CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 ACCOM PLISHING 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 REYES
NA M E EXTENSION (JR., SR)
FIRST NAME MARY

MIDDLE NAME GARCIA

All date must 3. DATE OF BIRTH
1/8/1992 16. CITIZENSHIP
(mm/dd/y y y y ) Filipino Dual Citizenship
be in numeric by birth by naturalization
POBLACION, TUBOD, LANAO DEL
format 4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
NORTE
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PUROK-3

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
POBLACION
Other/s:
Subdivision/Village Barangay
TUBOD LANAO DEL NORTE
7. HEIGHT (m) 1.499
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 9209

18. PERMANENT ADDRESS PUROK-3

9. BLOOD TYPE O
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay
TUBOD LANAO DEL NORTE
11. PAG-IBIG ID NO. 1212-3721-9472
City/Municipality Province

12. PHILHEALTH NO. 20-050018833-1 ZIP CODE 9209

13. SSS NO. 0828930349 19. TELEPHONE NO. NONE

14. TIN NO. N/A 20. MOBILE NO. 09091231234

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

NA M E EXTENSION (JR., SR)
FIRST NAME GREG

MIDDLE NAME CRUZ

25. MOTHER'S MAIDEN NAME

SURNAME GARCIA

FIRST NAME MAE

MIDDLE NAME LOPEZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLA RSHI
P ERIOD OF
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ YEA R P/
LEVEL A TTENDA NCE UNITS EA RNED GRA DUA TE A CA DEM IC
(Write in full) (Write in full) (if no t graduated) D HONORS
From To RECEIVED
1ST
ELEMENTARY BALOI CENTRAL ELEMENTARY SCHOOL P R IM A R Y E D UC A T IO N 2003 2009 N/A 2009 HONORABLE
M ENTION

WITH HIGH
SECONDARY MSU-BALOI COMMUNITY HIGHSCHOOL H IG H S C H O O L 2009 2013 N/A 2013 HONOR

VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE
MINDANAO STATE UNIVERSITY-ILIGAN BACHELOR OF SECONDARY CUM LAUDE/ DOST
COLLEGE 2013 2017 N/A 2017 SCHOLASTIC
INSTITUTE OF TECHNOLOGY EDUCATION IN BIOLOGY COMPLETION

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

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), P age 1o f 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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE
RA 1080EXAMINATION
(LET) FOR TEACHERS 82.40 09/29/2019 CAGAYAN DE ORO CITY 1843351 1/6//2023

(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.
SALARY/ JOB/
28. INCLUSIVE DATES PAY GRADE (if
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY M ONTHLY GOV'T
(mm/dd/y y y y ) applicable)& STA TUS OF
SERVICE
(Write in full/Do not abbrev iate) (Write in full/Do not abbrev iate) SA LA RY STEP (Format A P P OINTM ENT

From To
" 00-0" )/
(Y/ N) Salary grade
INCREM ENT

4/4/2021 7/4/2021 SUBSTITUTE TEACHER

LINAMON NATIONAL HIGH SCHOL-DIVISION
23877.00 11-1 CONTRACTUAL Y
must be in
All date must OF LANAO DEL NORTE
M.LHUILLIER FINANCIAL SERVICES this format
be in numeric 8/15/2011 6/15/2017 TELLER/ASSISTANT BRANCH MANAGER 9800.00 N/A REGULAR N
INCORPORATED (11-1) if
format
applicable.

If not
applicable
just put N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), P age 2 o f 4