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 DICDICAN
NAME EXTENSION (JR., SR)
FIRST NAME MARGINITA

MIDDLE NAME PAZ

3. DATE OF BIRTH
06/22/2022 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH CASAY, DALAGUETE, CEBU If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street
Separate
Widowed ANGAS CASAY
Other/s: d
Subdivision/Village Barangay
DALAGUETE CEBU
7. HEIGHT (m) 1.53
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 6022

18. PERMANENT ADDRESS

9. BLOOD TYPE O+
House/Block/Lot No. Street
ANGAS CASAY
10. GSIS ID NO. 2002619943
Subdivision/Village Barangay
DALAGUETE CEBU
11. PAG-IBIG ID NO. 1211-2849-5017
City/Municipality Province

12. PHILHEALTH NO. 12-000065994-6 ZIP CODE 6022

13. SSS NO. 3513742182 19. TELEPHONE NO. N.A.

14. TIN NO. 223-519-281-000 20. MOBILE NO. 09690055350

15. AGENCY EMPLOYEE NO. 4177093 21. E-MAIL ADDRESS (if any) marginita.dicdican@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME DICDICAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME NOEL MAHERSHALALHASHBAZ P. DICDICAN 1/12/2009

MIDDLE NAME CARIGO

OCCUPATION COOK

EMPLOYER/BUSINESS NAME CANADIAN BREWHOUSE

BUSINESS ADDRESS ALBERTA, CANADA

TELEPHONE NO. N.A.

24. FATHER'S SURNAME PAZ

NAME EXTENSION (JR., SR)
FIRST NAME EVARISTO

MIDDLE NAME BELAMIA

25. MOTHER'S MAIDEN NAME

SURNAME LUMAYAG

FIRST NAME MATILDE

MIDDLE NAME CATALAN (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

MARCH,
ELEMENTARY CASAY ELEMENTARY SCHOOL JUNE, 1978
1984
1984 N.A.

MARCH, 4TH
SECONDARY
VOCATIONAL / CASAY NATIONAL HIGH SCHOOL JUNE, 1984
1988
1988
HONORS

N.A. N.A N.A. N.A. N.A. N.A. N.A.

TRADE
CEBU TECHNOLOGICAL UNIVERSITY ARGAO MARCH, CUM
COURSE
COLLEGE BACHELOR IN ELEMENTARY EDUCATION JUNE, 1996
2000
2000
CAMPUS ( CSCST-AIFC ) LAUDE
CEBU TECHNOLOGICAL UNIVERSITY ARGAO NOVEMBE
GRADUATE STUDIES
CAMPUS ( CSCST-AIFC )
MASTER OF ARTS IN EDUCATION
R, 2000
MAY, 2008 30
(Continue on separate sheet if necessary)
SIGNATURE DATE MARCH 4, 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 76.8 AUGUST, 2000 CEBU CITY 0658321 06/22/2024

(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)

08/24/2021 PRESENT TEACHER 3 STP4 DEEPARTMENT OF EDUCATION P29,225.00 13-4 REG.PERM. Y

1/1/2021 08/23/2021 TEACHER 3 STP3 DEEPARTMENT OF EDUCATION P28,905.00 13-3 REG.PERM. Y

1/1/2020 12/31/2020 TEACHER 3 DEEPARTMENT OF EDUCATION P27,383.00 13-3 REG.PERM. Y

1/1/2019 12/31/2019 TEACHER 3 DEEPARTMENT OF EDUCATION P25,861.00 13-3 REG.PERM. Y

08/24/2018 12/31/2018 TEACHER 3 DEEPARTMENT OF EDUCATION P24,799.00 13-3 REG.PERM. Y

1/1/2018 08/23/2018 TEACHER 3 DEEPARTMENT OF EDUCATION P24,510.00 13-2 REG.PERM. Y

1/1/2017 12/31/2017 TEACHER 3 DEEPARTMENT OF EDUCATION P23,517.00 13-2 REG.PERM. Y

1/1/2016 12/31/2016 TEACHER 3 DEEPARTMENT OF EDUCATION P22,564.00 13-2 REG.PERM. Y

08/24/2015 12/31/2015 TEACHER 3 DEEPARTMENT OF EDUCATION P21,650.00 13-2 REG.PERM. Y

08/24/2012 08/23/2015 TEACHER 3 DEEPARTMENT OF EDUCATION P21,436.00 13-2 REG.PERM. Y

1/6/2012 08/23/2012 TEACHER 2 DEEPARTMENT OF EDUCATION P20,140.00 12 REG.PERM. Y

1/6/2011 05/31/2012 TEACHER 2 DEEPARTMENT OF EDUCATION P18,568 12 REG.PERM. Y

06/24/2010 05/31/2011 TEACHER 2 DEEPARTMENT OF EDUCATION P16,995.00 12 REG.PERM. Y

3/2/2010 06/23/2010 TEACHER 2 DEEPARTMENT OF EDUCATION P15,422.00 12 REG.PERM. Y

1/7/2009 2/2/2010 TEACHER 2 DEEPARTMENT OF EDUCATION P15,119.00 11 REG.PERM. Y

1/7/2008 06/30/2009 TEACHER 2 DEEPARTMENT OF EDUCATION P12,748.00 11 REG.PERM. Y

1/7/2007 06/30/2008 TEACHER 2 DEEPARTMENT OF EDUCATION P11,589.00 11 REG.PERM. Y

3/2/2007 06/30/2007 TEACHER 2 DEEPARTMENT OF EDUCATION P10,535.00 11 REG.PERM. Y

01/30/2003 2/2/2007 TEACHER 1 DEEPARTMENT OF EDUCATION P9939.00 10 REG.PERM. Y

06/17/2002 01/29/2003 TEACHER 1 DEEPARTMENT OF EDUCATION P4,000.00 MUNI Y

 (Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 4, 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

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

(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)
 (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.

ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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:
ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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