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 BOLUSO
NAME EXTENSION (JR., SR)
FIRST NAME ANA LINA

MIDDLE NAME HAGORILES

3. DATE OF BIRTH
8/21/1963 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘
by by
4. PLACE OF BIRTH TIGBAUAN, ILOILO If holder of dual citizenship, birth country:
Pls. indicate naturalization
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS lot 37 Block 14 9TH & 2ND
6 CIVIL STATUS
Single ✘
House/Block/Lot No. Street
Widowed Married
Separat VILLAMOR AIR BASE 183
Other/s: ed Subdivision/Village Barangay
PASAY METROMANILA
7. HEIGHT (m) 1.52
City/Municipality Province
8. WEIGHT (kg) 49 ZIP CODE 1309

18. PERMANENT ADDRESS 08-39 AERO ST.

9. BLOOD TYPE AB
House/Block/Lot No. Street
WOODCRESS 1 TAPIA
10. GSIS ID NO. 2005450085
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1040-0002-9124 GEN. TRIAS CAVITE

City/Municipality Province

12. PHILHEALTH NO. 19-050857672-6 ZIP CODE 4107

13. SSS NO. 03-8446968-8 19. TELEPHONE NO.

14. TIN NO. 133-267-297 20. MOBILE NO. 09991399198/

15. AGENCY EMPLOYEE NO. 5914383 21. E-MAIL ADDRESS (if any analina.boluso@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BOLUSO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) EXEQUIEL H. BOLUSO
FIRST NAME RICARDO 4/24/1995
EDEL GRACE ANDREA H. BOLUSO
MIDDLE NAME DE LA CRUZ 5/22/1996
RICA ANGELA H. BOLUSO
OCCUPATION SCHOOL BUS OPERATOR 12/11/1997
JOSEPHINE ANNE H. BOLUSO
EMPLOYER/BUSINESS NAME RACE J GEM TRANSPORT 2/18/1999
JOHN MICHAEL H. BOLUSO
BUSINESS ADDRESS SACRED HEART SCHOOL, PARAÑAQUE 6/26/2001

TELEPHONE NO.

24. FATHER'S SURNAME HAGORILES

NAME EXTENSION (JR., SR)
FIRST NAME EXEQUIEL

MIDDLE NAME BIÑAS

25. MOTHER'S MAIDEN NAME

SURNAME PADILLA

FIRST NAME PACITA

MIDDLE NAME LEDESMA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PAYAO ELEMENTARY SCHOOL ELEMENTARY 6/13/1971 3/30/1976 GRADUATED 1976 N/A

JUNE
SECONDARY /
VOCATIONAL SAN BLAS ACADEMY SECONDARY
13,1976
3/30/1980 GRADUATED 1980 FIRST HONORABLE MENTION

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

TRADE
BACHELOR OF SCIENCE IN CHEMICAL JUNE 13
COURSE
COLLEGE WESTERN INSTITUTE OF TECHNOLOGY
ENGINEERING 1980
3/29/1985 GRADUATED 1985 N/A

GRADUATE STUDIES COLLEGE UNIVERSITY OF PASAY MASTERAL DEGREE IN EDUCATION 10/21/2019 3/30/2020 9 units

PUBLIC ADMINISTRATION AND GOOD

PHILIPPINE CHRISTIAN UNIVERSITY
GOVERNANCE
6/25/2000 10/25/2000 9 units

CERTIFICATE FOR TEACHING

GRADUATE STUDIES PHILIPPINE NORMAL UNIVERSITY
PROFESSION
10/18/1988 3/30/1992 18 units 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
RA 1080 ( Licensure Examination foe Chemical
70.0 11/10/1985 Manila 15385 3/24/1986
Engineers)

RA 9293 ( Permit to Teach) 6/23/1996

(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)

1/1/2022 present Teacher 1 Pasay City South High school Step 2 Permanent N/A

7/16/2021 12/31/2021 Teacher 1 Pasay City South High school 21300.00 N/A Permanent N/A

1/1/2021 7/15/2021 Teacher 1 Pasay City South High school 800.00 N/A Permanent N/A

1/1/2020 12/31/2020 Teacher 1 Pasay City South High school 300.00 N/A Permanent N/A

1/1/2019 12/31/2019 Teacher 1 Pasay City South High school 3200.00 N/A Permanent N/A

7/16/2018 12/31/2018 Teacher 1 Pasay City South High school 20179.00 Permanent N/A

6/4/1988 5/31/2018 High School Faculty Sacred Heart School Permanent N/A

3/1/1986 5/31/1988 Junior Chemical Engineer integrated Electronics and Electrical Company N/A N/A
(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

Math and Science Club Outreach Program ( Sacred Heart School) 6/1/1990 3/31/2018 600.0 Moderator

Holy Eucharist Parish Outreach Program ( Moonwalk Paranaque) 8.0 Volunteer

Christian Living Program ( Sacred Heart School, Paranaque) 12/16/1998 12/16/2004 40.0 Assistant Moderator

Girl Scout of the Philippines ( Sacred Heart School, Paranaque) 6/1/1992 3/31/1996 20.0 Moderator

Disciples of Madre Isabella ( Sacred Heart School, Paranaque) 6/1/1996 3/31/2004 40.0 moderator

Brotherhood of Christian Businessmen and Professionals ( Pasay Chapter) 9/10/2002 1/31/2012 Member

