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 IBONA
NAME EXTENSION (JR., SR)
FIRST NAME MARIA REYNA EVE

MIDDLE NAME CABICO

3. DATE OF BIRTH
(mm/dd/yyyy) 8/24/1989 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
KABATAN, VINCENZO SAGUN,
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
ZAMBOANGA DEL SUR
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS N/A N/A

Widowed Separated House/Block/Lot No. Street
PUROK SAMPAGUITA KABATAN
Other/s:
Subdivision/Village Barangay

7. HEIGHT (m) 1.57 VINCENZO SAGUN ZAMBOANGA DEL SUR

City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 7036

9. BLOOD TYPE O
18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street

10. GSIS ID NO. 2004179344 PUROK SAMPAGUITA KABATAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121072044583 VINCENZO SAGUN ZAMBOANGA DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 140000863927 ZIP CODE 7036

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 430780045000 20. MOBILE NO. 09502199230

15. AGENCY EMPLOYEE NO. 6140231 21. E-MAIL ADDRESS (if any) mariareynaeve.ibona@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MONTES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) BIERTHA REENE I. MONTES
FIRST NAME ALBERT 03/18/2014

MIDDLE NAME VICENTE N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME IBONA N/A 09/27/1967

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

MIDDLE NAME PICULADOS N/A N/A

25. MOTHER'S MAIDEN NAME N/A 10/3/1966

SURNAME CABICO N/A N/A

FIRST NAME EVANILFA N/A N/A

MIDDLE NAME DUGHO (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

VINCENZO SAGUN CENTRAL SALUTATOR

ELEMENTARY PRIMARY SCHOOL 1998 2002 GRADUATED 2002
ELEMENTARY SCHOOL IAN
 SALUTATOR
SECONDARY /
VOCATIONAL KABATAN NATIONAL HIGH SCHOOL HIGH SCHOOL 2002 2006 GRADUATED 2006
IAN

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

TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE MINDANAO STATE UNIVERSITY 2006 2011 GRADUATED 2011 N/A
SECONDARY EDUCATION

GRADUATE STUDIES SOUTHERN MINDANAO COLLEGES DOCTOR OF EDUCATION 2014 2016 27 N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE June 9, 2023

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 TEACHERS 78.0 08/01/2012 PAGADIAN CITY 0490731 04/02/2026

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 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

(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)
DEPARTMENT OF EDUCATION-SAGUCAN REGULAR/
06/13/2013 PRESENT SECONDARY SCHOOL TEACHER 1 28, 012.00 11-1 PERMANENT
YES
NATIONAL HIGH SCHOOL
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 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

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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

(Continue on separate sheet if necessary)

SIGNATURE DATE 06/09/2023

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
(Write in full) (mm/dd/yyyy) HOURS POSITION / NATURE OF WORK
From To

NONE 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

(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 CONDUCTED/ SPONSORED BY
( Managerial/ Supervisory/
(Write in full) (mm/dd/yyyy)
HOURS
Technical/etc) (Write in full)

From To

INFECTION PREVENTION AND CONTROL IN SCHOOLS 03/13/2023 03/13/2023 6 HRS TECHNICAL DEPED

VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 08/30/2021 03/09/2023 40HRS 40HRS DEPED

VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 03/15/2021 01/19/2021 40HRS 40HRS DEPED

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 N/A N/A N/A

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

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

(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)

SAGUCAN NATIONAL HIGH SCHOOL

BREAD AND PASTRY NC II NONE
PARENT TEACHERS ASSOCIATION
N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 06/09/2023

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
YES ✘ 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 ✘ 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
KABATAN, VINCENZO SAGUN the last 6 months
LOIS B. HUPA ZAMBO.SUR
NONE 3.5 cm. X 4.5 cm
(passport size)
SAGUCAN, VINCENZO SAGUN
TIBURCIO M. SANDALAN ZAMBO.SUR
NONE With full and handwritten
name tag and signature over
printed name
JEFFREY MAATA KABATAN, MARGOSATUBIG ZAMBO.SUR NONE
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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: UMID

ID/License/Passport No.: 006-0183-5719-8

Signature (Sign inside the box)

Date/Place of Issuance: 11/01/12

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