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 POSO
NAME EXTENSION (JR., SR ) N/A
FIRST NAME MARLITO

MIDDLE NAME BALDEVIZO

3. DATE OF BIRTH
(mm/dd/yyyy) 06/25/1983 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH LAOANG, NORTHERN SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS N/A Purok 1
Widowed Separated House/Block/Lot No. Street
N/A E.J. DULAY
Other/s:
Subdivision/Village Barangay
LAOANG NORTHERN SAMAR
7. HEIGHT (m) 1.68
City/Municipality Province
8. WEIGHT (kg) 70 ZIP CODE 6411

18. PERMANENT ADDRESS N/A Purok 1

9. BLOOD TYPE "O"
House/Block/Lot No. Street
N/A E.J. DULAY
10. GSIS ID NO. 2004121623
Subdivision/Village Barangay
LAOANG NORTHERN SAMAR
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 13-201691335-2 ZIP CODE 6411

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

14. TIN NO. 281-326-421-000 20. MOBILE NO. 09274002560

15. AGENCY EMPLOYEE NO. 4530014 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME POSO

NAME EXTENSION (JR., SR) SR.
FIRST NAME OLIMPIO

MIDDLE NAME BALUYOT

25. MOTHER'S MAIDEN NAME

SURNAME BALDEVIZO

FIRST NAME HERMINIGILDA

MIDDLE NAME MONJE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS / ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

WITH
ELEMENTARY LAOANG I CENTRAL ELEMENTARY SCHOOL ELEMENTARY 1991 1996 N/A 1996
HONORS
UNUVERSITY OF EASTERN PHILIPPINES LAOANG
SECONDARY
VOCATIONAL / CAMPUS
HIGHSCHOOL 1996 2000 N/A 2000 N/A

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

TRADE
CUM
COURSE
COLLEGE UNIVERSITY OF EASTERN PHILIPPINES LAOANG BACHELOR OF ELEMENTARY EDUCATION 2006 2010 N/A 2004
LAUDE

GRADUATE STUDIES ASIAN DEV'T FOUNDATION COLLEGE INC. MASTERS IN EDUCATION 2018 2020 36 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 03/15/2024

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ DATE OF LICENSE (if applicable)
RATING
CES/ CSEE BARANGAY ELIGIBILITY / EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
DRIVER'S LICENSE CONFERMENT
Validity

LICENSURE EXAMINATION FOR TEACHERS 81.20% 09/30/2005 MANILA 0892986 06/25/2006

(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
28. SALARY/ JOB/ PAY SERVICE
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2024 PRESENT TEACHER-I 27865.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2023 12/31/2023 TEACHER-I 27865.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2022 12/31/2022 TEACHER-I 26304.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2021 12/31/2021 TEACHER-I 24724.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2020 12/31/2020 TEACHER-I 23181.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2019 12/31/2019 TEACHER-I 21619.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
07/01/2018 12/31/2018 TEACHER-I 20963.00 11-4 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2018 6/30/2018 TEACHER-I 20179.00 11-1 Reg./Pem. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2017 12/31/2017 TEACHER-I 19620.00 11-1 Reg./Perm. Y
DEPARTMENT OF EDUCATION
E.J. DULAY NATIONAL HIGH SCHOOL -
01/01/2016 12/31/2016 TEACHER-I 19077.00 11-1 Reg./Pem. Y
DEPARTMENT OF EDUCATION
LAOANG NATIONAL HIGH SCHOOL -
06/01/2012 12/31/2015 TEACHER-I 18549.00 11-1 Reg./Perm. Y
DEPARTMENT OF EDUCATION
LAOANG NATIONAL HIGH SCHOOL -
06/01/2011 05/31/2012 TEACHER-I 17099.00 11-1 Reg./Pem. Y
DEPARTMENT OF EDUCATION
LAOANG NATIONAL HIGH SCHOOL -
06/24/2010 05/31/2011 TEACHER-I 15649.00 11-1 Reg./Perm. Y
DEPARTMENT OF EDUCATION
LAOANG NATIONAL HIGH SCHOOL -
07/01/2012 06/23/2010 TEACHER-I 12026.00 11-1 Reg./Pem. Y
DEPARTMENT OF EDUCATION
 (Continue on separate sheet if necessary)

