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 LAURIO
N/A
FIRST NAME MA. ESTHER

MIDDLE NAME AMADOR

3. DATE OF BIRTH
3/30/1997 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH BALENO,MASBATE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS PUROK 5

Widowed House/Block/Lot No. Street

Separate
NURSERY
Other/s: d
Subdivision/Village Barangay
MASBATE CITY MASBATE
7. HEIGHT (m) 1.56
City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 5400

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. Street
MADANCALAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BALENO MASBATE
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 5413

13. SSS NO. 05-1398392-8 19. TELEPHONE NO. N/A

14. TIN NO. 607-397-668-00000 20. MOBILE NO. 09078930735

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) estherlaurio30@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A 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 LAURIO

SR
FIRST NAME EDWIN

MIDDLE NAME DELA CRUZ

25. MOTHER'S MAIDEN NAME

SURNAME AMADOR

FIRST NAME SUSAN

MIDDLE NAME SAMBAJON (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY NURSERY ELEMENTARY SCOOL ELEMENTARY 2003 2009 N/A 2009 N/A

MASBATE NATIONAL COMPREHENSIVE

SECONDARY /
VOCATIONAL HIGH SCHOOL 2009 2013 N/A 2013 N/A
HIGH SCHOOL
TECHNICAL EDUCATION AND SKILLS MARCH APRIL
BREAD AND PASTRY NC II N/A 2018 N/A
DEVELOPMENT AUTHORITY (TESDA) 2018 2018
TRADE
BACHELOR OF ELEMENTARY
COURSE
COLLEGE LICEO DE MASBATE 2013 2017 N/A 2017 N/A
EDUCATION

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), 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 78.2 1/30/2022 MASBATE CITY 1919903 3/30/2025

DRIVER'S LICENSE N/A 7/21/2021 MASBATE CITY E03-21-201422 3/30/2026

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

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

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

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

N/A N/A N/A N/A 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)

3/30/2018 9/30/2022 BARANGAY LITERACY WORKER ALTERNATIVE LEARNING SYSTEM MASBATE CITY (LOCAL GOVERNMENT UNIT
FUNDED) 6500.00 N/A JOB ORDER Y

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

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(Continue on separate sheet if necessary)

SIGNATURE DATE
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

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

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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
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

04/06/2022 04/08/2022 24 N/A DepEd ALS - Masbate City

Division Re-Orientation and Capacity Building of ALS Implementers on the ALS Fast Project
5-Day "Free Wi-Fi For All Capacity Building Component Digital Literacy Training: Basic Computer Department of Information and Communications
02/21/2022 02/25/2022 40 N/A
Essentials and Network Troubleshooting with MS Learning" Technology (DICT)
Pansangay na Webinar sa Pagsasanay sa Literasi sa Filipino sa mga Guro ng Alternatibong
Sistema ng Pagkatuto (ALS)
08/09/2021 08/13/2021 40 N/A DepEd ALS - Masbate City

2021 Online/On-site Alternative Learning System Mid-Year Program Implementation Review 09/20/2021 09/24/2021 40 N/A DepEd ALS - Masbate City

5-Day Training on Alternative Learning System 2.0 for Brgy. Literacy Workers (BLW) 12/02/2019 12/06/2019 40 N/A DepEd ALS - Masbate City

Semestral Break - In Service Training on ALS Curriculum 2.0 08/21/2019 08/25/2019 40 N/A DepEd ALS - Masbate City

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

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(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)

COMPUTER SKILLS N/A N/A

COMMUNICATION SKILLS N/A N/A

PROBLEM SOLVING SKILLS N/A N/A

LEADERSHIP SKILLS N/A N/A

TIME MANAGEMENT SKILLS N/A 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), 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
JUDITH S. LEONA BRGY.BAPOR MASBATE CITY N/A 4.5 cm. X 3.5 cm
(passport size)

JOSEPHINE D. RIMANDIMAN CROSSING ST. MASBATE CITY N/A

Computer generated
or photocopied picture
MARVIN M. GARCIA PUROK 7 NURSERY MASBATE CITY N/A is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: PRC

ID/License/Passport No.: 1919903

Signature (Sign inside the box)

Date/Place of Issuance: 05/30/2022

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