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 OMAR
NAME EXTENSION (JR., SR) N/A
FIRST NAME ALEX

MIDDLE NAME KATUA

3. DATE OF BIRTH
(mm/dd/yyyy) 6/28/1996 16. CITIZENSHIP

4. PLACE OF BIRTH MATILAC, PIGCAWAYAN, COTABATO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS N/A N/A

6 CIVIL STATUS
House/Block/Lot No. Street
SITIO BALUGO MATILAC
Subdivision/Village Barangay
PIGCAWAYAN COTABATO
7. HEIGHT (m) 1.6
City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 9412

18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE 0
House/Block/Lot No. Street
SITIO BALUGO MATILAC
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A PIGCAWAYAN COTABATO

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9412

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

14. TIN NO. N/A 20. MOBILE NO. 09653807273

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) akomar@usm.edu.ph
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
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 OMAR

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

MIDDLE NAME PIANG

25. MOTHER'S MAIDEN NAME WAHIDA B. KATUA

SURNAME KATUA

FIRST NAME WAHIDA

MIDDLE NAME BANGKONG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

VALEDICTORIA
ELEMENTARY MATILAC ELEMENTARY SCHOOL ELEMENTARY 2006 2011 GRADUATED 2011 N

VALEDICTORIA
SECONDARY /
VOCATIONAL MATILAC HIGH SCHOOL HIGH SCHOOL 2011 2015 GRADUATED 2015 N

DATU MONTAWAL EXTENSION CAMPUS TRAINING

CENTER
COMPUTER SYSTEMS SERVICING NCII 2019 2020 COMPLETED 2020 CERTIFICATE

TRADE
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE UNIVERSITY OF SOUTHERN MINDANAO- KABACAN
MAJOR IN SOCIAL STUDIES
2015 2019 GRADUATED 2019 CUM LAUDE

UNIVERSITY OF SOUTHERN MINDANAO- GRADUATE MASTER OF ARTS IN TEACHING SOCIAL

GRADUATE STUDIES
SCHOOL SCIENCE
2020 [ONGOING] 36 UNITS N/A CANDIDATE

(Continue on separate sheet if necessary)

SIGNATURE DATE April 15, 2022
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

LICENSE PROFESSIONAL TEACHER 85.8 9/29/2019 UM MATINA-DAVAO CITY 1849843 2020-2025

(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.
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)

9/1/1930 3/20/2022 SENIOR HIGH SCHOOL TEACHER GANI L. ABPI COLLEGE, INC. P 10,000.00 N/A CONTRACTUAL N

8/12/2020 10/20/2020 PSA ENUMERATOR PHILIPPINE STATISTICS AUTORITY P 6,000.00 N/A CONTRACTUAL YN

(Continue on separate sheet if necessary)

SIGNATURE DATE April 15, 2022

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

SSS- SOCIETY OF SOCIAL SCIENTISTS- USM KABACAN, COTABATO 6/28/2016 4/24/2017 17280.0 MEMBER

SSS- SOCIETY OF SOCIAL SCIENTISTS- USM KABACAN, COTABATO 4/24/2017 4/14/2018 8640.0 PRESIDENT

LSG- LOCAL STUDENT GVERNMENT- USM, KABACAN, COTABATO 4/24/2017 4/14/2018 8640.0 APPOINTEE

USG- UNIVERSITY STUDENT GVERNMENT- USM, KABACAN, COTABATO 8/3/2018 6/8/2019 8640.0 DEPARTMENT ASSISTANT SECRETARY

FSMS- FUTURE SECONDARY MENTOR SOCIETY- USM, KABACAN,

4/21/2015 6/8/2019 34 560.0 MEMBER
COTABATO
PGNCOS- PROVINIAL GOVERNMENT OF NORTH COTABATO
4/21/2015 6/8/2019 34 560.0 MEMBER
ORGANIZATIONS OF SCHOLARS- USM, KABACAN, COTABATO

(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
INSET 2021 07/15/2021 07/17/2021 72 TECHNICAL PEAC
FACULTY ENHANCEMENT TRAINING 03/08/2020 10/08/2020 168.0 TECHNICAL GANI L. ABPI COLLEGE, INC.
TECHNICAL EDUCATION AND SKILLS
COMPUTER SYSTEMS SERVICING NCII 12/9/2019 1/17/2020 280.0 TECHNICAL
DEVELOPMENT AUTHORITY

WATER SEARCH AND RESCUE TRAINING CLASS 02-2019 11/29/2019 12/6/2019 168.0 TECHNICAL
6TH DIVISION TRAINING SCHOOL.

