Marrisa PDS 2022

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 ALFORO
NAME EXTENSION ( JR., SR) N/A
FIRST NAME MARRISA
MIDDLE NAME LUAB

3. DATE OF BIRTH
(mm/dd/yyyy) 09/16/1977 16. CITIZENSHIP
✘
4. PLACE OF BIRTH SALONG, BAROY, LANAO DEL NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
✘
17. RESIDENTIAL ADDRESS N/A PUROK RAMBOTAN

6 CIVIL STATUS ✘
House/Block/Lot No. Street
N/A MARANDING
Subdivision/Village Barangay
LALA LANAO DEL NORTE
7. HEIGHT (m) 1.524m
City/Municipality Province
8. WEIGHT (kg) 85 kg ZIP CODE 9211
18. PERMANENT ADDRESS N/A PUROK RAMBOTAN

9. BLOOD TYPE A
House/Block/Lot No. Street
N/A MARANDING
10. GSIS ID NO. 056306
Subdivision/Village Barangay
LALA LANAO DEL NORTE
11. PAG-IBIG ID NO. 121005168660
City/Municipality Province
12. PHILHEALTH NO. 15-025215576-9 ZIP CODE 9211
13. SSS NO. NONE 19. TELEPHONE NO. NONE
14. TIN NO. 949-892-292 20. MOBILE NO. 0997-7449-227
15. AGENCY EMPLOYEE NO. LNC2006-10045 21. E-MAIL ADDRESS (if any) marrisa.alforo77@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ALFORO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME LARRY NONE YET
MIDDLE NAME NABRE
OCCUPATION TEACHING
EMPLOYER/BUSINESS NAME MSU-LNAC
BUSINESS ADDRESS RAMAIN, SULTAN NAGA DIMAPORO, LANAO DEL NORTE
TELEPHONE NO. NONE
24. FATHER'S SURNAME LUAB

FIRST NAME HELARIO
MIDDLE NAME SARAUSAS
25. MOTHER'S MAIDEN NAME
SURNAME PINTAC
FIRST NAME NORMA
MIDDLE NAME JUMAWAN (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND

HIGHEST LEVEL/
NAME OF SCHOOL SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE ACADEMIC
LEVEL (Write in UNITS EARNED GRADUATED
HONORS
(Write in full)
full) RECEIVED
From To (if not graduated)
ELEMENTARY SALONG ELEMENTARY SCHOOL PRIMARY EDUCATION 1984 1990 GRADUATED 1990 FIRST HONOR
LANAO NORTE NATIONAL COMPREHENSIVE HIGH

SECONDARY /
VOCATIONAL HIGH SCHOOL 1990 1994 GRADUATED 1994 NONE
SCHOOL
NONE NONE NONE NONE NONE NONE NONE
TRADE
COURSE
MINDANAO STATE UNIVERSITY - LANAO NORTE BACHELOR OF SCIENCE IN AGRICULTURE
COLLEGE 1995 1999 GRADUATED 1999 CUM LAUDE
AGRICULTURAL COLLEGE MAJOR IN AGRICULTURAL EDUCATION
MINDANAO STATE UNIVERSITY - LANAO NORTE MASTER OF ARTS IN EDUCATION MAJOR IN

GRADUATE STUDIES 2009 2011 GRADUATED 2011 NONE
AGRICULTURAL COLLEGE SCHOOL ADMINISTRATION
(Continue on separate sheet if necessary)
SIGNATURE DATE 01/25/2022 CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) RATING LICENSE (if applicable)
DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE (If
EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / Applicable NUMBER Date of
CONFERMENT
DRIVER'S LICENSE ) Validity
PD 907 - HONOR GRADUATE NONE 03/20/99 COTABATO CITY 10120206 NO EXPIRY
LICENSURE EXAMINATION FOR TEACHERS 75.0 8/8/1999 CAGAYAN DE ORO CITY 584301 9/16/2023

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/ PAY GOV'T SERVICE
28. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write applicable)& STEP
(Write in full/Do SALARY APPOINTMENT
From To in full/Do not abbreviate) (Format "00-0")/
not abbreviate)
INCREMENT (Y/ N)
MINDANAO STATE UNIVERSITY-LANAO DEL NORTE
01/01/2022 PRESENT TEACHER 1 11-4 PERMANENT YES
AGRICULTURAL COLLEGE
01/01/2021 12/31/2021 TEACHER 1 P 24,450.00 11-3 PERMANENT YES
01/01/2019 12/31/2019 TEACHER 1 P21,327.00 11-3 PERMANENT YES
06/01/2012 12/31/2012 TEACHER 1 P 17,099.00 NONE CONTRACTUAL YES

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
NONE N/A N/A N/A N/A
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
Online Learning Session on Addressing Disinformation to Promote Peace 07/29/2022 07/29/2022 3.0 VIRTUAL PRIVATE EDUCATION ASSISTANCE COMMITTEE
Fundamentals of Peace Education - 101 Teacher's Training 08/02/2019 08/04/2019 24.0 TECHNICAL MINDANAO STATE UNIVERSITY - MARAWI CAMPUS
2019 Summer In-Service Training (INSET) for Junior High School Teachers 04/22/2019 04/24/2019 24.0 TECHNICAL PRIVATE EDUCATION ASSISTANCE COMMITTEE
2018 Summer In-Service Training (INSET) for Junior High School Teachers 05/07/2018 05/09/2018 24.0 TECHNICAL PRIVATE EDUCATION ASSISTANCE COMMITTEE
Campus Wide Fire Prevention Drill and Seminar 03/09/2018 03/09/2018 8.0 TECHNICAL PROVINCIAL FIRE MARSHALL
21ST CENTURY PEDAGOGIES FOR HIGHER EDUCATION TEACHERS 09/15/2017 09/15/2017 8.0 TECHNICAL MSU-LNAC OFFICE OF RESEARCH AND EXTENSION
2017 Summer In-Service Training (INSET) for Senior High School Teachers 05/19/2017 05/21/2017 24.0 TECHNICAL PRIVATE EDUCATION ASSISTANCE COMMITTEE
GENDER AND SENSITIVITY MINDANAO STATE UNIVERSITY - ILIGAN INSTITUTE OF

