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

MIDDLE NAME DAGON

3. DATE OF BIRTH 16. CITIZENSHIP
(mm/dd/yyyy) 03/08/1977 ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH STA. MARIA, DAVAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
Male ✘ Female N/A

6 CIVIL STATUS Single

17. RESIDENTIAL ADDRESS N/A AVILA STREET
✘ Married
Widowed Separated House/Block/Lot No. Street

Other/s:
POBLACION
Subdivision/Village Barangay

7. HEIGHT (m) 1.50 SANTA MARIA DAVAO OCCIDENTAL

City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 8011

9. BLOOD TYPE A+
18. PERMANENT ADDRESS N/A AVILA STREET
House/Block/Lot No. Street

10. GSIS ID NO. 2005126046 POBLACION

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121147767455 SANTA MARIA DAVAO OCCIDENTAL

City/Municipality Province

12. PHILHEALTH NO. 160502593428 ZIP CODE 8011

13. SSS NO. 0928106662 19. TELEPHONE NO. N/A

14. TIN NO. 490574957000 20. MOBILE NO. 09672253719

15. AGENCY EMPLOYEE NO. 7227830 21. E-MAIL ADDRESS (if any) rubilyn.avila@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AVILA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME ADONES

NAME EXTENSION (JR., SR)
N/A
KIEM FRITZ D. AVILA 11/13/2000

MIDDLE NAME ROSARIO KIETH ENZO D. AVILA 07/31/2007

OCCUPATION UNEMPLOYED

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME DAGON

NAME EXTENSION (JR., SR)
FIRST NAME RESTITUTO SR.

MIDDLE NAME NAIG

25. MOTHER'S MAIDEN NAME

SURNAME TRASMIL
FIRST NAME MILAGROS
MIDDLE NAME GRANDE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PONGPONG ELEMENTARY SCHOOL ELEMENTARY 1984 1990 N/A 1990 VALEDICTORIAN

SECONDARY /
VOCATIONAL STA. MARIA INSTITUTE HIGH SCHOOL 1990 1994 N/A 1994 1ST HONORABLE

N/A
TRADE
UNIVERSITY OF MINDANAO BACHELOR OF SCIENCE IN
COURSE
COLLEGE 1994 1998 N/A 1998 N/A
DIGOS COLLEGE COMMERCE
SERAPION C. BASALO MEMORIAL BACHELOR OF SCIENCE IN
2014 2015 22 UNITS N/A N/A
FOUNDATION COLLEGES SECONDARY EDUCATION
MASTER OF ARTS IN
GRADUATE STUDIES RIZAL MEMORIAL COLLEGES 2017 2023 MAED 2023 N/A
EDUCATIONAL MANAGEMENT
(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 05, 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

CAREER SERVICE SUBPROFESSIONAL 81.13% 10/19/1997 DAVAO DEL SUR NATIONAL HIGH SCHOOL 11020438 11/01997/

LICENSURE EXAMINATION FOR TEACHERS 78.20% 03/20/2016 DAVAO CITY 1467762 6/24/2016

(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)

01/01/2022 PRESENT TEACHER II DEPARTMENT OF EDUCATION 26,052.00 12-1 PERMANENT Y

01/01/2021 12/31/2021 TEACHER II DEPARTMENT OF EDUCATION 24,161.00 12-1 PERMANENT Y

01/01/2020 12/31/2020 TEACHER I DEPARTMENT OF EDUCATION 20,754.00 11-2 PERMANENT Y

01/01/2019 12/31/2019 TEACHER I DEPARTMENT OF EDUCATION 20,179.00 11-1 PERMANENT Y

01/01/2018 12/31/2018 TEACHER I DEPARTMENT OF EDUCATION 24,161.00 11-1 PERMANENT Y

01/01/2017 12/31/2017 TEACHER I DEPARTMENT OF EDUCATION 19,620.00 11-1 PERMANENT Y

06/1/2016 12/21/2016 KINDERGARTEN VOLUNTEER TEACHER DEPARTMENT OF EDUCATION 3,000.00 N/A CONTRACTUAL Y

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 05, 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

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 ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
(LEADING WINS) SCHOOL-LEVEL WASH IN SCHOOLS(WinS) MASSIVE OPENLINE
COURSE 04/01/2022 04/09/2022 40 INSTRUCTIONAL
DEPARTMENT OF EDUCATION
VIRTUAL ORIENTATION ON COMPREHENSIVE SEXUALITY EDUCATION 03/14/2022 03/15/2022 16 INSTRUCTIONAL STA. MARIA EAST DISTRICT

6-DAY SCHOOL BASED IN-SERVICE TRAINING(INSET) 01/31/2022 02/05/2022 48 TECHNICAL SAN PEDRO ELEMENTARY SCHOOL
VIRTUAL TRAINING ON SCHOOL/DISTRICT MONITORING, EVALUATION AND
03/14/2022 03/11/2022 40 INSTRUCTIONAL STA. MARIA EAST DISTRICT
ADJUSTMENT AND QATAME
VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 2.0 08/30/2021 09/03/2021 40 TECHNICAL DEPARTMENT OF EDUCATION

VIRTUAL DISTRICT SCIENCE AND TECHNOLOGY FAIR 06/14/2021 06/14/2021 8 INSTRUCTIONAL STA. MARIA EAST DISTRICT
VIRTUAL DIVISION TRAINING ON LITERACY INSTRUCTION IN LITERACY WITH
05/19/2021 05/21/2021 24 INSTRUCTIONAL DIVISION OF DAVAO OCCIDENTAL
EMPHASIS ON THE 6 ELEMENTS IN READING
VIRTUAL DIVISION TRAINING ON LITERACY INSTRUCTION IN FILIPINO WITH
05/19/2021 05/12/2021 24 INSTRUCTIONAL DIVISION OF DAVAO OCCIDENTAL
EMPHASIS ON THE 6 ELEMENTS IN READING
DISTRICT DOWNLOADING ON DEPED PARTNERSHIP FRAMEWORK CUM
01/20/2020 01/20/2020 8 INSTRUCTIONAL STA. MARIA EAST DISTRICT
WORKSOP /TRAINING ON DEPED PARTNERSHIP DATABASE SYSTEM

(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)

COMPUTER LITERATE SCHOOL HEALTH COORDINATOR STA. MARIA EAST DISTRICT ASSOCIATION

SCHOOL BRIGADA ESKWELA COORDINATOR

SCHOOL CLINIC IN-CHARGE

SCHOOL BASED FEEDING PROGRAM COORDINATOR

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 05, 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? YES ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES
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? 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:
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
LARRY M. PANAL BASIAWAN, STA.MARIA 9750065605 3.5 cm. X 4.5 cm
(passport size)
MARICEL P. SENARILLOS BASIAWAN, STA.MARIA 9458164278
With full and handwritten
name tag and signature over
DEBIE MAE A. MISA BASIAWAN, STA.MARIA 9099428275 printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
is not acceptable
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
Government Issued ID:
COMMISSION
ID/License/Passport No.: 1467762 Signature (Sign inside the box)
JULY 05, 2022
Date/Place of Issuance: 06/24/2016/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