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

MIDDLE NAME DOMACYON

3. DATE OF BIRTH
(mm/dd/yyyy)
11/27/1977 16. CITIZENSHIP ✘ Filipino Dual by
Citizenship
bir by naturalization
th
4. PLACE OF BIRTH MANKAYAN, BENGUET If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
✘ Female
Male
Singl ✘ Married 17. RESIDENTIAL ADDRESS N/A PUROK 6
6 CIVIL STATUS
e
Wido Separate House/Block/Lot No. Street
wed d HILLTOP BULANAO CENTRO
Othe Subdivision/Village Barangay
r/s: TABUK CITY KALINGA
7. HEIGHT (m) 163
City/Municipality Province
8. WEIGHT (kg) 73 ZIP CODE 3800
18. PERMANENT ADDRESS
9. BLOOD TYPE B+
House/Block/Lot No. Street

10. GSIS ID NO. 02004626860

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 158000870688

City/Municipality Province

12. PHILHEALTH NO. 04-050035138-3 ZIP CODE 3800

13. SSS NO. 01-1024662-8 19. TELEPHONE NO. N/A

14. TIN NO. 932-688-689 20. MOBILE NO. 09159350381

15. AGENCY EMPLOYEE NO. 6360813 21. E-MAIL ADDRESS (if any) maguiyajesse43@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BELISARIO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME MADELYN MA. FRANCHESCA MAGUIYA 1/11/2018

MIDDLE NAME BERNAL

OCCUPATION OFW

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME MAGUIYA

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

MIDDLE NAME ANG-ANG

25. MOTHER'S MAIDEN NAME

SURNAME DOMACYON

FIRST NAME TERESA (+)

MIDDLE NAME ICAO (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

ELEMENTARY LEPANTO ELEMENTARY SCHOOL ELEMENTARY EDUCATION 1986 1992 N/A 1992 N/A

SECONDARY /
VOCATIONAL LEPANTO NATIONAL HIGH SCHOOL HIGH SCHOOL 1992 1996 N/A 1996 N/A

N/A
TRADE
COURSE BACHELOR OF ARTS IN
COLLEGE SAINT LOUIS UNIVERSITY 1996 2001 N/A 2001 N/A
COMMUNICATION
MASTER OF ARTS IN TEACHING-
GRADUATE STUDIES UNIVERSITY OF THE CORDILLERAS 2006 2006 18 UNITS N/A N/A
ENGLISH AS SECOND LANGUAGE
(Continue on separate sheet if necessary)

SIGNATURE DATE May 17, 2022 CS FORM 212 (Revised 2017), Page 1 of 4
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% 8/1/2003 PINES CITY COLLEGES 1018291 11/27/2023

LICENSURE
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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)

DEPARTMENT OF EDUCATION/ TABUK

01/01/2022 05/17/2022 TEACHER II 27, 608 11-04 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2021 12/31/2021 TEACHER I 26,102 11-03 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
07/22/2020 12/31/2020 TEACHER I 26, 010 STEP 3 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2020 07/21/2020 TEACHER I 21,549 11-02 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2019 12/31/2019 TEACHER I 21549 11-02 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2018 12/31/2018 TEACHER I 21549 11-02 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
07/22/2017 12/31/2017 TEACHER I 21,549 STEP 2 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2017 07/21/2017 TEACHER I 18,549 11-01 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2016 12/31/2016 TEACHER I 18,549 11-01 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
01/01/2015 12/31/2015 TEACHER I 18,549 11-01 PERMANENT Y
CITY NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION/ TABUK
07/22/2014 12/31/2014 TEACHER I 18,549 11-01 PERMANENT Y
CITY NATIONAL HIGH SCHOOL

(Continue on separate sheet if necessary)

SIGNATURE DATE May 17, 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 NUMBER OF
(Write in full) (mm/dd/yyyy) HOURS POSITION / NATURE OF WORK
From To

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 NUMBER OF CONDUCTED/ SPONSORED BY
( Managerial/ Supervisory/
(Write in full) (mm/dd/yyyy)
HOURS
Technical/etc) (Write in full)