05/18/2017 05/18/2017 8.0 TECHNICAL TECHNOLOGY
MINDANAO STATE UNIVERSITY - LANO NORTE
4/28/2017 4/28/2017 8.0 TECHNICAL
IDEYABREW Seminar Workshop AGRICULTURAL COLLEGE
Mindanao State University System-Wide Forestry and Basic Education Curriculum Summit
04/19/2017 04/20/2017 16.0 TECHNICAL MINDANAO STATE UNIVERSITY - MARAWI CAMPUS
Senior High School Teachers’ Training for State and Local Universities and Colleges of Regions IX, X, XI, XII
and CARAGA 09/20/2016 09/23/2016 32.0 TECHNICAL COMMISSION ON HIGHER EDUCATION
Alliance of Teachers for Innovative Educational

1st Multidisciplinary Research Conference 4/26/2016 4/28/2016 24.0 TECHNICAL
Excellence
Alliance of Teachers for Innovative Educational
Writeshop in Qualitative & Quantitative Research Writing 9/18/2015 9/18/2015 24.0 TECHNICAL
Excellence
Program Evaluation and Orientation on Outcomes - Based Education, Typology, New GEC, K-12 MINDANAO STATE UNIVERSITY - LANO NORTE
6/10/2022 6/10/2022 8.0 TECHNICAL
and Updates on Bangsamoro Governance AGRICULTURAL COLLEGE
VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write
(Write in full)
in full)
COOKING NONE Mindanao State University Alumni Association

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? ✘
b. within the fourth degree (for Local Government Unit - Career Employees)? ✘
If YES, give details: ________________________________

________________________________
35. a. Have you ever been found guilty of any administrative offense? ✘

________________________________
b. Have you been criminally charged before any court? ✘

________________________________
Date Filed:
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any
court or tribunal? ✘

________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, retirement, ✘
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the If YES, give details: ________________________________
public or private sector? ________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay ✘
election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last 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? ✘
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? ✘
If YES, please specify:

b. Are you a person with disability? ✘
If YES, please specify ID No:

c. Are you a solo parent? ✘
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
LILIBETH G. HEREBISE RAMAIN, SND, LANAO DEL NORTE 9171153740 3.5 cm. X 4.5 cm
(passport size)
LILIAN V.FEROLINO RAMAIN, SND, LANAO DEL NORTE NONE With full and handwritten
name tag and signature over
printed name
SHERLITA P. SANORIA POB., SND, LANAO DEL NORTE NONE
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 against me.
PHOTO
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/License/Passport No.:0584301 Signature (Sign inside the box)
01/25/2022
Date/Place of Issuance: 10/11/1999/ 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

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CS Form No.

PERSONAL DATA SHEET

MIDDLE NAME LUAB

17. RESIDENTIAL ADDRESS N/A PUROK RAMBOTAN

18. PERMANENT ADDRESS N/A PUROK RAMBOTAN

12. PHILHEALTH NO. 15-025215576-9 ZIP CODE 9211

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

14. TIN NO. 949-892-292 20. MOBILE NO. 0997-7449-227

MIDDLE NAME NABRE

EMPLOYER/BUSINESS NAME MSU-LNAC

BUSINESS ADDRESS RAMAIN, SULTAN NAGA DIMAPORO, LANAO DEL NORTE

TELEPHONE NO. NONE

24. FATHER'S SURNAME LUAB

MIDDLE NAME SARAUSAS

25. MOTHER'S MAIDEN NAME

FIRST NAME NORMA

MIDDLE NAME JUMAWAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

LANAO NORTE NATIONAL COMPREHENSIVE HIGH

NONE NONE NONE NONE NONE NONE NONE

MINDANAO STATE UNIVERSITY - LANAO NORTE MASTER OF ARTS IN EDUCATION MAJOR IN

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/25/2022 CS FORM 212 (Revised 2017), Page 1 of 4

PD 907 - HONOR GRADUATE NONE 03/20/99 COTABATO CITY 10120206 NO EXPIRY

(Continue on separate sheet if necessary)

(Continue on separate sheet if necessary)

NONE N/A N/A N/A N/A

(Continue on separate sheet if necessary)

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

INCLUSIVE DATES OF ATTENDANCE Type of LD

GENDER AND SENSITIVITY MINDANAO STATE UNIVERSITY - ILIGAN INSTITUTE OF

Alliance of Teachers for Innovative Educational

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

COOKING NONE Mindanao State University Alumni Association

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/25/2022 CS FORM 212 (Revised 2017), Page 3 of 4

If YES, give details: ________________________________

If YES, give details: ________________________________

b. Have you been criminally charged before any court? ✘

If YES, give details: ________________________________

If YES, give details: ________________________________

If YES, give details (country):

If YES, please specify:

If YES, please specify ID No:

If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4

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