Maam Lubiano

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.
I. PERSONAL INFORMATION
2. SURNAME LUBIANO
NAME EXTENSION (JR., SR
FIRST NAME MARIA LINDA
MIDDLE NAME TIZON

3. DATE OF BIRTH
(mm/dd/yyyy) 12/26/1963 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth ✘ by
4. PLACE OF BIRTH BUTUAN CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female
Single ✘ Married 17. RESIDENTIAL ADDRESS MAGSAYSAY 17-2

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
Other/s:
Subdivision/Village B
MATI CITY DAVA
7. HEIGHT (m) 5'1
City/Municipality P
8. WEIGHT (kg) 63 ZIP CODE
18. PERMANENT ADDRESS MAGSAYSAY 17-2

9. BLOOD TYPE "O"
House/Block/Lot No.
10. GSIS ID NO. 006-0107-1605-8

Subdivision/Village B
MATI CITY
11. PAG-IBIG ID NO. 1101-043805-11
City/Municipality P
12. PHILHEALTH NO. 111-0726-9 ZIP CODE 8200
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 042-564-790 20. MOBILE NO. 09108988297
15. AGENCY EMPLOYEE NO. 5318080 21. E-MAIL ADDRESS (if any) MARIALINDA.LUBIANO@DEPED
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME LUBIANO 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) N/A RELAINE T. LUBIANO
FIRST NAME RICARDO
MIDDLE NAME LEMOSNERO RICHELLE T. LUBIANO LINGO
OCCUPATION RADIO TELEPHONE OPERATOR DGYRRAH ANN T. LUBIANO
EMPLOYER/BUSINESS NAME PROVINCIAL DISASTER RISK REDUCTION OFFICE DEBORRAH ANN T. LUBIANO
BUSINESS ADDRESS CAPITOL HILLS,MATI CITY MAYENNE CHRISTI T. LUBIANO
TELEPHONE NO. 3883-911 GERICO KING T. LUBIANO
24. FATHER'S SURNAME TIZON

NAME EXTENSION (JR., SR) N/A
FIRST NAME ROGELIO
MIDDLE NAME ROMERO
25. MOTHER'S MAIDEN NAME
SURNAME GADOT
FIRST NAME ANTIPAZ
MIDDLE NAME NACAYTONA (Continue on separate sheet if necessa
III. EDUCATIONAL BACKGROUND
26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in N/A
(Write in full)
full)
From To
ELEMENTARY M.I.T ANNEX E.S PRIMARY EDUCATION 6/30/1970 3/30/1974 N/A
SECONDARY /
VOCATIONAL DAVAO CITY NATIONAL HIGH SCHOOL SECONDARY EDUCATION 6/30/1975 3/30/1978 N/A
N/A N/A N/A N/A N/A
TRADE
COURSE
COLLEGE HOLY CROSS OF DAVAO COLLEGE BACHELOR OF SCIENCE IN EDUCATION 6/30/1979 3/30/1983 N/A
GRADUATE STUDIES RIZAL MEMORIAL COLLEGE MASTER OF ARTS IN EDUCATION 6/30/1998 3/30/2017 22 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE
L DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person
FORE 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
Barangay
DAVAO ORIENTAL
Province
Street
Barangay
DAVAO ORIENTAL
Province
N/A
09108988297
MARIALINDA.LUBIANO@DEPED.GOV.PH
DATE OF BIRTH (mm/dd/yyyy)
2/22/1984
10/17/1987
10/22/1991
10/22/1991
10/23/1998
1/25/2001
YEAR SCHOLARSHIP/
GRADUATED ACADEMIC HONORS
RECEIVED
1975 N/A
1979 N/A
N/A N/A
1983 N/A
2017 N/A
parate sheet if necessary)

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
PBET 74.0 11/28/1988 MATI DAVAO ORIENTAL 0453732

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
DEPARTMENT OF EDUCATION, MATIAO

1/1/2020 to Present HEAD TEACHER-I 29277.00 14-1 PERM
NATIONAL HIGH SCHOOL
1/1/2019 12/31/2019 HEAD TEACHER-I 29277.00 14-1 PERM
12/19/2018 12/31/2018 HEAD TEACHER-I 26494.00 14-1 PERM
1/1/2018 12/18/2018 SST-II 24043.00 PERM
1/1/2017 12/31/2017 SST-II 23120.00 PERM
1/1/2016 12/31/2016 SST-II 22232.00 PERM
1/1/2015 12/31/2015 SST-II 21379.00 PERM
1/1/2014 12/31/2014 SST-II 21379.00 PERM
2/1/2013 12/31/2013 SST-II 21379.00 11-8 PERM
1/1/2013 1/31/2013 SST-II 21167.00 PERM
6/1/2012 12/31/2012 SST-II 21167.00 PERM
1/1/2012 5/30/2012 SST-II 21167.00 PERM
6/1/2011 12/31/2011 SST-II 19793.00 PERM
1/1/2011 5/31/2011 SST-II 19793.00 PERM
6/24/2010 12/31/2010 SST-II 18418.83 PERM
2/1/2010 6/23/2010 SST-II 18418.83 11-7 PERM
1/1/2010 1/31/2010 SST-II 17044.00 PERM
7/1/2009 12/31/2009 SST-II 16706.00 PERM
1/1/2009 6/30/2009 SST-II 14423.00 PERM
7/1/2008 12/31/2008 SST-II 14423.00 PERM
1/1/2008 6/30/2008 SST-II 13112.00 PERM
7/1/2007 12/31/2007 SST-II 13112.00 PERM
2/1/2007 12/31/2007 SST-II 11920.00 PERM
1/1/2007 1/31/2007 SST-I 11527.00 PERM
11/27/2006 12/31/2006 SST-I 11527.00 10-7 PERM
1/1/2006 11/26/2006 SST-I 11246.00 PERM
1/1/2005 12/31/2005 SST-I 11246.00 PERM
1/1/2004 12/31/2004 SST-I 11246.00 PERM
11/27/2003 12/31/2003 SST-I 11246.00 10-6 PERM
SIGNATURE DATE
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
12/26/2020
arate sheet if necessary)
GOV'T
SERVICE
(Y/
N)
Y
Y
Y
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
CFC- HANDMAIDS OF THE LORD 12/3/1995 1/21/2020 4 HRS./WEEK CHAPT