SIGNATURE DATE 03/15/2024

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

N/A 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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
DISTRICT BASED TRAINING ON EARLY LANGUAGE LITERACY AND NUMERACY (ELLN) LAOANG V DISTRICT - DEPARTMENT OF
11/09/2022 11/11/2022 24 HOURS TECHNICAL
DIGITAL EDUCATION
CAPABILITY BUILDING WORKSHOP FOR SCHOOL HEADS, TEACHERS AND MOBILE LAOANG V DISTRICT - DEPARTMENT OF
06/20/2022 06/22/2022 24 HOURS TECHNICAL
TEACHERS ON GLOBAL CITIZENSHIP EDUCATION EDUCATION
DIVISION TRAINING-WORKSHOP ON THE ADMINISTRATION AND UTILIZATION OF THE LAOANG V DISTRICT - DEPARTMENT OF
03/22/2022 03/22/2022 8 HOURS TECHNICAL
COMPREHENSIVE RAPID LITERACY ASSESSMENT EDUCATION
DISTRICT TRAINING ON ENHANCING PEDAGOGICAL SKILLS IN TEACHING READING IN LAOANG V DISTRICT - DEPARTMENT OF
03/09/2022 03/11/2022 24 HOURS TECHNICAL
MOTHER TONGUE BASED MULTILINGUAL EDUCATION EDUCATION
LAOANG V DISTRICT - DEPARTMENT OF
PSYCHOLOGICAL FIRST AID FOR TEACHING AND NON TEACHING PERSONNEL 11/29/2021 11/29/2021 8 HOURS TECHNICAL
EDUCATION
LAOANG V DISTRICT - DEPARTMENT OF
DISTRICT ORIENTATION ON THE CONDUCT OF PHIL IRI AND NUMERACY ASSESSMENT 12/11/2021 12/11/2021 8 HOURS TECHNICAL
EDUCATION
DISTRICT WRITESHOP ON THE CONTEXTUALIZATION OF QUARTER 1,BUDGET OF LAOANG V DISTRICT - DEPARTMENT OF
09/01/2021 09/03/2021 24 HOURS TECHNICAL
LESSONS (BOL) AND LEARNING ACTIVITY SHEETS (LAS) EDUCATION
DISTRICT WRITESHOP ON THE CONTEXTUALIZATION OF QUARTER 4,BUDGET OF LAOANG V DISTRICT - DEPARTMENT OF
12/5/2021 05/14/2021 24 HOURS TECHNICAL
LESSONS (BOL) AND LEARNING ACTIVITY SHEETS (LAS) EDUCATION
DISTRICT WRITESHOP ON THE CONTEXTUALIZATION OF QUARTER 3,BUDGET OF LAOANG V DISTRICT - DEPARTMENT OF
03/17/2021 03/19/2021 24 HOURS TECHNICAL
LESSONS (BOL) AND LEARNING ACTIVITY SHEETS (LAS) EDUCATION
DISTRICT TRAINING WORKSHOP ON THE FINALIZATION OF RESULTS-BASED LAOANG V DISTRICT - DEPARTMENT OF
03/15/2021 03/15/2021 8 HOURS TECHNICAL
PERFORMANCE MANAGEMENT SYSTEM -SELF ASSESSMENT EDUCATION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

SPORTS ENTHUSIAST N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 03/15/2024

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? ________________________________
________________________________
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
CERBITO, JANETTE BALANQUIT LAOANG, NORTHERN SAMAR 9219928250 3.5 cm. X 4.5 cm
(passport size)

DR. CECELIA G. ROBIS LAOANG, NORTHERN SAMAR 9078363745 With full and handwritten
name tag and signature over
printed name
DR. NELIDA M. LOBOS LAOANG, NORTHERN SAMAR 9274002560
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: TIN CARD

ID/License/Passport No.: 416-577-658

Signature (Sign inside the box)
MARCH 15,2024
Date/Place of Issuance: 04/07/2016 /BIR CATARMAN
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