INSTRUCTIONS

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Administrative Unit - 8938-7266
Personnel Unit - 8891-3148
INSTRUCTIONS
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Unit - 8938-7266
- 8891-3148
CS FORM 212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of
administrative/criminal
READ THE ATTACHED GUIDE case/s
TOagainst
FILLINGthe
OUTperson concerned.
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
VALDEZ
FIRST NAME NAME EXTENSION (JR., SR)
JOJO
MIDDLE NAME
CENTENO
3. DATE OF BIRTH 16. CITIZENSHIP
(mm/dd/yyyy) 1 Filipino 0 Dual Citizenship
March 21, 1984
0 by birth 0 by Naturalization
4. PLACE OF BIRTH If holder of dual citizenship,
MALASIQUI,PANGASINAN Pls. indicate country:
5. SEX please indicate the details.
1 Male 0 Female PHILIPPINES
6 CIVIL STATUS 17. RESIDENTIAL ADDRES 163 PISCES ST.
0 Single 1 Married
0 Widowed 0 Separated House/Block/Lot No. Street

0 Others: BATIMANA COMPOUND MARULAS

Subdivision/Village Barangay
7. HEIGHT (m) VALENZUELA CITY METRO MANILA
5'4
City/Municipality Province
8. WEIGHT (kg) ZIP CODE 1440
72 kg
9. BLOOD TYPE 18. PERMANENT ADDRES 293 BILDONG ST
B
House/Block/Lot No. Street
10. GSIS ID NO. MALIMPEC
2004719619
Subdivision/Village Barangay
11. PAG-IBIG ID NO. MALASIQUI PANGASINAN
1211-1875-2685
City/Municipality Province
12. PHILHEALTH NO. ZIP CODE
03-0257958724 2421
13. SSS NO. 19. TELEPHONE NO.
0111-2989118-6
14. TIN NO. 20. MOBILE NO. B
466-990-325 09091900528 A
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if an
5903452 jojo.valdez@deped.gov.ph N
G
II. FAMILY BACKGROUND
L
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name DATE OF BIRTH (mm/dd/yyyy)
CAYAGO and list all)
A
FIRST NAME NAME EXTENSION GAZELEM AMMON C. March 12, 2017 D
MERLAN (JR., SR) E
VALDEZ
MIDDLE NAME
BAYANGAT ALTHEA FAITH C. VALDEZ December 8, 2018 S
OCCUPATION
H
HOUSEWIFE
EMPLOYER/BUSINESS NAN/A

BUSINESS ADDRESS
N/A
TELEPHONE NO.
N/A
24. FATHER'S SURNAME
VALDEZ
FIRST NAME NAME EXTENSION
ONOFRE (JR., SR)
MIDDLE NAME
APOSTOL
25. MOTHER'S MAIDEN NAME

SURNAME
CENTENO
FIRST NAME
ADELINA
MIDDLE NAME
VILLENA (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND

BASIC PERIOD OF HIGHEST LEVEL/ SCHOLARSHI

NAME OF SCHOOL YEAR
EDUCATION/DEGREE/COURSE ATTENDANCE UNITS P/ ACADEMIC
26. LEVEL GRADUATE
EARNED HONORS
 BASIC PERIOD OF HIGHEST LEVEL/ SCHOLARSHI
NAME OF SCHOOL YEAR
EDUCATION/DEGREE/COURSE ATTENDANCE UNITS P/ ACADEMIC
26. LEVEL GRADUATE
EARNED HONORS
(Write in full) D
(Write in full) (if not graduated) RECEIVED
From To
ELEMENTARY MALIMPEC ELEMENTARY SCHOOL 06/05/199003/30/1996 1996
W/ HONORS
SECONDARY MALASIQUI NATIONAL HIGH SCHOOL 06/06/199604/01/2000 2000 C
H
VOCATIONAL / IC
LH
E
I
COLLEGE PERPETUAL HELP COLLEGE OF PANGASINA BEED 06/16/200105/30/2009 2009 C
N
O
TRADE COURSE
GRADUATE STUDIES
A
L
C
O
M
M
(Continue on separate sheet if necessary) O
B
R
SIGNATURE DATE February 9, 2023 IO
A
S
CS FORM 212 (Revised 2017), Page 1 of 4
IV.CIVIL SERVICE ELIGIBILITY
27 CAREER SERVICE/ RA 1080 (BOARD/ BAR) RATING LICENSE (if applicable)
UNDER SPECIAL LAWS/ CES/ (If DATE OF EXAMINATION /
CSEEBARANGAY ELIGIBILITY / DRIVER'S PLACE OF EXAMINATION / CONFERMENT Date of
Applicable) CONFERMENT NUMBER
LICENSE Validity

