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 MONSANTO
NAME EXTENSION (JR., SR)
FIRST NAME CLINT
MIDDLE NAME JARANTILLA
3. DATE OF BIRTH
(mm/dd/yyyy)
4/15/1984 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH USUCAN, PLARIDEL, MIS. OCC. If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK 3A, LAHOYLAHOY STREET

Widowed House/Block/Lot No. Street

Separate
PIONEER VILLAGE, HINAPLANON
Other/s: d
Subdivision/Village Barangay
ILIGAN CITY
7. HEIGHT (m) 5"7
City/Municipality Province
8. WEIGHT (kg) 99KG ZIP CODE house/Block/Lot No.

18. PERMANENT ADDRESS PUROK RIZAL, ZONE 3 RIZAL SREET

9. BLOOD TYPE A
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO. CRN-006-0045-5707-4
Subdivision/Village Barangay
LUGAIT MISAMIS ORIENTAL
11. PAG-IBIG ID NO. 1210-6654-0495
City/Municipality Province

12. PHILHEALTH NO. 15-201155396-0 ZIP CODE 9025

13. SSS NO. N/A 19. TELEPHONE NO. (063) 222-1941
14. TIN NO. 405-871-005 20. MOBILE NO. 09557120203
15. AGENCY EMPLOYEE NO. 4259278 21. E-MAIL ADDRESS (if any) lugait_district@yahoo.com / clint.monsanto@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MONSANTO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME CHARITY MARIA VENICE L. MONSANTO 2/6/2007

MIDDLE NAME LAHOYLAHOY

OCCUPATION PRIVATE SCHOOL TEACHER

EMPLOYER/BUSINESS NAME ILIGAN HOLY FAMILY LEARNING ACADEMY INC.

BUSINESS ADDRESS SEMINARY DRIVE, PALA-O, ILIGAN CITY

TELEPHONE NO. 223-5399

24. FATHER'S SURNAME MONSANTO

NAME EXTENSION (JR., SR)
FIRST NAME EFREN

MIDDLE NAME BUHAY

25. MOTHER'S MAIDEN NAME

SURNAME JARANTILLA

FIRST NAME CARMEN

MIDDLE NAME BASTILLADA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LUGAIT CENTRAL SCHOOL 1997

SECONDARY
VOCATIONAL / SACRED HEART HIGH SCHOOL 2001

TRADE
COURSE BUKIDNON STATE UNIVERSITY-MANTICAO
COLLEGE
EXTERNAL STUDIES CENTER
BEED MAJOR IN FILIPINO 2005

MASTER OF ARTS MAJOR IN EDUCATIONAL

GRADUATE STUDIES ST. PETER'S COLLEGE
MANAGEMENT 2019

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 22, 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 OF TEACHERS 76.2 LICEO DE CAGAYAN UNIVERSITY 0928636 4/15/2018

(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)
GRADE 11
6/1/2011 PRESENT TCH 1 DEPARTMENT OF EDUCATION 26,450.00 PERMANENT Y
STEP 3

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 22, 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

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

Virtual In-servicxe training for Public School Teachers 03/15/2021 03/19/2021 40 hours TECHNICAL DepED Central Office

Curriculumn Management Support System Webinar 4/3/2021 4/3/2021 8 hours TECHNICAL DepED R-10

2-Day Seminar-Workshop on Sports Officiating 8/8/2019 8/9/2019 16 hours TECHNICAL DepED Division of Misamis Oriental

Strategic Planning Conference on School Sports for the SY 2019-2020 6/19/2019 6/19/2019 8 hours TECHNICAL DepED Division of Misamis Oriental

Lecture-Workshop on Athletes Assesment: When to Rest and When to return to Play 6/11/2019 6/11/2010 8 hours TECHNICAL DepED Division of Misamis Oriental

2-Day Seminar-Workshop on Sports Officiating in all DedEd Sports Events 8/30/2018 8/31/2018 16 hours TECHNICAL DepED Division of Misamis Oriental

3-Day Capability Building of Sports Coaches 6/28/2018 6/30/2018 24 hours TECHNICAL DepED Division of Misamis Oriental

Enhancement live-out Training on Sports Coaching 11/18/2016 11/20/2016 24 hours TECHNICAL DepED R-10

Division Enhancement Seminar / Workshop on Coaching, Officiating and Philippine folk / Social
8/5/2016 8/7/2016 24 hours TECHNICAL DepED Division of Misamis Oriental
Dances

(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)

Adobe Photoshop Editing N/A BUFFALOS BROTHERHOOD

Microsoft Word, Excel, Publisher, PowerPoint COUPLES FOR CHRIST

Cyberlink Video Editor RESCUE LUGAIT

Bonsai Collector COLUMBIAN SQUIRES

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 22, 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,
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
SOLOME D. FABRIGAS INITAO, MIS. OR. 3.5 cm. X 4.5 cm
(passport size)

IMELDA C. BAGUIO POB. LUGAIT, MIS. OR. 222-2435 With full and handwritten
name tag and signature over
printed name
ZOSIMO A. PEREZ JR. POB. LUGAIT, MIS. OR.
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: GSIS UMID

ID/License/Passport No.: CRN-006-0045-5707-4

Signature (Sign inside the box)

Date/Place of Issuance: GSIS, CAGAYAN DE ORO 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