CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

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. T15243173 (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME Balaobao
NAME EXTENSION (JR., SR)
FIRST NAME Honey Lou

MIDDLE NAME Jabla

3. DATE OF BIRTH
12/3/1997 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH Kalubiha San Pedro Dumingag, Zamboanga del Sur If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL Purok 7
6 CIVIL STATUS ✘ Single Married
ADDRESS House/Block/Lot No. Street
Widowed Separated
Caridad
Other/s:
Subdivision/Village Barangay
DUMINGAG ZAMBOANGA DEL SUR
7. HEIGHT (m) 5'0
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 7028

18. PERMANENT Purok 7

9. BLOOD TYPE 0
House/Block/Lot No. Street
ADDRESS Caridad
10. GSIS ID NO. N/A
Subdivision/Village Barangay
DUMINGAG ZAMBOANGA DEL SUR
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 7028

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

14. TIN NO. N/A 20. MOBILE NO. 09463547805

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) honeyjah97@gmil.com
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 N/A

N/A
OCCUPATION N/A N/A

N/A
EMPLOYER/BUSINESS NAMN/A N/A

N/A
BUSINESS ADDRESS CARIDAD, DUMINGAG ZAMBOANGA DEL SUR N/A

N/A
TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME Balaobao 7/29/1964

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

N/A
MIDDLE NAME Dabalos N/A

N/A
25. MOTHER'S MAIDEN NAME Jabla 11/18/1968
N/A
SURNAME Balaobao N/A

N/A
FIRST NAME Lina N/A

MIDDLE NAME Alcorin (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY CARIDAD, DUMINGAG ZAMBOANGA DEL SUR 2004-2005 2009-2010 N/A 2010

SECONDARY WETERN MINDANAO ACADEMY 2010- 2011 2013-2014 N/A 2014

VOCATIONAL /TRADE
COURSE

Bachelor in Secondary Education

COLLEGE JOSEFINA HERRERA CERILLES STATE COLLEGE
(English)
6/5/2014 4/8/2018 N/A 2018

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE January 22,2020

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
CAREER SERVICE/
RA 1080 (BOARD/ RATING DATE OF EXAMINATION /
LICENSE (if applicable)
BAR) UNDER (If Applicable) CONFERMENT
27. SPECIAL LAWS/
CES/ CSEE PLACE OF EXAMINATION / CONFERMENT

BARANGAY NUMBER
ELIGIBILITY / Date of
DRIVER'S LICENSE Validity

LICENSURE EXAMINATION
76.80 September 30, 2019 PAGADIAN CITY 1676253 12/3/2021
for TEACHERS

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

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

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

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

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

(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. DEPARTMENT / AGENCY / OFFICE / SALARY/ JOB/ GOV'T SERVICE

INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE PAY GRADE (if
COMPANY STATUS OF
MONTHLY SALARY applicable)& STEP
(Write in full/Do not (Format "00-0")/ APPOINTMENT
(Write in full/Do not abbreviate)
abbreviate) INCREMENT (Y/ N)
From To

Dumingag Technological Training

10/2/2018 TO DATE English Teacher 10000.00
School (DTTS)
N/A N/A N/A N/A N/A N/A N/A N/A

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

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

(Continue on separate sheet if necessary)

SIGNATURE DATE January 22,2020

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

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

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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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
CONDUCTED/ SPONSORED BY (Write in full)
(Write in full) (mm/dd/yyyy)
Technical/etc)
From To

CAPACITY DEVELOPMENT TRAINING COURSE 04/18/2018 04/20/2018 24 HOURS DAPIWAK, DUMINGAG, ZAMBOANGA DEL SUR

2019 CONSULTATIVE CONFERENCE

ON GUIDELINES AND POLICIES FOR 7/10/2019 7/11/2019 16 HOURS MARCIAN GARDEN CONVENTION CENTER, ZAMBOANGA CITY

PRIVATE SCHOOLS OPERATION

Teach International 08/31/2019 11/20/2019 140 HOURS

PERSONAL COMPUTER OPERATIONS 011/4/2019 11/22/2019 120 HOURS DUMINGAG TECHNOLOGICAL TRAINING SCHOOL

PRIVATE SCHOOLS DIVISION SUMMIT 01/08/2019 01/08/2019 8 HOURS MAGUINDANAO HALL, DAO PAGADIAN CITY

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

N/A

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N/A
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE January 22,2020

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? ✘ NO

b. within the fourth degree (for Local Government Unit - Career Employees)? ✘ NO
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘ NO
If YES, give details:
________________________________
________________________________
✘ NO
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 ✘ NO
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, ________________________________
✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
✘ NO
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year
(except Barangay election)?
✘ NO
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?
✘ NO
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: ✘ NO
a. Are you a member of any indigenous group? ✘ NO
If YES, please specify:
b. Are you a person with disability? ✘ NO
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
Billy P. Tadlas Dumingag Zamboanga del Sur 9487086014 3.5 cm. X 4.5 cm
(passport size)

Perla B. Majorenos San Pedro, Dumingag Zamboanga del Sur 9484873660 With full and handwritten
name tag and signature over
printed name
Dr. Aiwedeh Patadlas San Pedro, Dumingag Zamboanga del Sur 9999922542
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:

ID/License/Passport No.: PRC:1676253

Signature (Sign inside the box)
January 22, 2020
Date/Place of Issuance: 12/18/18 PAGADIAN 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 of 4