From To

ED TALKS: A JOURNALISM TRAINING SERIES FOR REGIONAL MEDIA 09/28/2019 09/28/2019 10HRS JOURNALISM SAN MIGUEL CORPORATION
SCHOOL LEARNING ACTION CELL ON PEDAGOGICAL RETOOLING IN
DEPARTMENT OF EDUCATION, TABUK CITY
MATHEMATICS, LANGUAGES AND SCIENCE FOR JUNIOR HIGH SCHOOL 01/23/2019 01/25/2019 32 HRS INSTRUCTIONAL
DIVISION
ENGLISH SUBJECT TEACHERS
EMPOWERING TEACHERS FOR EFFECTIVE AND INCLUSIVE LEARNING DEPARTMENT OF EDUACTION,TABUK CITY
10/24/2018 10/26/2018 30HRS INSTRUCTIONAL
PROCESS DIVISION
DEPARTMENT OF EDUCATION, TABUK CITY
PHILIPPINE PROFESSIONAL STANDARDS FOR TEACHERS 07/24/2018 07/26/2018 32 HRS INSTRUCTIONAL
DIVISION
SEMINAR WORKSHOP ON ADVANCE NEWS WRITING,RADIO BROADCASTING PROVINCIAL LOCA GOVERNMENT UNIT,
10/29/2018 10/31/2019 32 HRS INSTRUCTIONAL
AND PHOTOGRAPHY KALINGA PROVINCE
DEPARTMENT OF EDUCATION, TABUK CITY
ORIENTATION MEETING OF MAPEH FESTIVAL OF TALENTS ACTIVITIES 05/10/2017 05/14/2017 31 HRS INSTRUCTIONAL
DIVISION
SANAYGURO 2016 (NATIONAL TRAINING OF THE SPECIAL PROGRAM IN THE NATIONAL COMMISSION FOR CULTURE AND
10/10/2017 10/14/2017 41 HRS INSTRUCTIONAL
ARTS) THE ARTS
CAPACITY BUILDING SEMINAR ON CAREER GUIDANCE BASIC FOR GUIDANCE
06/08/2016 10/10/2016 30 HRS INSTRUCTIONAL DEPARTMENT OF EDUCATION, TABUK CITY
COUNSELORS/DESIGNATES AND CAREER ADVOCATES

DIVISION CAMPUS JOURNALISM TRAINING 10/09/2015 10/17/2015 30 HRS INSTRUCTIONAL DEPARTMENT OF EDUCATION, TABUK CITY
DEPARTMENT OF EDUCATION, CORDILLERA
REGIONAL BASIC EDUCATION CONGRESS 10/07/2015 10/09/2015 30 HRS INSTRUCTIONAL ADMINISTRATIVE REGION, WANGAL, LA
TRINIDAD, BENGUET
SPEECH MANAGEMENT AND RHETORIC
SUMMER SPEECH TRAINING PROGRAM 04/28/2015 04/30/2015 30 HRS INSTRUCTIONAL
TRAINING SYSTEM
SANAYGURO 2014 (NATIONAL TRAINING OF THE SPECIAL PROGRAM IN THE NATIONAL COMMISSION FOR CULTURE AND
10/25/2014 10/28/2014 32 HRS INSTRUCTIONAL
ARTS) THE ARTS
KNOWLEDGE AND UNDERSTANDINGON THE K TO 12 STANDARDS-BASED
10/03/2014 10/05/2014 30 HRS INSTRUCTIONAL DEPARTMENT OF EDUCATION
ASSESSMENT AND RATING SYSTEM
SCHOOL BASED SEMINAR-WORKSHOP ON CAMPUS JOURNALISM 09/26/2014 09/28/2014 30 HRS JOURNALISM DEPARTMENT OF EDUCATION, TABUK CITY

(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)

DRIVING N/A N/A

FIRST PLACE, REGIONAL BASIC EDUCATION CONRESS, ON-THE-SPOT PHOTO

PHOTOGRAPHY
CHALLENGE (TEACHER CATEGORY)

SINGING

(Continue on separate sheet if necessary)

SIGNATURE DATE May 17, 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? ✘ NO
YES
b. within the fourth degree (for Local Government Unit - Career Employees)? NO
✘
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 ✘
by any court or tribunal? YES NO
If YES, give details:
________________________________
________________________________
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 If YES
YES, give details: NO
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 ✘ NO
Barangay election)? YES
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last ✘ NO
YES
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? ✘ NO
YES
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? ✘ NO
YES
If YES, please specify:
b. Are you a person with disability? ✘ NO
YES
If YES, please specify ID No:
c. Are you a solo parent? ✘ NO
YES
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
MARIE LEE ANN CASTRO BONIFACIO ST, BAGUIO CITY 09175061214 3.5 cm. X 4.5 cm
(passport size)
LEXBER HEIGHTS, BALACBAC,
EDDIE O CARTA 09195947166 With full and handwritten
BAGUIO CITY name tag and signature over
HOLYGHOST EXTENSION, BAGUIO printed name
JOCELYN S. AMADEO 09275086451
CITY 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
ID/License/Passport No.: 1018291 Signature (Sign inside the box)
5/17/2022
Date/Place of Issuance: 11/27/2018/TUGEGARAO Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

CATHERINE M. BADONG
Administrative officer IV
Person Administering Oath

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