CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 MARISGA
NAME EXTENSION (JR., SR)
FIRST NAME ANGELINE
N/A
MIDDLE NAME BALTAR
3. DATE OF BIRTH
(mm/dd/yyyy)
16. CITIZENSHIP
03/22/1999 ✘

4. PLACE OF BIRTH SAN JOSE,OCCIDENTAL MINDORO If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX ✘

6 CIVIL STATUS ✘
17. RESIDENTIAL ADDRESS
House/Block/Lot No. Street
MANGARIN
Subdivision/Village Barangay
7. HEIGHT (m) 1.57 SAN JOSE OCCIDENTAL MINDORO
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 5100

9. BLOOD TYPE O 18. PERMANENT ADDRESS

House/Block/Lot No. Street
10. GSIS ID NO. N/A MANGARIN
Subdivision/Village Barangay
SAN JOSE OCCIDENTAL MINDORO
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 5100

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

14. TIN NO. N/A 20. MOBILE NO. 0906-2374-341

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) angeline22marisga@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
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME MARISGA

FIRST NAME EDWIN SR.

MIDDLE NAME CASUNCAD

25. MOTHER'S MAIDEN NAME

SURNAME BALTAR

FIRST NAME HELEN

MIDDLE NAME QUITORIANO

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MANGARIN ELEMENTARY SCHOOL ELEMENTARY 2005 2011 GRADUATED 2011 N/A
VOCATIONAL / ESC
SECONDARY DIVINE WORD COLLEGE OF SAN JOSE HIGH SCHOOL 2011 2015 GRADUATED 2015 SCHOLARSHI
P
N/A N/A N/A N/A N/A N/A N/A
CHED FULL
BACHELOR OF SECONDARY EDUCATION
COLLEGE TRADE DIVINE WORD COLLEGE OF SAN JOSE 2015 2019 GRADUATED 2019 SCHOLARSHI
COURSE MAJOR IN GENERAL SCIENCE
P
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

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

SIGNATURE DATE
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
SEPTEMBER 25,
RA 1080 PROFESSIONAL TEACHER 79.20 MAMBURAO OCCIDENTAL MINDORO 1805471 12/16/2019
2019

…..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.
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)

1/10/2020 PRESENT VOLUNTEER TEACHER MANGARIN NATIONAL HIGH SCHOOL N/A N/A VOLUNTEER YES

SIGNATURE DATE 05/01/2021

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

(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

In-Service Training 12/14/2020 12/19/2020 48 hours Technical Mangarin National High School
Technical Education and Skills Development
National Certificate II in Computer Systems Servicing 4/8/2020 10/16/2020 280 hours Technical
Authority
Shifting to Online Learning: The Effects on Students' and Teachers' Mental Health 5/26/2020 4 hours Technical Vibal Group

Merging Learning Competencies and Practices to Facilitate the Shift to the New Normal 4 hours Technical Vibal Group

Organizing Science Research Program in Basic Education in the New Normal 4 hours Technical Vibal Group

Preparing Science Lessons in the New Normal: 5E/7E Inquiry Model in Focus ………NOTHING FOLLOWS…….. 4 hours Technical Vibal Group

Art in Times of Crisis 4 hours Technical Vibal Group

Contextualized Learning Delivery Modalities 4 hours Technical Vibal Group

Meeting International Research Standards: The Demands of the Fourth Industrial
4 hours Technical Vibal Group
Revolution
Developing Effective Learning Activities for Preschool and Primary Learners from Home-based
Materials
4 hours Technical Vibal Group

Horizontal Integration of Subject Area Competencies 4 hours Technical Vibal Group

Addressing Challenges in Leading the School to Online Teaching and Learning 1/6/2020 4 hours Technical Vibal Group
Psychological Understanding of the Emerging Technological Drift and Surge of Online -Distance
5/28/2020 5 hours Technical The Intelligente Publishing, Inc.'s
Learning

(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)
Microsoft Office Package: Microsoft Word, PHILIPPINE ASSOCIATION FOR TEACHERS
N/A
Microsoft Excel, Microsoft Power Point AND EDUCATORS (PAFTE), Inc.
Enter data into computer system using defined
….Nothing follows…..
computer programs
Communication Skills

…Nothing follows…

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/01/2021

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
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? ________________________________
________________________________
Q 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
Sir Jayson Valera Mabini st. San Jose Occidetal Mindoro 09189646543 3.5 cm. X 4.5 cm
(passport size)

Ma'am Melinda O. Mendoza Tanyag, Calintaan Occidental Mindoro 09564200677 With full and handwritten
name tag and signature over
printed name
Capt. Warren T. Sales Mangarin, San Jose, Occidental Mindoro N/A
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: PRC
ID/License/Passport No.: 1805471 Signature (Sign inside the box)
05/01/2021
Date/Place of Issuance: 12/16/2019 PRC Lucena, Lucena City
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 5th day April 2019, affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4