LISCENSURE EXAMINATION FOR TEACHERS 76.40% 10/4/2009 BAGUIO CITY 1053492 2/4/2010

(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.
28 SALARY/ JOB/
INCLUSIVE DATES PAY GRADE GOV'T
(mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / STATUS OF
POSITION TITLE(Write in MONTHLY (if applicable)& SERVICE
COMPANY(Write in full/Do not APPOINTMEN
full/Do not abbreviate) SALARY STEP(Format (Y/
abbreviate) T
"00-0")/ N)
From To INCREMENT

06/22/2015 PRESENT TEACHER 1 SALAPAN ELEMENTARY SCHOOL ₱27,573 REGULAR YES

01/26/2015 03/26/2015 TEACHER 1 PALAPAR ELEMENTARY SCHOOL ₱18,549 Reg. Sub. YES

10/27/2014 12/24/2014 TEACHER 1 OLEA ELEMENTARY SCHOOL ₱18,549 Reg. Sub. YES

8/11/0214 10-09-14 TEACHER 1 OLEA ELEMENTARY SCHOOL ₱18,549 Reg. Sub. YES

06-03-14 08/02/2014 TEACHER 1 OLEA ELEMENTARY SCHOOL ₱18,549 Reg. Sub. YES

03/03/2013 03-31-14 KD TEACHER MALIMPEC ELEMENTARY SCHOOL ₱6,000 Contractual YES

06/06/2012 03/22/2013 KD TEACHER MALIMPEC ELEMENTARY SCHOOL ₱3,000 Contractual YES

06/06/2011 03/30/2012 KD TEACHER / VOLUNTEER MALIMPEC ELEMENTARY SCHOOL ₱4,000 Contractual YES

06/06/2010 04-06-11 ELEMENTARY TEACHER LYCEUM NORTHWESTERN-FTDCI ₱5,240 Contractual NO

 (Continue on separate sheet if necessary)

SIGNATURE DATE February 9, 2023

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
29 INCLUSIVE NUMBE
NAME & ADDRESS OF ORGANIZATION(Write in full) DATES(mm/dd/yyyy) R OF POSITION / NATURE OF WORK
From To HOURS

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

(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)
30
INCLUSIVE DATES OF Type of LD
ATTENDANCE(mm/dd/yyyy) NUMBE
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING ( Managerial/ CONDUCTED/ SPONSORED BY
R OF
PROGRAMS(Write in full) Supervisory/ (Write in full)
HOURS
From To Technical /etc)

Seminar-workshop on Financial and Administrative Matters 11/17/2022 11/18/2022 16 DIVISION OF THE CITY OF SAN JUAN

MODULE WRITER 9/10/2020 10/10/2020 DIVISION OF THE CITY OF SAN JUAN

SEMINAR-WORKSHOP ON THE DEVELOPMENT AND VALIDATION OF RUVBRIKS ON CERTAIN

11/14/2019 11/16/2019 24 DIVISION OF THE CITY OF SAN JUAN
TOPICS IN MATHEMATICS
DepEd NCR-MTAP REGIONAL INTENSIVE TRAINING ON CONTENT AND PEDAGOGY FOR
5/25/2019 6/29/2019 40 MTAP-NCR
TEACHERS IN MATHEMATICS

INTEGRATED AND COMPREHENSIVE PLANNING AND BUDGETING WORKSHOP 03-20-2019- 3/21/2019 16 DIVISION OF THE CITY OF SAN JUAN

DIVISION SEMINAR WORKSHOP ON CONTENT KNOWLEDGE AND PEDAGOGY ENRICHMENT

22/10/2018 26/10/2018 32 DIVISION OF THE CITY OF SAN JUAN
FOR INTERMEDIATE TEACHERS

PROCUREMENT PLANNING WORKSHOP FOR BUDGET YEAR 2019 16/08/2018 18/08/2018 24 DIVISION OF THE CITY OF SAN JUAN

BASIC TRAINING COURSE FOR TROOP LEADERS COURSE NO. 2018-007 27/07/2018 29/07/2018 24 DIVISION OF THE CITY OF SAN JUAN

DIVISION TRAINING ON PEDAGOGICAL RETOOLING IN MATHEMATICS, LANGUAGES AND

16/07/2018 26/07/2018 16 DIVISION OF THE CITY OF SAN JUAN
SCIENCE

SEMINAR ON HEALTH AND NUTRITION PROGRAM IMPLEMENTATION 26/06/2018 27/06/2018 16 DIVISION OF THE CITY OF SAN JUAN

DIVISION COACHING SEMINAR 23/10/2017 29/10/2017 24 DIVISION OF THE CITY OF SAN JUAN

DIVISION CAPABILITY BUILDING SEMINAR ON PROPERTY AND SUPPLYMANAGEMENT FOR

ACCOUNTABLE OFFICIALS AND EMPLOYEE
10/10/2017 10/10/2017 8 DIVISION OF THE CITY OF SAN JUAN

MTAP-DepEd-NCR- Seminar Workshop in Mathematics wiith the Theme: " Making K-12 Succeed" 30/09/2017 07/10/2017 24
MTAP-NCR

