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 GABRIEL
NAME EXTENSION (JR., SR) NA
FIRST NAME CORINTHIAN

MIDDLE NAME DONATO

3. DATE OF BIRTH
(mm/dd/yyyy) 11/27/1988 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH PANIQUI, TARLAC If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
Single ✘ Married 17. RESIDENTIAL ADDRESS 75 PUROK SAN GABRIEL
Widowe Separat House/Block/Lot No. Street
MATINDEG
d ed
Other/s: Subdivision/Village Barangay
PURA TARLAC
7. HEIGHT (m) 1.42M
City/Municipality Province
8. WEIGHT (kg) 50KG ZIP CODE 2312

18. PERMANENT ADDRESS 75 PUROK SAN GABRIEL

9. BLOOD TYPE A+
House/Block/Lot No. Street
MATINDEG
10. GSIS ID NO. 2004870819
Subdivision/Village Barangay
PURA TARLAC
11. PAG-IBIG ID NO. 121088342007
City/Municipality Province

12. PHILHEALTH NO. 07-025618358-5 ZIP CODE 2312

13. SSS NO. N/A 19. TELEPHONE NO. 9310402

14. TIN NO. 298-826-963 20. MOBILE NO. 09105279711

15. AGENCY EMPLOYEE NO. 4672928 21. E-MAIL ADDRESS (if any) corinthian.gabriel@deped.gov.ph/ corinthian27donato1988@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME GABRIEL 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JOSEPH HENRY D. GABRIEL
FIRST NAME FELICIANO JR. 9/21/2017

MIDDLE NAME DUEÑAS

OCCUPATION TEACHER

EMPLOYER/BUSINESS NAME POROC ELEMENTARY SCHOOL -DEPED -PURA

BUSINESS ADDRESS POROC PURA TARLAC

TELEPHONE NO. 9501826928

24. FATHER'S SURNAME DONATO

NAME EXTENSION (JR., SR)
FIRST NAME JEFFERSON

MIDDLE NAME RAMIL

25. MOTHER'S MAIDEN NAME

SURNAME MELCHOR

FIRST NAME ESTRELLA

MIDDLE NAME ARQUEZA (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

CARIÑO ELEMENTARY SCHOOL GRADE 1 TO 5 1995 2000 GRADE 5

ELEMENTARY
DILIGENT
COL.E.DELEON ELEMENTARY SCHOOL ELEMENTARY 2000 2001 GRADUATED 2001
PUPIL
DISTINCTIO
SECONDARY /
VOCATIONAL CENTRAL INSTITUTE OF TECHNOLOGY HIGH SCHOOL 2001 2005 GRADUATED 2005
N AWARD

NA NA NA NA NA NA NA
TRADE
COURSE
COLLEGE ST. ROSE COLLEGE EDUCATION FOUNDATION INC. BACHELOR OF ELEMENTARY EDUCATION 2005 2009 GRADUATED 2009

MASTER OF ARTS IN EDUCATION MAJOR IN

TARLAC STATE UNIVERSITY
EDUCATION MANAGEMENT
2009 2013 42 UNITS
GRADUATE STUDIES
MASTER OF ARTS IN EDUCATION MAJOR IN
LYCEUM NORTHWESTERN UNIVERSITY
EDUCATION MANAGEMENT
2016 2017 GRADUATED 2017
(Continue on separate sheet if necessary)

SIGNATURE DATE
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 77.20% 4/18/2010 SAN ANDRES, MALATE, MANILA 1071202 11/27/2020

(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)
1/1/2021 TO DATE TEACHER II DEPARTMENT OF EDUCATION-PURA 28,052.00 12-1 PERMANENT YES

1/1/2020 12/31/2020 TEACHER II DEPARTMENT OF EDUCATION-PURA 26,495.00 12-1 PERMANENT YES

DEPARTMENT OF EDUCATION-PANIQUI
1/14/1019 12/31/2019 TEACHER II 24,938.00 12-1 PERMANENT YES
NORTH
DEPARTMENT OF EDUCATION-PANIQUI
1/1/2018 12/31/2018 TEACHER I 20,179.00 11-1 PERMANENT YES
NORTH
DEPARTMENT OF EDUCATION-PANIQUI
1/1/2017 12/31/2017 TEACHER I 19,620.00 11-1 PERMANENT YES
NORTH
DEPARTMENT OF EDUCATION-PANIQUI
1/1/2016 12/31/2016 TEACHER I 19,077.00 11-1 PERMANENT YES
NORTH
DEPARTMENT OF EDUCATION-PANIQUI
6/22/2015 12/31/2015 TEACHER I 18547.00 11-1 PERMANENT YES
NORTH
DEPARTMENT OF EDUCATION-PANIQUI CONTRACTUA
1/6/2014 3/30/2015 TEACHER 6000.00 NA YES
SOUTH L
DEPARTMENT OF EDUCATION-PANIQUI CONTRACTUA
3/6/2013 3/30/2014 TEACHER 6000.00 NA YES
SOUTH L
DEPARTMENT OF EDUCATION-PANIQUI CONTRACTUA
1/6/2012 3/30/2013 TEACHER 6000.00 NA YES
SOUTH L
DEPARTMENT OF EDUCATION-PANIQUI CONTRACTUA
1/6/2011 3/30/2012 TEACHER 3000.00 NA YES
SOUTH L
8/11/2010 3/31/2011 TEACHER ST. PAUL COLLEGE 5000.00 NA SUBSTITUTE NO

7/15/2010 10/29/2010 TEACHER ST. VINCENT SCHOOL 6000.00 NA TEMPORARY NO

CONTRACTUA
1/6/2009 3/30/2010 TEACHER MOTHER REGINA SCHOOL 5000.00 NA NO
L

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

NA NA NA NA NA

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

DIVISION SKILLS WEBINAR IN ORGANIC AGRICULTURE 6/15/2021 6/17/2021 24 HOURS TECHNICAL SCHOOLS DIVISION OF TARLAC PROVINCE

WEBINAR ON KOTOBEE 7/23/2020 7/23/2020 4 HOURS TECHNICAL SCHOOLS DIVISION OF TARLAC PROVINCE

(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 in
(Write in full)
full)
PANIQUI NORTH DISTRICT TEACHERS
COMPUTER LITERATE
ASSOCIATION
DANCING

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE
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.

LIEZEL B. SARMIENTO, Ed.D. PURA TARLAC

MARILOU F. SANTIAGO, Ph.D. GERONA, TARLAC

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: PRC ID

ID/License/Passport No.: 1071202

Signature (Sign inside the box)

Date/Place of Issuance: 12/26/2010 PRC, MANILA

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