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 ALEGRIA
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARY CATHLEEN

MIDDLE NAME FEBRERO

3. DATE OF BIRTH
(mm/dd/yyyy) 3/6/1996 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘
by ✘ by naturalization
birth
4. PLACE OF BIRTH STA. CRUZ, MANILA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A AZUCENA STREET
House/Block/Lot No. Street
Widowed Separated
PUROK ZENIA ORCHIDS POBLACION 2
Other/s:
Subdivision/Village Barangay
MIDSAYAP NORTH COTABATO
7. HEIGHT (m) 152
City/Municipality Province
8. WEIGHT (kg) 42 ZIP CODE 9410

18. PERMANENT ADDRESS N/A AZUCENA STREET

9. BLOOD TYPE B+
House/Block/Lot No. Street
PUROK ZENIA ORCHIDS POBLACION 2
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MIDSAYAP NORTH COTABATO
11. PAG-IBIG ID NO. 121286911127
City/Municipality Province

12. PHILHEALTH NO. 1702-5685-8986 ZIP CODE 9410

13. SSS NO. 0939948987 19. TELEPHONE NO. N/A

14. TIN NO. 601-183-306-00000 20. MOBILE NO. 09312179742 /09350259246

15. AGENCY EMPLOYEE NO. 830026233 21. E-MAIL ADDRESS (if any) ekadelosa46@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)

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

N/A

MIDDLE NAME N/A 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 Delosa N/A N/A

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

N/A

MIDDLE NAME Academia N/A N/A

25. MOTHER'S MAIDEN NAME Vidal N/A N/A

SURNAME Delosa N/A N/A

FIRST NAME Leodelyn N/A N/A

MIDDLE NAME Tomarong (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Notre Dame of Midsayap College Elementary Training Department 3/1/2005 3/1/2011 N/A 2011 N/A

SECONDARY /
VOCATIONAL Notre Dame of Midsayap College High School Department 3/1/2011 3/1/2015 N/A 2015 N/A

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

TRADE
COURSE
COLLEGE San Pedro College-Davao City Bachelor of Science in Pharmacy 6/1/2015 5/1/2019 N/A 2019 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
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ DATE OF LICENSE (if applicable)
RATING
CES/ CSEE BARANGAY ELIGIBILITY / EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
DRIVER'S LICENSE CONFERMENT
Validity

Pharmacy Licensure Exam board passer 79.2 June 29-30, 2021 University of Mindanao -Matina Campus 0089627 12/6/2024

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

12/6/2016 1/9/2017 Pharmacy Intern Suyhoo Farmacia N/A N/A INTERN N

12/28/2017 1/15/2018 Pharmacy Intern Malta Medical Center, INC N/A N/A INTERN N

6/4/2018 7/10/2018 Pharmacy Intern Lejal Laboratories, INC N/A N/A INTERN N

8/15/2018 10/16/2018 Pharmacy Intern HB1 Damosa, Davao City N/A N/A INTERN N

10/8/2021 12/31/2022 Store Pharmacist Watsons CityMall Cotabato City 22000.00 10/2 REGULAR 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

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Type of LD
CONDUCTED/ SPONSORED BY
(mm/dd/yyyy) NUMBER OF HOURS ( Managerial/ Supervisory/
(Write in full) Technical/etc) (Write in full)

From To

Adult Pneumococcal Vaccines 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Ensuring A safe Vaccination Experience 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

HPV: The Silent Pandemic 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Oncology for Pharmacists 101 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Cholesterol Management in Diabetes: Why it’s Essential and What Should Be Done 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Managing Pain: A Pharmacists’ Approach 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Patient Counseling 5/20/2022 5/20/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

PPhA-PSH-Watsons Hypertension Educator Program 11/5/2021 11/5/2021 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

PPHA- PFV Usapang V.I.P (Vaccination in Pharmacy) 8/19/2021 8/19/2021 8HRS Supervisory Philippine Pharmacist Association

Licensing for Drug Outlets Online Seminar 8/16/2021 8/16/2021 2HRS Supervisory Food And Drud Administration

Fit for the future: Digital Fluency 5/31/2022 5/31/2022 8HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Team Effectiveness 5/31/2022 5/31/2022 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

A.S. Watsons Cyber Ready 2021 6/10/2022 6/10/2022 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Cyber Game: Cyber Hero 11/21/2021 11/21/2021 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Cyber Game: Device Protection 11/2/2022 11/2/2022 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Modern Day Slavery: Labour Practices and Human Rights 11/2/2021 11/2/2021 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Foundations of Sustainability 11/2/2021 11/2/2021 30MINS Supervisory Watsons Personal Care Stores(Philippines), Inc.

UMED Mental Health (Goal Centered Pharmacy Care) 10/13/2022 10/13/2022 2HRS Supervisory Unilab Medical Education and Development

NATCON Winning Health with O+O 10/5/2022 10/15/2022 10HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Passion&Purpose Towards Better Health Outcome Part 2 7/6/2022 7/6/2022 10HRS Supervisory Watsons Personal Care Stores(Philippines), Inc.

Poisoning From Medications And Hazaradous Substances 2/9/2023 2/9/2023 3HRS Supervisory Unilab Medical Education and Development

Covid-19 Vaccine Communications Training Program 8/17/2021 8/17/2021 4HRS Supervisory

Department of Health
Psychoactive drugs: Pharmacists in Action 4/21/2023 4/21/2023 4HRS Supervisory
British Cambridge College
Head Cold: Evidenced-Based Reviews&Updates 8/5/2022 8/5/2022 4HRS Supervisory Philippine Pharmacist Association

Discipline Management in HATCH for Minor Cases 9/15/2022 9/15/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Watsons ph Sustainability Courses 10/9/2022 10/9/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Social Listening Technical Terms, Decoded 7/7/2022 7/7/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Mental Flexibility: Cognitive Flexibility and Flexible Thinking 9/11/2022 9/11/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Fit for the Future: Mental Flexibility 7/26/2022 7/26/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Electronic Loss and Breakage Report(e-LBR) Training 12/20/2022 12/20/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

Store Cyber Awareness 10/15/2022 10/15/2022 1HR Supervisory Watsons Personal Care Stores(Philippines), Inc.

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3
NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 3
(Write in full) (Write in full)
.

Reading books N/A Philippine Pharmacist Association

Travelling N/A N/A

(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
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
the last 6 months
Honorable Vivencio V. Deomampo Midsayap 0918-9203-095 3.5 cm. X 4.5 cm
(passport size)

Honorable Justine Clio Ostique Midsayap 0966-300-2287 With full and handwritten
name tag and signature over
printed name
Nashiba Panansaran, RPh Cotabato 0917-4683-958
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

PROFESSIONAL REGULATION COMMISSION

Government Issued ID: IDENTIFICATION CARD

ID/License/Passport No.: 0089627

Signature (Sign inside the box)

Date/Place of Issuance: 08/10/2021 - Davao 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