QUALITY TOOLS FOR QUALITY LEARNING 6/6/2017 6/12/2017 24 SALAPAN ELEMENTARY SCHOOL

RETOOLING AND REVISITING OF K TO 12BASIC EDUCATION

PROGRAM
01/06/2017 06/03/2017 24 SALAPAN ELEMENTARY SCHOOL
 34 Are you related by consanguinity or affinity to the appointing or recommending authority,
chief of bureau or office or to the person who has immediate supervision over you in the
Bureau or Department where you will be apppointed,
a. within the third degree? 0 YES 1 NO
b. within the fourth degree (for Local Government Unit - Career Employees)? 0 YES 1 NO
If YES, give details:

35 a. Have you ever been found guilty of any administrative offense? 0 YES 1 NO
If YES, give details:

b. Have you been criminally charged before any court? 0 YES 1 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 0 YES 1 NO
or regulation by any court or tribunal? If YES, give details:

37 Have you ever been separated from the service in any of the following modes: 0 YES 1 NO
resignation, retirement, dropped from the rolls, dismissal, termination, end of term, If YES, give details:
finished contract or phased 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 0 YES 1 NO
year (except Barangay election)? If YES, give details:
b. Have you resigned from the government service during the three (3)-month period 0 YES 1 NO
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 0 YES 1 NO
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? 0 YES 1 NO
If YES, please specify:
b. Are you a person with disability? 0 YES 1 NO
If YES, please specify ID No:
c. Are you a solo parent? 0 YES 1 NO
If YES, please specify ID No:
41 REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
ID picture taken within
NAME ADDRESS TEL. NO. the last 6 months
3.5 cm. X 4.5 cm
09399055615 (passport size)
MR. JUMMAN AUDSON CORPUZ SAN CARLOS CITY, PANGASINAN
With full and handwritten
MR. MARK RYAN P. CENTENO DAGUPAN CITY, PANGASINAN 09172519115 name tag and signature over
printed name

MR. ROLLY A. LIQUIRAN MALASIQUI, PANGASINAN 09213264973

Computer generated
42 I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
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
PHOTO
herein.Iagree that any misrepresentation made in this document and its attachments shall cause the filing of
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:SSS

ID/License/Passport No Signature (Sign inside the box)

0111-2989918-6
February 9, 2023
Date/Place of Issuance
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me t , affiant exhibiting his/her validly issued government ID as indicated above.

ALLAN ELIEZER M. MAL-IN

Administrative Officer V
Person Administering Oath

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

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/Ma
30
INCLUSIVE DATES OF
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING ATTENDANCE(mm/dd/yyyy)
PROGRAMS(Write in full)
From
G PROGRAMS ATTENDED
ive (5) years for Division Chief/Executive/Managerial positions)
INCLUSIVE DATES OF Type of LD
TENDANCE(mm/dd/yyyy) NUMBE
( Managerial/ CONDUCTED/ SPONSORED BY
R OF
Supervisory/ (Write in full)
HOURS
To Technical /etc)
 Revised as of January 2015
Per CSC Resolution No. 1500088
Promulgated on January 23, 2015

SWORN STATEMENT OF ASSETS, LIABILITIES AND NET WORTH

As of December 31, 2022
(Required by R.A. 6713)

Note: Husband and wife who are both public officials and employees may file the required statements jointly or separately.