(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 (Write in ( Managerial/
NUMBER OF HOURS
Supervisory/
CONDUCTED/ SPONSORED BY (Write in full)
full) (mm/dd/yyyy)
Technical/etc)
From To
GENDER AND DEVELOPMENT (GAD): TOWARDS A MORE INCLUSIVE MODEL OF GENDER BASED
6/22/2022 8.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
VIOLENCE
NATIONAL INSTITUTE FOR SCIENCE AND MATHEMATICS EDUCATION
ONLINE COURSE ON TEACHING FOR CONCEPTUAL UNDERSTANDING IN REMOTE LEARNING 3/25/2022 3/22/2022 16.0 TECHNICAL
DEVELOPMENT

3/20/2022 4.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL

WEBINAR FOR MAGNA CARTA FOR WOMEN
1/31/2022 2/2/2022 24.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
PCSHS- MID YEAR VIRTUAL INSET
STRATEGIES FOR ONLINE TEACHING IN FLEXIBLE LEARNING
11/15/2021 8.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
ENVIRONMENT
INTERNATIONAL MULTIDISCIPLANARY WEBINAR SERIES OF TECHNOLOGY
6/20/2021 7/2/2021 24.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
AND ITS APPLICATION IN DIFFERENT SUBJECT AREAS
3/25/2021 8.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
NATIONAL WOMEN'S MONTH WEBINAR
3/15/2021 8.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
VIRTUAL IN-SERVICE TRAINING FOR PUBLIC SCHOOL TEACHERS
2/23/2021 8.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
MENTAL HEALTH AWARENESS AND SUICIDAL PREVENTION
12/12/2020 12/14/2020 16.0 TECHNICAL ATENEO DE MANILA
sysTEM UPGRADE: STEM EDUCATION IN THE NEW NORMAL
12/12/2020 12/14/2020 16.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
PCSHS- MID YEAR VIRTUAL INSET
INTERNATIONAL TRAINING WORKSHOP ON ACTION RESEARCH FOR THE
12/16/2019 12/18/2019 16.0 TECHNICAL ATENEO DE MANILA
21ST CENTURY EDUCATORS
12/11/2019 12/12/2019 16.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
GENDER AND DEVELOPMENT (GAD):
REVITALIZING TEACHER COMPETENCEIN THE PURSUIT OF THE
10/21/2019 10/25/2019 24.0 TECHNICAL PASAY CITY SOUTH HIGH SCHOOL
IMPROVED SCHOOL PERFORMANCE
4/18/2019 4/20/2020 16.0 TECHNICAL ATENEO DE MANILA
TRAINING WORKSHOP ON RESEARCH AND LABORATORY MANAGEMENT
3/12/2019 8.0 PASAY CITY SOUTH HIGH SCHOOL
SCIENCE, TECHNOLOGY, ENGINEERING, AND MATHEMATICS (STEM)
3/28/2019 8.0 BUREAU OF FIRE PROTECTION, NCR
FIRE SQUARE ROADSHOW
TIP: A STEP TOWARDS BECOMING A PROFECIENT AND COMMITTED
10/30/2018 8.0 TAGUIG LAKESHORE HALL, TAGUIG CITY
TEACHER"
11/17/2018 8.0 WORLD TRADE CENTER, PASAY CITY
BIOTECHNOLOGY IN EDUCATION AND FOOD SAFETY
ENGAGING THE YOUTH IN SCIENTIFIC RESEARCH FOR HIGHER AMPLITUDE OF INNOVATION 3/8/2019 8.0 PASAY CITY NATIONAL SCIENCE HIGH SCHOOL

SCHOOL-BASED ROLL OUT ON THE RESULTS-BASED PERFORMANCE MANAGEMENT SYSTEM 7/14-15/2018 7/25/2018 24.0 PASAY CITY SOUTH HIGH SCHOOL

TRAIN IT FORWARD: EMPOWERING EDUCATORS TO FURTHER THEIR PROFESSIONAL DEVELOPMENT 11/10/2018 8.0 ASIA PACIFIC COLLEGE

CONTACT CENTER SERVICES NC II 7/16/2018 8/4/2018 144.0 TECHNICAL BIG HANDS FOUNDATION,INC

BETTER COMMUNITY THRU SCIENCE AND TECHNOLOGY 12/2/2017 8.0 TECHNICAL DE LA SALLE HEALTH SCIENCES INSTITUTE

GLOBAL RESOURCES FOR ASSESSMENT CURRICULIM AND

DESIGNING AND IMPLEMENTING EFFECTIVE TEACHING STRATEGIES 10/7/2017 8.0 TECHNICAL
EVALUATION
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

BAKING BEST IN RELIGION

CADETTE OF THE YEAR DISCIPLES OF MARY IMMACULATE

BROTHERHOOD OF CHRISTIAN BUSINESSMAN AND
PROFESSIONALS

(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
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
YES ✘ NO
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
Barangay election)? YES ✘ NO
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
VICTOR L. TUBILAN PASAY CITY SOUTH HIGH SCHOOL 9606121966 3.5 cm. X 4.5 cm
(passport size)

EDITHA F. ALIMBUYUGUEN PASAY CITY SOUTH HIGH SCHOOL 9999946442 With full and handwritten
name tag and signature over
printed name
EMILIA T. TOLENTINO PASAY CITY SOUTH HIGH SCHOOL 83593994
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: PROFESSIONAL TEACHER

ID/License/Passport No.: 60790

Signature (Sign inside the box)

Date/Place of Issuance: 05/16/1997 PRC MANILA

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