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

MIDDLE NAME URBANA

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 10/16/1990 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MARAWOY, LIPA CITY 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 1

Widowed Separated House/Block/Lot No. Street
Latayan Compound Pusil
Other/s:
Subdivision/Village Barangay
LIPA CITY BATANGAS
7. HEIGHT (m) 1.71
City/Municipality Province
8. WEIGHT (kg) 65 ZIP CODE 4217

18. PERMANENT ADDRESS Purok 1

9. BLOOD TYPE B+
House/Block/Lot No. Street
Latayan Compound Pusil
10. GSIS ID NO. 2004347989
Subdivision/Village Barangay
LIPA CITY BATANGAS
11. PAG-IBIG ID NO. 914063089060
City/Municipality Province

12. PHILHEALTH NO. 0905-0319451-0 ZIP CODE 4217

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 437-691-328 20. MOBILE NO. 0956-479-4657

15. AGENCY EMPLOYEE NO. 4740610 21. E-MAIL ADDRESS (if any) jerome.osello001@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME OSELLO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME DENISSE N/A N/A N/A

MIDDLE NAME LATAYAN

OCCUPATION TEACHER

EMPLOYER/BUSINESS NAME DEPED LIPA CITY

BUSINESS ADDRESS OLAN'S PLACE MARAWOY, LIPA CITY

TELEPHONE NO. N/A

24. FATHER'S SURNAME

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

MIDDLE NAME
OGAÑA
25. MOTHER'S MAIDEN NAME

SURNAME
URBANA
FIRST NAME
ESTELITA
MIDDLE NAME (Continue on separate sheet if necessary)
DEL SOCCORO
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS YEAR
SCHOLARSHIP/
LEVEL (Write in EARNED GRADUATED
ACADEMIC HONORS
(Write in full) RECEIVED
full) (if not graduated)
From To

ELEMENTARY GAUDENCIO B. LONTOK MEMORIAL SCHOOL PRIMARY 1996 2002 N/A 2002 N/A

SECONDARY /
VOCATIONAL INOSLOBAN-MARAWOY NATIONAL HIGH SCHOOL SECONDARY 2002 2006 N/A 2006 N/A

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

TRADE
COURSE
COLLEGE KOLEHIYO NG LUNGSOD NG LIPA BACHELOR OF ELEMENTARY EDUCATION 2007 2011 N/A 2011 N/A

MASTER OF ARTS IN EDUCATION MAJOR IN 36 UNITS

GRADUATE STUDIES RIZAL COLLEGE OF TAAL EDUCATIONAL ADMINISTRATION 2014 2016 N/A N/A
(CARMA)
(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

LICENCESURE EXAMINATION FOR TEACHERS 75.00% 09/25/2011 IBABANG DUPAY ELEM SCHOOL LUCENA CITY 1138186 10/16/2025

(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. INCLUSIVE DATES SALARY/ JOB/ PAY GOV'T 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")/ (Y/
abbreviate) full/Do not abbreviate) INCREMENT
From To N)

DEPED LIPA- STO. TORIBIO ELEMENTARY

2/9/2018 PRESENT TEACHER III 24,224.00 13-1 PERMANENT Y
SCHOOL
DEPED LIPA- STO. TORIBIO ELEMENTARY
6/3/2014 1/9/2018 TEACHER I 19,067.00 11-1 PERMANENT Y
SCHOOL
DEPED LIPA- STO. TORIBIO ELEMENTARY LOCAL
7/1/2013 6/2/2014 TEACHER I 18,549.00 11-1 Y
SCHOOL PERMANENT

06/25/2011 03/13/2013 TEACHER AGES AND STAGES LEARNING CENTER 6,000.00 N/A CONTRACTUAL N
 (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

(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 ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
Refresher Course for Coaches, Officiating Officials and Torunament Managers on DEPED SPORTS ENTHUSIAST ASSOCIATION OF LIPA
7/3/2023 7/3/2023 24 TECHNICAL
Selected Sports Phase 2 (DEPED-SEAL)
FIT AND RIGHT TEACHING PEDAGOGY: A SHORT COURSE ON CRITICAL CONTENT IN
MUSIC AND ARTS
6/2/2023 10/2/2023 40 TECHNICAL Department of Education Lipa City

Refresher Course for Coaches, Officiating Officials and Torunament Managers on DEPED SPORTS ENTHUSIAST ASSOCIATION OF LIPA
01/20/2023 01/20/2023 8 TECHNICAL
Selected Sports Phase 1 (DEPED-SEAL)
Regional Association of Communication Arts
2022 REGIONAL VIRTUAL WORKSHOP ON READING INTERVENTION 07/13/2022 07/15/2022 24 TECHNICAL
Supervisors (RACAS)
TRAINING WORKSHOP ON MANAGING SPECIAL INTEREST PROGRAM FOR CULTURE AND
ARTS (SIPCA) SCHOOLS
07/28/2021 07/30/2021 24 TECHNICAL Department of Education Lipa City

