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 only)

I. PERSONAL INFORMATION
2. SURNAME ESPINOSA
NAME EXTENSION (JR., SR)
FIRST NAME TERESITA
✘ Filipino Dual Citizenship
MIDDLE NAME DIGAL ✘
by by
birth naturalization
3. DATE OF BIRTH
(mm/dd/yyyy) 3/14/1969 16. CITIZENSHIP

Male ✘ Female

4. PLACE OF BIRTH Single

DAVAO CITY ✘ Married If holder of dual citizenship, Pls. indicate country:
Separate
Widowed please indicate the details.
5. SEX Other/s: d

17. RESIDENTIAL ADDRESS BLK 15 LOT 14 DUHAT ST.

6 CIVIL STATUS
House/Block/Lot No. Street
ROSALINA 3 VILLAGE BALIOK
Subdivision/Village Barangay
DAVAO CITY DAVAO DEL SUR
7. HEIGHT (m) 1.68 M
City/Municipality Province
8. WEIGHT (kg) 63 kg ZIP CODE 8000

18. PERMANENT ADDRESS BLK 15 LOT 14 DUHAT ST.

9. BLOOD TYPE B
House/Block/Lot No. Street
ROSALINA 3 VILLAGE BALIOK
10. GSIS ID NO. 2002713948
Subdivision/Village Barangay
DAVAO CITY DAVAO DEL SUR
11. PAG-IBIG ID NO. 110111780709
City/Municipality Province

12. PHILHEALTH NO. 190003540646 ZIP CODE 8000

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 900583163 20. MOBILE NO. 09237411063

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
6108025 21. E-MAIL ADDRESS (if any) teresitadespinosa@yahoo.com
ESPINOSA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) TRISHA JOY D. ESPINOSA
JOSE IAN 3/27/2000

MIDDLE NAME NERI STEPANIE JOY D. ESPINOSA 10/17/2001

OCCUPATION FARMER NIÑA JOY D. ESPINOSA 1/21/2010

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME DIGAL

NAME EXTENSION (JR., SR)
FIRST NAME CRESENCIO

MIDDLE NAME LIMBAGO

25. MOTHER'S MAIDEN NAME

SURNAME CAÑONES

FIRST NAME MARCELINA

MIDDLE NAME SALEM (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

ELEMENTARY RIZAL ELEMENTARY SCHOOL ELEMENTARY 6/1/1975 3/25/1980

SECONDARY /
VOCATIONAL STA ANA NATIONAL HIGH SCHOOL HIGH SCHOOL 6/1/1981 3/25/1985

RIZAL MEMORIAL COLLEGES JUNIOR SECRETARIAL COURSE 6/5/1987 3/25/1988

TRADE
COURSE
COLLEGE UNIVERSITY OF MINDANAO BEED 6/1/1992 3/25/1995

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE July 6, 2020

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

LET 75.8 8/1/1996 DAVAO CITY 280571 03-14-21

(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 sheeP
GOV'T
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES PAY GRADE (if
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY applicable)& STATUS OF
(Write in full/Do not (Write in
SALARY STEP (Format APPOINTMENT
abbreviate) full/Do not abbreviate)
"00-0")/
From To INCREMENT
(Y/ N)
08-13-97 10-30-97 Teacher I Departmnet of Education Matina District P7,309. P(S) Y

02-23-98 03-27-98 Teacher I Departmnet of Education Matina District P8,605 P(S) Y

06-22-98 08-24-98 Teacher I Departmnet of Education Matina District P8,605 P(S) Y

7/9/1998 12-31-99 Teacher I Departmnet of Education Matina District P8,605 Permanent Y
1/1/1998 03-21-2000 Teacher I Departmnet of Education Matina District P9,466 Permanent Y

03-22-2000 05-14-2000 Teacher I Departmnet of Education Matina District P9,466 Permanent Y

05-15-2000 05-20-2000 Teacher I Departmnet of Education Matina District P9,466 Permanent Y

05-21-2000 12-31-2000 Teacher I Departmnet of Education Matina District P9,466 Permanent Y

1/1/2001 06-31-01 Teacher I Departmnet of Education Talomo District P9,466 Permanent Y

1/7/2001 6/9/2001 Teacher I Department of Education, Talomo District P9,466 Permanent Y

7/9/2001 10-14-2001 Teacher I Department of Education, Talomo District P 9,939 Permanent Y

10-15-2001 12-13-2001 Teacher I Department of Education, Talomo District P 10,188. Permanent Y

8/8/2003 12-31-2003 Teacher II Department of Education, Talomo District P 10,535. Permanent Y

1/1/2004 12-31-2004 Teacher II Department of Education, Talomo District P 10,535. Permanent Y

