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 DADTING
NAME EXTENSION (JR., SR)
FIRST NAME ZENAIDA

MIDDLE NAME MANSAWI

3. DATE OF BIRTH
(mm/dd/yyyy) 8/8/1996 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH MANARAPAN CARMEN COTABATO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
17. RESIDENTIAL ADDRESS N/A N/A
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separated
MAGULING MANARAPAN
Other/s: Subdivision/Village Barangay
CARMEN COTABATO
7. HEIGHT (m) 1.60
City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 9407

18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE O
House/Block/Lot No. Street
MAGULING MANARAPAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A CARMEN COTABATO

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9408

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

14. TIN NO. N/A 20. MOBILE NO. 09752891920

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) zenaidadadting12@gmail.com
II. FAMILY BACKGROUND
NAME EXTENSION (JR., SR)
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

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 MACAN

NAME EXTENSION (JR., SR)
FIRST NAME DADTING

MIDDLE NAME SENOMENANG

25. MOTHER'S MAIDEN NAME

SURNAME MANSAWI

FIRST NAME ZAIDA

MIDDLE NAME AMPATUAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MANARAPAN CARMEN COTABATO PRIMARY EDUCATION 2002 2008 GRADUATED 2008 WITH HONORS

CARMEN ACADEMY ASIA INTERNATIONAL COLLEGE

SECONDARY /
VOCATIONAL OF SCIENCE AND TECHNOLOGY
SECONDARY EDUCATION 2008 2012 GRADUATED 2012 WITH HONORS

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

TRADE
COURSE BACHELOR OF PHYSICAL EDUCATION MAJOR IN
COLLEGE UNIVERSITY OF SOUTHERN MINDANAO SCHOOL PHYSICAL EDUCATION 2012 2016 GRADUATED 2016 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 16, 2021 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

LICENSURE EXAMINATION FOR TEACHERS 79.2% 3/25/2018 KIDAPAWAN CITY 1647916 8/8/2021

(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. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
(Y/ N)

1/28/2020 2/17/2020 TEACHER 1 DEPARTMENT OF EDUCATION 22361.00 SUBSTITUTE

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 16, 2021 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

UNITED YOUTH FOR PEACE AND DEVELOPMENT 9/27/2019 12/31/2019 MEMBER

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

HEALTH CARE SERVICES NATIONAL CERTIFICATE LEVEL II 11/3/2017 5/28/2018 960 TECHNICAL TESDA XII

JOB INFORMATION 11/14/2015 11/14/2015 8 TECHNICAL UNIVERSITY OF SOUTHERN MINDANAO

PAGTUDLO 2015 ( NATIONAL CONFERENCE WORKSHOP ON ENHANCING THE QUALITY

OFTEACHING AND LEARNING THROUGH PRODUCTIVE PEDAGOGY,DATA AND RESEARCH 8/22/2015 8/22/2015 8 TECHNICAL DEPARTMENT OF MATHEMATICS AND STATISTIC
ANALYSIS)

SEMINAR WORKSHOP ON STRESS MANAGEMENT 09/03/2015 09/03/2015 8 TECHNICAL

UNIVERSITY GUIDANCE CENTER

STANDARD FIRST AID WITH CPR AND AED OPERATION 3/5/2014 3/8/2014 27 TECHNICAL PHILIPPINE RED CROSS KIDAPAWAN
CHAPTER

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

GARDENING

COOKING

DANCING

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 16, 2021 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,
Y ✘ N
Bureau or Department where you will be apppointed, Y
E ✘ N
a. within the third degree? E O
S
O
S
b. within the fourth degree (for Local Government Unit - Career Employees)?
Y ✘ N
E If YES, give details:
O ________________________________
S
Y ✘ N
35. a. Have you ever been found guilty of any administrative offense?
E
O
S If YES, give details:
________________________________
Y ✘ N ________________________________
E
b. Have you been criminally charged before any court? O
S
Y If YES, give details:
✘ N
E ________________________________
Date Filed:
O ________________________________
S Status of Case/s:
Y ✘ N
E ordinance or regulation
36. Have you ever been convicted of any crime or violation of any law, decree,Y O
by any court or tribunal? S ✘ N
E If YES, give details:
O
YS ✘ N
________________________________
E ________________________________
37. Have you ever been separated from the service in any of the following S
O
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? Y ________________________________
✘ N
E ________________________________
38. a. Have you ever been a candidate in a national or local election held within
Y the lastOyear (except
S ✘ N
Barangay election)? E
Y O If YES, give details:
S ✘ N
E
b. Have you resigned from the government service during the three (3)-month periodObefore the last
election to promote/actively campaign for a national or local candidate?S 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
AKMAD MAGUID MANARAPAN CARMEN COTABATO N/A 3.5 cm. X 4.5 cm
(passport size)

ELAYSA LATIBAN POBLACION CARMEN COT N/A With full and handwritten
name tag and signature over
printed name
INGCO DALID
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
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: PRC

ID/License/Passport No.: 1647916

Signature (Sign inside the box)

Date/Place of Issuance: 09/29/2018 PRC KIDAPAWAN CITY

Date/Place of Issuance: 09/29/2018 PRC KIDAPAWAN 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