CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 CAIREL
NAME EXTENSION (JR., SR)
FIRST NAME FLORA MIE

MIDDLE NAME FLORES

3. DATE OF BIRTH
(mm/dd/yyyy)
08/17/1993 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH PINDASAN MABINI DAVAO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS PUROK-13 PINETREE

Widowed Separated House/Block/Lot No. Street
TAGNANAN
Other/s:
Subdivision/Village Barangay
MABINI DAVAO DE ORO
7. HEIGHT (m) 1.50
City/Municipality Province
8. WEIGHT (kg) 50kg ZIP CODE 8807

18. PERMANENT ADDRESS PUROK-13 PINETREE

9. BLOOD TYPE 0
House/Block/Lot No. Street
TAGNANAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MABINI DAVAO DE ORO
11. PAG-IBIG ID NO. 121- 132-530-120
City/Municipality Province

12. PHILHEALTH NO. 16- 050645591- 7 ZIP CODE 8807

13. SSS NO. 0938204279 19. TELEPHONE NO. N/A

14. TIN NO. 462- 099- 874 20. MOBILE NO. 09094154616

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) floresfloramie4@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME CAIREL 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME JEIMAR PZYCHE IVEN FLORES CAIREL 04/28/2018

MIDDLE NAME TAGANAHAN

OCCUPATION LABORER

EMPLOYER/BUSINESS NAME TAGCO MULTIPURPOSE COOPERATIVE

BUSINESS ADDRESS PUROK 18, FARM 2 TAGNANAN, MABINI, DAVAO DE ORO

TELEPHONE NO. N/A

24. FATHER'S SURNAME FLORES

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

MIDDLE NAME ANDO

25. MOTHER'S MAIDEN NAME

SURNAME CUTAY

FIRST NAME NORMA

MIDDLE NAME CLAVEL (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PINDASAN ELEMENTARY SCHOOL ELEMENTARY 2001 2006 GRADUATED 2006 N/A

SECONDARY PINDASAN NATIONAL HIGH SCHOOL HIGH SCHOOL 2006 2010 GRADUATED 2010 N/A

VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A

BACHELOR OF SECONDARY EDUCATION

COLLEGE ST. MARY'S COLLEGE OF TAGUM, INC.
MAJOR IN ENGLISH
2010 2014 GRADUATED 2014 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 MARCH 11, 2024

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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity
MAGUGPO PILOT CENTRAL ELEMENTARY SCHOOL, SOBRECAREY
LICENSURE EXAMINATION FOR TEACHERS 81.6 2/10/2022 ST. MAGUGPO POBLACION TAGUM CITY 2051895 08/17/2026

(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.
INCLUSIVE DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT

N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 11. 2024

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(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 Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
INTERNATIONAL COLLEGE OF ALLIED HEALTH,
OMNI- MODAL PEDAGOGY: 10-DAY PPST TRAINING ON ICT IN EDUCATION 03/22/2023 03/31/2023 80HOURS TECHNICAL
SCIENCE AND TECHNOLOGY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

DANCING N/A N/A

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 11, 2024

CS FORM 212 (Revised 2017), Page 3 of 4