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 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

I. PERSONAL INFORMATION

2. SURNAME GABAY

FIRST NAME HAYNIE NAME EXTENSION (JR., SR)

MIDDLE NAME AMATUNDING

3. DATE OF BIRTH FILIPINO
5/17/1997 16. CITIZENSHIP
(mm/dd/yyyy)

4. PLACE OF BIRTH MALABANG, LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE

6 CIVIL STATUS SINGLE 17. RESIDENTIAL ADDRES

House/Block/Lot No. Street
CORAHAB
Subdivision/Village Barangay
7. HEIGHT (m) 5'0 MALABANG LANAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 55kg ZIP CODE 9300

9. BLOOD TYPE TYPE O 18. PERMANENT ADDRES

House/Block/Lot No. Street
10. GSIS ID NO. N/A CORAHAB
Subdivision/Village Barangay
MALABANG LANAO DEL SUR
11. PAG-IBIG ID NO. 121186222963
City/Municipality Province
12. PHILHEALTH NO. 070510645128 ZIP CODE

13. SSS NO. 0241082845 19. TELEPHONE NO. N/A

14. TIN NO. 332544631000 20. MOBILE NO. 09631309061

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if [email protected]

II. FAMILY BACKGROUND

DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
FIRST NAME N/A NAME EXTENSION (JR., N/A N/A
SR)
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAMN/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24.FATHER'S SURNAME GABAY

FIRST NAME TANTAWIE NAME EXTENSION (JR.,

SR)
MIDDLE NAME MALATUS

25. MOTHER'S MAIDEN NAME

SURNAME AMATUNDING

FIRST NAME OMAIMA

MIDDLE NAME AMPUAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND HIGHEST
PERIOD OF LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR
ATTENDANCE UNITS
LEVEL GRADUA
EARNED
(Write in full) (Write in full) TED
From To (if not
JOSE ABAD SANTOS CENTRAL graduated)
ELEMENTARY ELEMENTARY N/A 2009
ELEMENTARY SCHOOL
VOCATIONAL /
SECONDARY OUR LADY OF PEACE HIGH SCHOOL SECONDARY N/A 2013

J.I SKILLS TRAINING AND ASSESSMENT

DRESSMAKING NCII N/A 2018
CENTER INC.
PHILIPPINE MUSLIM TEACHERS' BACHELOR OF ELEMENTARY
COLLEGE N/A 2016
COLLEGE EDUCATION
TRADE COURSE
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE May 26, 2022
CS FORM 212 (Revised 2017), Page
AL DATA SHEET
Experience Sheet shall cause the filing of administrative/criminal case/s against the person

S) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

FILIPINO

Pls. indicate country:

Street
CORAHAB
Barangay
LANAO DEL SUR
Province
9300

Street
CORAHAB
Barangay
LANAO DEL SUR
Province

N/A

09631309061

[email protected]

DATE OF BIRTH
(mm/dd/yyyy)
N/A

(Continue on separate sheet if necessary)

SCHOLARSH
IP/
ACADEMIC
HONORS
RECEIVED
N/A
 N/A

N/A

N/A

on separate sheet if necessary)

May 26, 2022
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
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHERS(LET) 86.00% 3/27/2022 CAGAYAN DE ORO CITY 1916148

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
SALARY/
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.JOB/ PAY
28. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / GRADE (if
(mm/dd/yyyy) COMPANY MONTHLY applicable)& STATUS OF
(Write in full/Do not SALARY STEP APPOINTMENT
From To (Write in full/Do not abbreviate)
abbreviate) (Format "00-
0")/
8/25/2021 9/3/2021 Field Interviewer Social Weather Stations (SWS) 8,500 N/A
INCREMENT N/A

10/11/2020 12/31/2020 Contact Tracer istry of Interior and Local Government (MILG) 18,000 N/A N/A

6/8/2019 3/26/2020 Substitute Teacher Calimodan Village Central Elementary School 3,000 N/A N/A

6/28/2018 PRESENT Barangay Treasurer Barangay Local Government Unit (BLGU) 3,000 N/A N/A
 (Continue on separate sheet if necessary)

SIGNATURE DATE MAY 26, 2022

CS FORM 212 (Revised 2017), Page 2
 LICENSE (if applicable)

Date of
Validity

5/17/2025

n separate sheet if necessary)

GOV'T
SERVICE

N/A
(Y/ N)
N/A

N/A

N/A
e on separate 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 / NATURE OF WORK
From To

Bangsamoro Autonomous Region in Muslim Mindanao (Project Tabang) N/A ENUMERATOR

Bangsamoro Development Agency (BDA) N/A ENUMERATOR

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

The Sacrifice of Bangsamoro for the Realization of Freedom  1/31/2014 1/31/2014 N/A N/A

On Becoming a Global Teacher  4/19/2014 4/19/2014 N/A

Empowering 21st Century Teachers for Global Competitiveness  5/8/2015 5/8/2015 N/A

Dressmaking NCII Basic, Common and Core Competences  11/27/2018 12/17/2018 N/A

Social Mobilization Component of the Polio Outbreak Rapid Response  10/21/2019 10/31/2019 N/A

Training on the Barangay Financial Management (BFM) 2/20/2020 2/21/2020 N/A

Training in Business Transformation via Zoom 7/5/2021 7/5/2021 N/A

Orientation to Entrepreneurship Level-1 under MOVERS PROGRAMME via Zoom 10/15/2021 10/15/2021 N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/OR
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
full)

Time Management N/A N/A

Interpersonal Skills

Effective Classroom Management

Microsoft Word

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 26, 2022

NMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

ENUMERATOR

ENUMERATOR

(Continue on separate sheet if necessary)

NING PROGRAMS ATTENDED
r the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

N/A

(Continue on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in
full)

N/A
(Continue on separate sheet if necessary)

MAY 26, 2022

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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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
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,
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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
3.5 cm. X 4.5 cm
N/A N/A N/A (passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
42. 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: POSTAL ID
ID/License/Passport No.: L96210559834 Signature (Sign inside the box)
MAY 26, 2022
Date/Place of Issuance: 11/16/2024 ILIGAN CITY Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated abov

Person Administering Oath

CS FORM 212 (Revised 2

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details (country):

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark
, affiant exhibiting his/her validly issued government ID as indicated above.

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