0 Joint Filing 0 Separate Filing 1 Not Applicable

DECLARANT: VALDEZ JOJO C. POSITION: TEACHER I

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: SALAPAN ELEM.
ADDRESS: 163 PISCES ST., MARULAS, VALENZUELA CITY OFFICE ADDRESS:11 S. VELOSO ST., SALAPAN, SAN JUAN CITY

SPOUSE: VALDEZ, MERLAN C. POSITION: NONE

(Family Name) (First Name) (M.I.) AGENCY/OFFICE: N/A
OFFICE ADDRESS:N/A

UNMARRIED CHILDREN BELOW EIGHTEEN (18) YEARS OF AGE LIVING IN DECLARANT’S HOUSEHOLD

NAME DATE OF BIRTH AGE

GAZELEM AMMON C. VALDEZ 03-12-2017 5
ALTHEA FAITH C. VALDEZ 12-08-2018 4
-nothing follows-

ASSETS, LIABILITIES AND NETWORTH

(Including those of the spouse and unmarried children below eighteen (18)
years of age living in declarant’s household)

1. ASSETS
a. Real Properties*
ASSESSED CURRET FAIR
VALUE MARKET VALUE ACQUISITION ACQUISITIO
DESCRIPTION KIND EXACT LOCATION (As found in the Tax Declaration of
YEAR MODE N COST
Real Property)

Malimpec, Malasiqui,
House Residential 480,000 480,000 2022 Construction 480,000
Pangasinan

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

Subtotal: 480,000
b. Personal Properties*
ACQUISITION
DESCRIPTION YEAR ACQUIRED COST /
AMOUNT

1 TRICYCLE W/ FRANCHIZE 2019 150,000.00

HONDA CLICK 2019 76,400

-nothing follows-

Subtotal: 226,400.00

TOTAL ASSETS (a+b): 706,400

*Additional sheet/s may be used, if necessary.

Page 1 of 2

2. LIABILITIES*

NATURE NAME OF CREDITORS OUTSTANDING BALANCE

CONSUMPTION ONE NETWORK BANK 246,000.00
CONSUMPTION EAST WEST 241,000.00
CONSUMPTION CHINA BANK 9,790.00
CONSUMPTION GSIS CONSOLIDATED LOAN 21,000.00
 TOTAL LIABILITIES: 517,790.00
ET WORTH : Total Assets less Total Liabilities = 188,610
* Additional sheet/s may be used, if necessary.

BUSINESS INTERESTS AND FINANCIAL CONNECTIONS

(of Declarant /Declarant’s spouse/ Unmarried Children Below Eighteen (18) years of Age Living in Declarant’s Household)
0 I/We do not have any business interest or financial connection.
NAME OF NATURE OF BUSINESS
INTEREST &/OR
ENTITY/BUSINESS BUSINESS ADDRESS INTEREST &/OR FINANCIAL
N/A ENTERPRISE N/A FINANCIAL CONNECTION N/A
N/A
N/A N/A N/A N/A
N/A N/A N/A N/A

RELATIVES IN THE GOVERNMENT SERVICE

(Within the Fourth Degree of Consanguinity or Affinity. Include also Bilas, Balae and Inso)
0 I/We do not know of any relative/s in the government service)

NAME RELATIONSHIP POSITION NAME OF AGENCY/OFFICE AND ADDRESS

N/A N/A N/A N/A
N/A N/A N/A N/A
N/A N/A N/A N/A
age living in my household, and that to the best of my knowledge, the above-enumerated are names of my relatives in the
government within the fourth civil degree of consanguinity or affinity.
children below 18 years of age living with me in my household covering previous years to include the year I first assumed
office in government.

Date February 9,2023

N/A
(Signature of Declarant) (Signature of Co-Declarant/Spouse)

Government Issued IDPRC Government Issued ID N/A

ID No.: 1053492 ID No.: N/A
Date Issued: 2-4-2010 Date Issued: N/A

SUBSCRIBED AND SWORN to before me this day of , affiant exhibiting to me the

above-stated government issued identification card.

(Person Administering Oath)

Page 2 of 2
 SERVICE RECORD
NAME: VALDEZ JOJO CENTENO
Surname First Name Middle Name

BIRTH: March 21, 1984 MALASIQUI,PANGASINAN

Date Place

Service (Inclusive Dates) Record of Appointment

Station/Place of
Assignment
From To Designation Status Salary

*** Nothings Follow ***

ECORD
EMP NO.:

Leave Without Separation

Division/ Branch
Pay Date/Cause

w ***
 LEAVE CREDITS

NAME VALDEZ, JOJO CENTENO

BIRTHDATE: March 21, 1984
BIRTH PLACE: MALASIQUI,PANGASINAN
Special Order No. of Days
Earned Kind of Leave
Number Used
*** Nothing Follows ***
EAVE CREDITS

VICATION
Particulars Inclusive Period of Absence SICK LEAVE
LEAVE
*** Nothing Follows ***
 SUMMARY OF RATING

NUMERICAL ADJECTIVAL
SCHOOL YEAR
RATING RATING

SY 2019-2020

SY 2018-2019

SY 2017-2018

SY 2016-2017