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 EBRADA
NAME EXTENSION (JR., SR) N/A
FIRST NAME LEO

MIDDLE NAME RAMIREZ

3. DATE OF BIRTH
(mm/dd/yyyy) 3/14/1974 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CALAPAN CITY, ORIENTAL MINDORO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male ✘ Female

6 CIVIL STATUS Single ✘ Married

17. RESIDENTIAL ADDRES SITIO 1B
Widowed
House/Block/Lot No. Street
Separated
DEL PILAR
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.60 NAUJAN ORIENTAL MINDORO
City/Municipality Province
8. WEIGHT (kg) 65 ZIP CODE 5204

9. BLOOD TYPE "O"

18. PERMANENT ADDRESS 004 CENTRO
House/Block/Lot No. Street
10. GSIS ID NO. 74031400299 COMUNAL
Subdivision/Village Barangay
CALAPAN CITY ORIENTAL MINDORO
11. PAG-IBIG ID NO. 04013538605
City/Municipality Province

12. PHILHEALTH NO. 09-000-589-526 ZIP CODE 5200

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

14. TIN NO. 198-860286 20. MOBILE NO. 09369440226

15. AGENCY EMPLOYEE NO. 4431296 21. E-MAIL ADDRESS (if any ebradaleo@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME HERNANDEZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) AARON H. EBRADA

FIRST NAME PORTIA N/A 8/6/1998

MIDDLE NAME PARINGIT CRISPAULO H. EBRADA 6/10/2001

OCCUPATION SUPERVISING PHARMACIST SHANNON LEI H. EBRADA 12/30/2004

EMPLOYER/BUSINESS NAMMA. ESTRELLA GEN. HOSPITAL

BUSINESS ADDRESS TAWIRAN, CALAPAN CITY, ORIENTAL MINDORO

TELEPHONE NO. 043-2867386

24.FATHER'S SURNAME EBRADA

NAME EXTENSION (JR., SR)
FIRST NAME OSCAR N/A

MIDDLE NAME GAA

25. MOTHER'S MAIDEN NAME

SURNAME RAMIREZ

FIRST NAME CATALINA

MIDDLE NAME VERDADERO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY FILEMON SAMACO MEM. SCHOOL PRIMARY EDUCATION 06/08/1981 03/28/1987 N/A 1987 N/A

VOCATIONAL
SECONDARY / DIVINE WORD COLLEGE OF CALAPAN HIGH SCHOOL 6/7/1987 03/27/1991 N/A 1991 N/A

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

COLLEGE
TRADE COURSE DIVINE WORD COLLEGE OF CALAPAN BACHELOR OF ELEMENTARY EDUCATION 6/2/1991 04/10/1996 N/A 1996 N/A

MASTER OR ARTSMAJOR IN
GRADUATE STUDIES DIVINE WORD COLLEGE OF CALAPAN
ADMINISTRATION AND SUPERVISION
04/06/1996 06/06/2015 MA GRADUATE 2015 N/A

DOCTOR OF PHILOSOPHY IN
DIVINE WORD COLLEGE OF CALAPAN
EDUCATIONAL MANAGEMENT
04/01/2015 05/30/2017 24 N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 14, 2022 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 80.60% 8/24/1996 MLQU-MANILA 0020302 11/19/1996

CAREER EXECUTIVE SERVICE (CESWE) 81.01% 11/23/2013 DWCC HS DEPARTMENT, CALAPAN CITY N/A N/A

(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)
11/17/2019 6/15/2020 INTERNATIONAL TEACHER LIVINGSTON AMERICAN SCHOOL 80000.00 N/A CONTRACTUAL N
01/01/2019 11/16/2019 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 47522.00 19-4 PERMANENT Y
01/01/2018 12/31/2018 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 43371.00 19-3 PERMANENT Y
1/1/2017 12/31/2017 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 40227.00 19-3 PERMANENT Y

1/1/2016 12/31/2016 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 34608.00 19-3 PERMANENT Y

1/5/2015 12/31/2015 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 34608.00 19-3 PERMANENT Y

6/1/2012 1/4/2015 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 34321.00 19-2 PERMANENT Y

1/5/2012 5/31/2012 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 30880.00 19-2 PERMANENT Y

6/1/2011 1/4/2012 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 30474.00 19-1 PERMANENT Y

6/24/2010 5/31/2011 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 27088.00 19-1 PERMANENT Y

7/1/2009 6/23/2010 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 23703.00 19-1 PERMANENT Y

1/5/2009 6/30/2009 ELEMENTARY SCHOOL PRINCIPAL I DEPARTMENT OF EDUCATION 19168.00 19-1 PERMANENT Y

7/1/2008 1/4/2009 MASTER TEACHER 1 DEPARTMENT OF EDUCATION 17059.00 16-1 PERMANENT Y

11/5/2007 06/302008 MASTER TEACHER 1 DEPARTMENT OF EDUCATION 15508.00 16-1 PERMANENT Y

7/1/2007 11/4/2007 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 11207.00 10-2 PERMANENT Y

1/1/2003 6/30/2007 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 10188.00 10-2 PERMANENT Y

7/1/2001 12/31/2002 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 9939.00 10-1 PERMANENT Y

1/1/2000 6/30/2001 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 9466.00 10-1 PERMANENT Y