SEGIESEMINAR -WORKSHOP ON INNOVATIVE TACHING STRATEGIES 11/16/2018 11/17/2018 48.0 TECHNICAL

COLLEGE OF EDUCATION

SEMINAR ON WRITING THE RESEARCH OUTPUT 8/31/2018 8/31/2018 24.0 TECHNICAL COLLEGE OF ARTS AND SOCIAL SCIENCES

2-DAY YOUNG LEADERS CONGRESS 9/19/2017 9/20/2017 48.0 MANAGERIAL

COLLEGE OF EDUCATION
GROUP GROWTH PROGRAM SEMINAR 2/19/2016 2/19/2016 24.0 TECHNICAL
USM-GAD
ADOLESCENT REPRODUCTIVE HEALTH AND HIV/AIDS AWARENESS 11/17/2017 11/17/2017 24.0 TECHNICAL
USM-GAD
SOCIETY AND CULTURAL DAY 2/27/2016 2/27/2016 24.0 TECHNICAL COLLEGE OF ARTS AND SOCIAL SCIENCES

2ND TWAP INTEGRATED WRITING COMPETITION WITH SEMINAR 11/19/2016 11/19/2016 24.0 TECHNICAL COLLEGE OF ARTS AND SOCIAL SCIENCES

PAGTUDLO 2015 NATIONAL CONFERENCE AND WORKSHP ON ENHANCING THE QUALITY OF

LEARNING THROUGH PRODUCTIVE PEDAGOGY, REAEARCH AND DATA ANALYSIS
8/22/2015 8/22/2015 24.0 TECHNICAL COLLEGE OF ARTS AND SOCIAL SCIENCES

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 2 (Write in
(Write in full)
. full)
SOCIETY OF SOCIAL SCIENTISTS ALUMNI
BASIC COMPUTER LITERATE OUTSTANDNG SOCIAL SCIENTIST PRESIDENT MEMBER
BARMM- RAPID EMERGENCY ACTION ON
PLAYING BASKETBALL LET PASSER
DISASTER INSIDENCE
PAFTE- PHILIPPINE ASSOCIATION OF
DAMATH/SCIDAMA PLAYER/COACH/TRAINER LOCAL GOVERNMENT STUDENT OFFICER
TEACHERS AND EDUCATORS
PRESIDENT OF SOCIETY OF SOCIAL SCIENTIST FOR TWO CONSECUTIVE SCHOOL
VOLLEYBALL PLAYER USM- ALUMNI ORGANIZATION
YEAR
FSMS- FUTURE SECONDARY MENTOR
SWIMMER UNIVERSITY STUDENT GOVERNMENT OFFICER
SOCIETY
BAD MENTON PLAYER BEST TEACHER SY. 2020-2021 SSS- SOCIETY OF SOCIAL SCIENTISTS
UNYPAD-UNITED YOUTH FOR PEACE
AND DEVELOPMENT (DATU PIANG
ORGANIZER (EVENT) BEST TEACHER SY. 2021-2022
CHAPTER PEACE AND ADVOCACY
GLACI-SHSCHAIRMAN)
OVERALLPPROGRAM
BEST CLASSROOM SY. 2021-2022
COORDINATOR
(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 15,2022

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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
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
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,
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
Barangay election)?
If YES, give details:
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
MARS R. DILANGALEN MATILAC, PIGCAWAYAN, COTABATO 9186959677 3.5 cm. X 4.5 cm
(passport size)

KAUTIN S. KULANO, PhD USM, KABACAN, COTABATO 9091914837 With full and handwritten
name tag and signature over
printed name
RANJE S. JURANE, LPT DATU PIANG, MAGUINDANAO 9358622381
Computer generated
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 administrative/criminal case/s against me.

or photocopied picture
is not acceptable

PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID:

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

Date/Place of Issuance:
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