CS Form No.

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 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 PASCUA
FIRST NAME CHRISTINE GRACE
MIDDLE NAME PERALTA
3. DATE OF BIRTH
(mm/dd/yyyy) 5/8/1996 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH DAGUPAN, PANGASINAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS ZONE 3
Widowed Separated House/Block/Lot No. Street
BARANGAY
Other/s:
Subdivision/Village
STA CRUZ
7. HEIGHT (m) 151
City/Municipality Province
8. WEIGHT (kg) 48 ZIP CODE PAMPLONA CAGAYAN
18. PERMANENT ADDRESS ZONE 3
9. BLOOD TYPE O
House/Block/Lot No. Street

10. GSIS ID NO. N/A

Subdivision/Village Barangay
STA CRUZ
11. PAG-IBIG ID NO. 121273905666
City/Municipality Province
12. PHILHEALTH NO. 06-250264718-6 ZIP CODE PAMPLONA CAGAYAN

13. SSS NO. 0127432632 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09679420203

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) pascuachristinegrace08@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)
FIRST NAME 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 PASCUA

FIRST NAME ROLAND

MIDDLE NAME PAMITTAN

25. MOTHER'S MAIDEN NAME

SURNAME PERALTA

FIRST NAME SALVACION

MIDDLE NAME BASBAS (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 PIMPILA ELEMENTARY SCHOOL ELEMENTARY 2003 2009 GRADUATED 2009

SECONDARY
VOCATIONAL /
SANCHEZ MIRA SCHOOL OF ARTS AND TRADES SECONDARY 2009 2013 GRADUATED 2013

SANCHEZ MIRA SCHOOL OF ARTS AND TRADES BEAUTY CARE SERVICES (NAILS) 2012 2013 GRADUATED 2013
TRADE BACHELOR OF SECONDARY EDUCATION
COLLEGE
COURSE CAGAYAN STATE UNIVERSITY-SANCHEZ MIRA
MAJOR IN FILIPINO
2013 2017 GRADUATED 2017

GRADUATE STUDIES N/A N/A NA NA NA NA

(Continue on separate sheet if necessary)

SIGNATURE DATE 6-8-22 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 PROFESSIONAL
78.40 9\25\2017 TUGUEGARAO CITY 1623688 9/25/2020
TEACHERS

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

1/9/2021 Present Teacher FL.Vargas Colleges Inc. 8000 Contructual N/A

8-16-2018 3-14-2020 Teacher St. Michael Institute For lifelong Education 8,500:00 Contructual N/A

10/1/2017 3/1/2018 Teacher Little Angel Learning Center 1000.00 Contructual N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 6-8-22 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
(mm/dd/yyyy) HOURS POSITION / NATURE OF WORK
(Write in full)
From To

(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 ( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy)
HOURS Supervisory/ (Write in full)
Technical/etc)
From To
DEPARTMENT OF EDUCATION AND
DESIGNING, ASSESING and FACILITATING LEARNING FOR THE K-12 CURRICULUM PRIVATE EDUCATION ASSISTANCE
4/30/2018 5/2/2018 24
STANDARDS COMMITTEE
JO-ES PUBLISHING
TEACHING GROWTH MIND SET 2/3/2019 7.5
HOUSE ,INC.
ASOSASYON NG MGA
TEACHING OUT OF THE BOX 9-20-2019 9 PRIBADONG PAARALAN NG
MAKATI(APPMI)
DIWA INNOVATION WORKSHOP FOR EDUCATORS 7/12/2019 9 DIWA INNOVATION

CONTEXTUALIZED LEARNING DELIEVERY MODALITIES 5-27-2020 1 VIBAL GROUP

ADDRESING CHALLENGES IN DELIVERING REMOTE LEARNING FOR OFFLINE
8-28-2020 1 VIBAL GROUP
LEARNING
CONDUCTING ASSESSMENT ON ONLINE DISTANCE LEARNING 5/6/2020 1 VIBAL GROUP

PARENTAL ROLE TOWARDS EFFECTIVE DELIEVERY OF HOME -BASED EDUCATION 6-18-2020 1 VIBAL GROUP
OFFLINE LEARNING OPPORTUNITIES : IMPLEMENTING MODULAR APPROACH IN THE
1/6/2020 1 VIBAL GROUP
CURRENT EDUCATIONAL SYSTEM
MERGING LEARNING COMPETENCIES AND PRACTICES TO FACILITATE THE SHIFT
5-28-2020 1 VIBAL GROUP
TO THE NEW NORMAL
KEY CONSIDERATIONS IN DESIGNING MODULES FOR DISTANCE LEARNING 4/6/2020 1 VIBAL GROUP

PAGTATAHIP -DUNONG : PAGGAMIT NG MUSIAKNG MAKABAYAN SA PAGTUTURO 5-21-2020 3 TANGGOL WIKA

MULTIDISIPLINARING DULOG SA PAGBASA AT PAGTUTURO NG PANITIKAN 5-22-2020 3 TANGGOL WIKA

ENSURING ENDURING STUDENT LEARNING OUTCOMES WITH ONLINE DISTANCE PRIVATE EDUCATION
9-14-2020 9-16-2020 5
LEARNING AND TEACHING OF K-12 STANDARDS IN THE TIM OF COVID -19 ASSISTANCE COMMITTEE
PRIVATE EDUCATION
TEACHING SHS CORE SUBJECTS FOR SENIOR HIGH SCHOOL TEACHERS 9-17-2020 9-19-20 5
ASSISTANCE COMMITTEE
TEKNOLOHIYA : ANG PAGSASANIB NG TEKNOLOHIYA AT KULTURA SA PAGTUTURO
10/6/2020 2 VIBAL GROUP
NG FILIPINO SA BAGONG NORMAL
PAGLIKHA NG MGA PINALATUNTUNANG KAGAMITANG PANTURO TUNGO SA SARILI
8/6/2020 2 VIBAL GROUP
NG PAGKATUTO NG MGA MAG-AARAL
CLASSNOVATION SKILLS
COMPUTER LITERACY 8/11/2021 11-26-2021 90
LEARNING CENTER

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

READING BOOKS N/A

PLAYING BADMINTON

COMPUTER LITERACY

(Continue on separate sheet if necessary)

SIGNATURE DATE 6-8-22 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:
________________________________
________________________________

YES ✘ NO
b. Have you been criminally charged before any court?
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? ________________________________
resignation, finished contract
________________________________
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:

YES ✘ NO
b. Have you resigned from the government service during the three (3)-month period 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 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.
Mrs. LETICIA B.BELIGANIO STA CRUZ,PAMPLONA, CAGAYAN 9171872686 ID picture taken within
the last 6 months
Mr.NORMITO R. YAGUE BIDDUANG,PAMPLONA CAGAYAN 9663795322 3.5 cm. X 4.5 cm
(passport size)
Mrs. Marilyn L.Yague BIDDUANG,PAMPLONA CAGAYAN 9267853518
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete With full and handwritten
name tag and signature over
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I PHOTO
printed name
authorize the agency head / authorized representative to verify/validate the contents stated herein. I agree that any
Computer generated
misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s or photocopied picture
against me. is not acceptable
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.: 1623688

Signature (Sign inside the box)
6-8-22
Date/Place of Issuance: 2-5-2018- PRC TUGUEGARAO
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 8 day of June 2022 , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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