6/1/1998 12/31/1999 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 8605.00 10-1 PERMANENT Y

7/11/1997 5/31/1998 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 7309.00 10-1 PERMANENT Y

6/15/1997 7/10/1997 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 7309.00 10-1 PERMANENT Y

1/27/1997 3/27/1997 ELEMENTARY GRADE TEACHER I DEPARTMENT OF EDUCATION 7309.00 10-1 PERMANENT Y

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 14, 2022 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

PHILIPPINE ELEMENTARY SCHOOL PRINCIPALS ASSOCIATION 1/5/2010 11/16/2019 BOARD MEMBER

BOY SCOUTS OF THE PHILIPPINES 8/5/2009 PRESENT WOOD BADGE HOLDER

(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
TRAINING OF TRAINERS (TOT) ON HIGH QUALITY INBRED RICE SEED
11/16/2020 11/27/2020 80 MANAGERIAL
PRODUCTION AND RICE BASED FARM MACHINERY OPERATIONS ATI
PRODUCTION OF HIGH QUALITY INBRED RICE AND SEED 08/06/2020 10/19/2020 96 MANAGERIAL
CERTIFICATION AND FARM MECHANIZATION TESDA
SCHOOL HEADS DEVELOPMENT PROGRAM: FOUNDATION COURSE (SHDPC) 02/25/2017 03/03/2017 50 MANAGERIAL DEPARTMENT OF EDUCATION
BATCH 2-MODULE 2, ORIENTAL MINDORO/CALAPAN CITY CLUSTER
SCHOOL HEADS DEVELOPMENT PROGRAM: FOUNDATION COURSE (SHDPC) 2/9/2017 2/15/2017 50 MANAGERIAL DEPARTMENT OF EDUCATION
BATCH 2-MODULE 1, ORIENTAL MINDORO/CALAPAN CITY CLUSTER

TEACHeXCELS 11/25/2013 1/10/2014 54 MANAGERIAL DEPARTMENT OF EDUCATION

CAPABILITY BUILDING ON EFFECTIVE ADMINISTRATION AND

3/19/2014 3/21/2014 24 MANAGERIAL DEPARTMENT OF EDUCATION
MANAGEMENT OF PERSONNEL FOR SCHOOL HEADS
DIVISION TRAINING WORKSHOP FOR UNTRAINED GRADES IV TO
5/7/2014 5/9/2014 24 MANAGERIAL DEPARTMENT OF EDUCATION
VI SCIENCE TEACHERS ON SCIENCE CONTENTS
18TH PROVINCIAL SCOUTS JAMBORETTE 1/10/2014 1/12/2014 24 MANAGERIAL BOY SCOUT OF THE PHILIPPINES

DIVISION TRAINING WORKSHOP FOR UNTRAINED GRADES IV TO

5/8/2013 5/10/2013 24 MANAGERIAL DEPARTMENT OF EDUCATION
VI SCIENCE TEACHERS ON SCIENCE CONTENTS
PSI LEADERSHIPSUCCESS SEMINAR 9/28/2012 9/30/2012 24 MANAGERIAL PURPOSEFUL STEWARDSHIP INSTITUTE
ACCENTUATING CAPACITY, ACCOUNTABILITY AND DYNAMISM
OF EDUCATION MANAGERS THROUGH INSTRUCTION AND 8/23/2011 8/27/2011 24 MANAGERIAL DEPARTMENT OF EDUCATION
ADVANCEMENT
DIVISION MULTIGRADE TRAINING WORKSHOP 9/9/2009 9/11/2009 24 MANAGERIAL DEPARTMENT OF EDUCATION

9TH REGIONAL STUDENT TECHNOLOGISTS AND

ENTREPRENEURS OF THE PHILIPPINES REGIONAL SKILLS 10/26/2009 10/28/2009 24 MANAGERIAL DEPARTMENT OF EDUCATION
DEVELOPMENT AND COMPETITIONS
CLUSTER ORIENTATION TRAINING ON THE UTILIZATION OF THE
PHILIPPINE INFORMAL READING INVENTORY (Phil-IRI) REPORTING AND 8/26/2009 8/29/2009 24 MANAGERIAL DEPARTMENT OF EDUCATION
DATABASE SYSTEM
SEMINAR-WORKSHOP ON THE TRENDS AND BEST PRACTICES ON
5/25/2009 5/27/2009 24 MANAGERIAL DEPARTMENT OF EDUCATION
MULTIGRADE INSTRUCTION FOR MULTIGRADE TEACHERS

(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)

GUITAR IMPROVIZATION BEST LEAD GUITARIST BOY SCOUT OF THE PHILIPPINES

COMPUTER MANIPULATION

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 14, 2022 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? ________________________________
Resignation
________________________________
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
SALMORIN, ARACELI R. ROXAS, ORIENTAL MINDORO 9177121048 3.5 cm. X 4.5 cm
(passport size)

ATTY. USSAM, REIMUND AL F. CALAPAN CITY, ORIENTAL MINDORO 9272395381 With full and handwritten
name tag and signature over
printed name
NICHOLAS, RAMIL CASTRO CALAPAN CITY, ORIENTAL MINDORO 9194347115
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 LICENSE

ID/License/Passport No.: 0020302 Signature (Sign inside the box)

JUNE 14, 2022
Date/Place of Issuance: PRC Baguio 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