VIRTUAL IN-SERVICE TRAINING FOR PUBLIC SCHOOL TEACHERS 03/15/2021 03/19/2021 40 TECHNICAL ICTS-EdTech

WEBINAR ON DESIGNING RESEARCH PROPOSALS 6/3/2021 6/4/2021 8 TECHNICAL Department of Education Lipa City

IKA-7 KONGRESO NG CALABARZON PASATAF (WIKA NG KASAYSAYAN, KASAYSAYAN NG

WIKA)
08/29/2020 08/29/2021 8 TECHNICAL CALABARZON-PASATAF
ADAPT AND OVERCOME: Redefining the Teaching Delivery of MAPEH in the New
5/11/2020 6/11/2020 8 TECHNICAL Department of Education Lipa City
Normal
WEBINAR ON MANAGING TEACHING AND LEARNING IN THE NEW NORMAL
ENVIRONMENT
1/7/2020 1/7/2020 8 TECHNICAL Department of Education Lipa City- North District

THE SCIENCE AND ART OF SPEAKING IN THE NEW NORMAL 09/15/2020 09/16/2020 6 TECHNICAL Department of Education Lipa City- North District

CAPACITY BUILDING FOR TEACHERS AND SCHOOL LEADERS FCUSED ON

DEVELPOMENT AND UTILIZATION OF I.D.E.A. LESSON EXEMPLAR
07/13/2020 07/15/2020 12 TECHNICAL National Educators Academy of the Philippines
2019 DIVISION TRAINING ON SCHOOL SPORTS OFFICIATING AND COACHING DEPED SPORTS ENTHUSIAST ASSOCIATION OF LIPA
10/21/2019 10/23/2019 24 TECHNICAL
(TABLE TENNIS) (DEPED-SEAL)
IKA-6 NA PANREHIYONG KONGRESO NG MGA GURO SA FILIPINO (WIKANG KATUTUBO:
TUNGO SA ISANG BANSANG FILIPINO)
08/31/2019 08/31/2019 8 TECHNICAL CALABARZON-PASATAF
2018 TRAINING OF COACHES AND OFFICIATING OFFICIALS ON SELECTED DEPED SPORTS ENTHUSIAST ASSOCIATION OF LIPA
10/24/2018 10/26/2018 24 TECHNICAL
SPORTS EVENT PHASE 2 (DANCESPORT) (DEPED-SEAL)
2018 TRAINING OF COACHES AND OFFICIATING OFFICIALS ON SELECTED DEPED SPORTS ENTHUSIAST ASSOCIATION OF LIPA
7/8/2018 8/8/2018 16 TECHNICAL
SPORTS EVENT PHASE 1 (DANCESPORT) (DEPED-SEAL)
DIVISION TRAINING ON PEDAGOGICAL RETOOLING IN MATHEMATICS,
05/23/2018 05/25/2018 12 TECHNICAL Department of Education Lipa City
LANGUAGES AND SCIENCE (PRIMALS) PROGRAM
2018 ACADEMIC INSTITUTE FOR DISTINCTION: TRAINING ON CURRICULUM INTERVENTIONS/INNOVATIONS FOR TEACHERS AND
SCHOOL HEADS OF PUBLIC ELEMENTARY SCHOOLS (MUSIC) 04/19/2018 04/20/2018 12 TECHNICAL Department of Education Lipa City

(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)

DISTRICT SCIENCE FAIR AND CONGRESS 2015 COLLAGE MAKING TEACHERS CATEGORY- LIPA CITY ASSOCIATION OF PUBLIC SCHOOL
DANCING TEACHERS AND EMPLOYEES, INC.
SECOND PLACE
DIVISION SCIENCE FAIR AND CONGRESS 2015 COLLAGE MAKING TEACHERS CATEGORY- LIPA CITY ASSOCIATION OF SCHOOL PAPER
CHOREOGRAPHING
FIRST PLACE ADVISERS, INC.
12TH REGIONAL SCIENCE QUEST 2015 COLLAGE MAKING TEACHERS CATEGORY- FIRST DEPED SPORTS ENTHUSIASTS ASSOCIATION OF
COMPUTER LITERATE
PLACE LIPA
12TH NATIONAL SCIENCE QUEST 2015 COLLAGE MAKING TEACHERS CATEGORY- FIFTH
DRAWING
PLACE
 (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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
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 NO
YES ✘
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
DR. FLORDELIZA L. RITAN STO. TORIBIO MARAWOY, LIPA CITY 0919 933 0314 3.5 cm. X 4.5 cm
(passport size)

MELODY K. LIPA BULACNIN, LIPA CITY 0916 3644 901 With full and handwritten
name tag and signature over
printed name
DR. EDITA T. OLAN BULACNIN, LIPA CITY 0919 993 0211
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.: 1138186

Signature (Sign inside the box)

Date/Place of Issuance: 07/13/2012/ LUCENA 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