATHER'S SURNAME MIRANDO

NAME EXTENSION (JR., SR)
FIRST NAME MAURO

MIDDLE NAME BERME0

25. MOTHER'S MAIDEN NAME BAGACINA

SURNAME SERRANO

FIRST NAME LETICIA

MIDDLE NAME BAGACINA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND HIGHEST

LEVEL/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE
BASIC EDUCATION/DEGREE/COURSE UNITS SCHOLARSHIP/ ACADEMIC HONORS
LEVEL (Write in EARNED RECEIVED
(Write in full)
full)
From To (if not
graduated)
ELEMENTARY SAN JUAN ELEMENTARY SCHOOL, IRIGA CITY PRIMARY EDUCATION 1977 1982 1982

UNIVERSITY OF NORTHESERN PHILIPPINES, IRIGA

SECONDARY /
VOCATIONAL CITY
HIGHSCHOOL 1982 1986 1986

COLUMBIAN SECRETARIAL SCHOOL, IRIGA CITY VOCATIONAL 1986 1987 1987

TRADE
UNIVERSITY OF NORTHESERN PHILIPPINES, IRIGA BACHELOR OF SCIENCE IN ELEMENTARY
COURSE
COLLEGE CITY EDUCATION
1987 1991 1991

UNIVERSITY OF NORTHESERN PHILIPPINES, IRIGA

GRADUATE STUDIES CITY
MASTER OF ARTS IN EDUCATION 2001 36 units
(Continue on separate sheet if necessary)

SIGNATURE DATE
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

PBET 71.4 5/30/1993 NAGA CITY 0189469 10/22/1997

(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. 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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/
N)
9/28/2009 to present Teacher III Department of Education 23360.00 `13-3 Permanent Yes

9/28/2009 7/1/2001 Teacher II Department of Education 185064.00 12-2 Permanent Yes

7/3/1995 1/2/2007 Teacher I Department of Education 116436.00 11-4 Permanent Yes

6/23/1994 11/1/1994 Teacher I Department of Education 46824.00 11-0 R (S) Yes

10/3/1994 8/21/1994 Teacher I Department of Education 46824.00 11-0 R (S) Yes

7/6/1992 8/29/1992 Teacher I Department of Education 37224.00 11-0 P (S) Yes

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

(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
Sch. Based In-Service Training on the Appropriate Practices in
Preparation for
Instructional Materials 10/26/17 10/27/17 16 hrs Technical San Juan

3-Day Sch Based Echo Seminar on ICT Lieracy Workshop 3/18,25/17 2/28/17 24 hrs Technical San Juan

Mid-Yr £ Day Sch. Based In Service Training of Teachers #

in Developing the 21st Century Skills, Teaching Strategies

Enhancement Technique
Based on RPMS Principles 10/27/16 10/29/16 24 hrs Technical San Juan

Div. Sem Break Enhancement Seminar Workshop 10/24/16 10/27/16 16 hrs Technical SDO, Iriga

Iriga City Division Website Develpoment 10/30/15 10/31/15 16 hrs Tecnnical SDO, Iriga

Training of Gr IV Teachers on K-12 Education Program 10/5/2015 5/14/15 40 hrs Technical SDO, Iriga
Ikaanim na Pambansang Kongreso ng Wikang Pilipino sa
4/29/15 2/5/2015 40 hrs Technical
Paaralang Pribado At Pampubliko
Pambansang Seminar Workshop sa Filipino Antas Elementarya 12/2/2015 2/15/15 40 hrs Technical ng Wikang
Seminar Workshop on Stress
Free Management Towards Safe 1/15/15 1/17/15 30 hrs Technical
and Abuse Free Community
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

ENCODING(ICT)

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

San Juan Elem. School

San Juan Elem. School

San Juan Elem. School

SDO, Iriga City

SDO, Iriga City

SDO, Iriga City

Pambansang Kongreso
ng Wikang Pilipino

SDO, Iriga City

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

ICDTEA

PPSTA

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:
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
LEONCIA B. NAGRAMPA SAN MIGUEL IRIGA CITY 3.5 cm. X 4.5 cm
(passport size)

MARICEL L. INTIA SAN NICOLAS IRIGA CITY With full and handwritten
name tag and signature over
printed name
PEDRO N. MORADA STO. DOMINGO, IRIGA CITY
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 NO. 1809469

ID/License/Passport No.:
Signature (Sign inside the box)
5/2/17
Date/Place of Issuance: 10/27/97
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 of 4