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

MIDDLE NAME ZACARIAS

3. DATE OF BIRTH
(mm/dd/yyyy) 8/31/1985 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH TAGUMPAY,ROXAS,PALAWAN If holder of dual citizenship, Pls. indicate country:

please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS N/A N/A

6 CIVIL STATUS SINGLE
House/Block/Lot No. Street
PUROK 1 TAGUMPAY
Subdivision/Village Barangay

7. HEIGHT (m) 1.49m ROXAS PALAWAN

City/Municipality Province
8. WEIGHT (kg) 45kg ZIP CODE 5308

9. BLOOD TYPE "O"

18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street
PUROK 1 TAGUMPAY
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-2079-8472 ROXAS PALAWAN

City/Municipality Province

12. PHILHEALTH NO. 09-050211105-0 ZIP CODE 5308

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

14. TIN NO. 309-708-256 20. MOBILE NO. 0909 942 3193/ 0951 292 3385

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) ailenelegaspi13@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 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 LEGASPI

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

MIDDLE NAME AURELIO

25. MOTHER'S MAIDEN NAME

SURNAME ZACARIAS

FIRST NAME HERMINIA

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

1992 1997
ELEMENTARY ABAROAN ELEMENTARY SCHOOL ELEMENTARY GRADUATED 1997 N/A

1999 2003
SECONDARY
VOCATIONAL / ROXAS NATIONAL COMPREHENSIVE SCHOOL HIGH SCHOOL GRADUATED 2003 N/A

2018 2018
PUERTO PRINCESA SCHOOL OF ARTS AND TRADES DRESS MAKING NCII GRADUATED 2018 N/A
TRADE
BACHELOR OF SECONDARY EDUCATION 2015 2018
COURSE
COLLEGE FULLBRIGHT COLLEGE
MAJOR IN SOCIAL STUDIES GRADUATED 2018 N/A

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

(Continue on separate sheet if necessary)

SIGNATURE DATE September 5, 2021

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
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

BOARD FOR PROFESSIONAL TEACHERS 78% 9/30/2018 PALAWAN STATE UNIVERSITY 1728798

NOTHING FOLLOWS

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy)
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP STATUS OF APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

11/23/2020 3/5/2021 SUBSTITUTE TEACHER BUCANA NATIONAL HIGH SCHOOL Php22,316.00 N/A TEMPORARY

PALAWAN POLYTECHNIC COLLEGE

6/17/2019 4/15/2020 TEACHER Php 9,500.00 N/A CONTRACTUAL
INCORPORATED
8/1/2018 10/30/2018 TEACHER TAGUMPAY NATIONAL HIGH SCHOOL Php 4,000.00 N/A CONTRACTUAL

8/1/2018 10/30/2018 ASSISTANT PHARMACIST BIOCHEMIST DRUGSTORE Php 8,000.00 N/A REGULAR

8/10/2010 5/31/2015 ASSISTANT PHARMACIST BIOCHEMIST DRUG Php 8,000.00 N/A REGULAR

1/1/2006 1/1/2009 ASSISTANT PHARMACIST DRUGMAN DRUGHOUSE Php7,000.00 N/A REGULAR

 (Continue on separate sheet if necessary)

SIGNATURE DATE 05/02/2022

CS FORM 212 (Revised 2017)

 LICENSE (if applicable)

Date of
Validity

1/16/2019

THING FOLLOWS

separate sheet if necessary)

GOV'T
SERVICE

(Y/ N)

N
separate sheet if necessary)

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
TEACHER
ROXAS NATIONAL COMPREHENSIVE HIGH SCHOOL 1/3/2022 5/1/2022

(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

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

BAKING N/A N/A

 COOKING

COMPUTER LITERATE

READING

SALESTALK

SEWING

WRITING
(Continue on separate sheet if necessary)

SIGNATURE DATE 05/02/2022

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, NO
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? NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? 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
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
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? ________________________________
END OF CONTRACT
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except NO
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? 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: NO
a. Are you a member of any indigenous group?
If YES, please specify:
b. Are you a person with disability? NO
If YES, please specify ID No:
c. Are you a solo parent? 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
RECARDO L. CONVOCAR BUCANA,EL NIDO, PALAWAN 9399179451 (passport size)

With full and handwritten

BGY.MILAGROSA, PUERTO PRINCESA name tag and signature over
NORMA F. SOLITA CITY
9198611868
printed name

Computer generated
EDNA J. EDEP TAGUMPAY, ROXAS, PALAWAN 9503596006 or photocopied picture
is not acceptable
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 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: PRC ID
ID/License/Passport No.: 1728798
Signature (Sign inside the box)
05/02/2022
Date/Place of Issuance: 04/12/21-ROXAS, PALAWAN
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