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
DIVISION SEMINAR ON PERSONAL FINANCIAL MANAGEMENT FOR TEACHERS 11/6/2019 11/6/2019 8.0 TECHNICAL DEP
TRAINING WORKSHOP ON CONTINOUS IMPROVEMENT PROGRAM 10/24/2016 10/26/2016 16.0 TECHNICAL DEP
CONTENT BASED TRAINING FOR GRADES 9 AND 10 TEACHERS 10/28/2015 10/29/2015 8.0 TECHNICAL DEP
BASIC COMPUTER OPERATION AND CONCEPT TRAINING 8/23/2014 8/30/2014 42.0 TECHNICAL DEP
VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
COOKING, DANCING N/A CFC- H
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
POSITION / NATURE OF WORK
CHAPTER LEADER
eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)
CONDUCTED/ SPONSORED BY
(Write in full)
DEPARTMENT OF EDUCATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
CFC- HANDMAIDS OF THE LORD

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
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
________________________________
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?
________________________________
________________________________
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)?
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
EMELIA BARRERA INTERCO MATIAO MATI CITY 3883-870 3.5 cm. X 4.5 cm
(passport size)
LOLITA R. YARA NHA, DAHICAN MATI CITY 3883-140 With full and handwritten
name tag and signature over
printed name
ALVIELOU M. VILLANUEVA MARTINEZ, DAHICAN MATI 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
PROFESSIONAL REGULATION
Government Issued ID:
COMMISSION
ID/License/Passport No.: 0453732

Signature (Sign inside the box)
Date/Place of Issuance: 10/07/1998 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.

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CS Form No.

PERSONAL DATA SHEET

MIDDLE NAME TIZON

Single ✘ Married 17. RESIDENTIAL ADDRESS MAGSAYSAY 17-2

18. PERMANENT ADDRESS MAGSAYSAY 17-2

10. GSIS ID NO. 006-0107-1605-8

12. PHILHEALTH NO. 111-0726-9 ZIP CODE 8200

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

14. TIN NO. 042-564-790 20. MOBILE NO. 09108988297

MIDDLE NAME LEMOSNERO RICHELLE T. LUBIANO LINGO

OCCUPATION RADIO TELEPHONE OPERATOR DGYRRAH ANN T. LUBIANO

BUSINESS ADDRESS CAPITOL HILLS,MATI CITY MAYENNE CHRISTI T. LUBIANO

TELEPHONE NO. 3883-911 GERICO KING T. LUBIANO

24. FATHER'S SURNAME TIZON

25. MOTHER'S MAIDEN NAME

FIRST NAME ANTIPAZ

MIDDLE NAME NACAYTONA (Continue on separate sheet if necessa

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

ELEMENTARY M.I.T ANNEX E.S PRIMARY EDUCATION 6/30/1970 3/30/1974 N/A

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

(Continue on separate sheet if necessary)

FORE ACCOMPLISHING THE PDS FORM.

NAME EXTENSION (JR., SR) N/A

Pls. indicate country:

DATE OF BIRTH (mm/dd/yyyy)

parate sheet if necessary)

PBET 74.0 11/28/1988 MATI DAVAO ORIENTAL 0453732

(Continue on separate sheet if necessary)

DEPARTMENT OF EDUCATION, MATIAO

arate sheet if necessary)

CS FORM 212 (Revised 2017), Page 2 of 4

CFC- HANDMAIDS OF THE LORD 12/3/1995 1/21/2020 4 HRS./WEEK CHAPT

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

COOKING, DANCING N/A CFC- H

(Continue on separate sheet if necessary)

POSITION / NATURE OF WORK

eparate sheet if necessary)

CFC- HANDMAIDS OF THE LORD

eparate sheet if necessary)

CS FORM 212 (Revised 2017), Page 3 of 4

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID/License/Passport No.: 0453732

Date/Place of Issuance: 10/07/1998 DAVAO CITY

Person Administering Oath

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

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