1/1/2005 7/8/2006 Teacher II Department of Education, Talomo District P 10,798. Permanent Y

8/8/2006 12-31-2006 Teacher II Department of Education, Talomo District P 10,798. Permanent Y

01-012007 06-30-2007 Teacher II Department of Education, Talomo District P118,878. Permanent Y

1/7/2007 06-30-2008 Teacher II Department of Education, Talomo District P13,066. Permanent Y

07--01-2008 06-30-2009 Teacher II Department of Education, Talomo District P15,422. Permanent Y

1/7/2009 12/7/2009 Teacher II Department of Education, Talomo District P15,733 Permanent Y

07-13-2009 11/8/2009 Teacher II Department of Education, Talomo District P 17, 269. Permanent Y

8/8/2009 12-31-2009 Teacher II Department of Education, Talomo District P18,805 Permanent Y

1/1/2011 05-31-2011 Teacher II Department of Education, Talomo District P17,269 Permanent Y

1/6/2011 7/12/2011 Teacher II Department of Education, Talomo District P 18,805. Permanent Y

1/1/2012 05-31-12 Teacher II Department of Education, Talomo District P 18,805. Permanent Y

1/6/2012 12-31-2012 Teacher II Department of Education, Talomo District P20,341. Permanent Y

1/1/2013 12-31-2013 Teacher II Department of Education, Talomo District P 20,553 Permanent Y

2014-2014 12-31-2014 Teacher II Department of Education, Talomo District P 20,553 Permanent Y

1/1/2015 7/8/2015 Teacher II Department of Education, Talomo District P 20,553 Permanent Y

8/8/2015 7/8/2015 Teacher II Department of Education, Talomo District P20,750. Permanent Y

8/8/2015 12-31-15 Teacher II Department of Education, Talomo District P 21,540 Permanent Y

1/1/2016 12-31-2016 Teacher II Department of Education, Talomo District P 22,361 Permanent Y

1/1/2017 12-31-2017 Teacher II Department of Education, Talomo District P 23,212 Permanent Y

1/1/2018 7/8/2018 Teacher II Department of Education, Talomo District P23,486 Permanent Y

8/8/2018 12-31-209 Teacher II Department of Education, Talomo District P25,952. Permanent Y

1/1/2020 Present Teacher II Department of Education, Talomo District P25,952. Permanent Y

(Continue on separate sheet if necessary)

SIGNATURE DATE July 6, 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 NUMBER OF
(Write in full) HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
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 NUMBER OF CONDUCTED/ SPONSORED BY
( Managerial/ Supervisory/
(Write in full) (mm/dd/yyyy)
HOURS
Technical/etc) (Write in full)

From To

3 Day District Level Mid-Year Assessment Oct. 20-22 ,2014 24 hrs Technical Dep Ed. Talomo District D.C.

2 Day School Level Orientation (RPMS) Jul .12-19, 2014 16 hrs. Technical
Dep. Ed. Talomo District D.C.
Mid Year Assessment and Inset Oct. 23-24, 2014 16 hrs. Technical
Bago E/S Talomo District

Apr.11-14, 2015 24 hrs

Competency Skills Training and Enhancement for Dep. Ed. XI Division of Davao City

MAPEH Component
GSP Troop Leadership Course Oct. 14-15, 2015 16 hrs. Technical
Talomo District

Early Language Literacy and Numeracy (ELLN) Oct. 17,& 24, 2015 16 hrs. Technical
Bago E/S Talomo District

Competency

Reading Material Workshop Jul. 2,9 & 16, 2016 24 hrs Technical
Talomo District

GSP Free Being Me Workshop 3/11/2017 8 hrs. Technical

Talomo District

Grammar Writing Workshop for MTB-MLE Teachers May 1-7, 2018 56 hrs Technical
University of the Philippines

(Mindanao Campus)

VIII.
OT
HE
on separate sheet if necessary)
R
INF 33.
OR
MA31. SPECIAL SKILLS and HOBBIES 32.
NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full) (Write in full)
TIO
N
drawing

on separate sheet if necessary)

SIGNATURE DATE July 6, 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? 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
SONIA D. ANG ALPHA HOMES SUBD, MATINA D.C. 3.5 cm. X 4.5 cm
(passport size)

HELENITA P. ANGGA ROHA SUBD. BALIOK D.C. With full and handwritten
name tag and signature over
ELENITA HEIGHT SUBD. CATALUNAN printed name
AMELYN T. COUNTRYMAN PEQUEÑO, D.C. 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: GSIS

ID/License/Passport No.: 2002713948

Signature (Sign inside the box)
July 6, 2020
Date/Place of Issuance: 2005 DAVAOCITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

MARILYN A. MARCELO
Person Administering Oath

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