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 GREGORIO
NAME EXTENSION (JR., SR)
FIRST NAME ROBERTO

MIDDLE NAME BRASA

3. DATE OF BIRTH
(mm/dd/yyyy) 11/12/1974 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH GEN.SANTOS CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS

Widowed
Separated PALKAN
Other/s:
Barangay
7. HEIGHT (m) 1.58m POLOMOLOK SOUTH COTABATO
City/Municipality Province
8. WEIGHT (kg) 78 Kg ZIP CODE 9504
18. PERMANENT ADDRESS
9. BLOOD TYPE "A+"
10. GSIS ID NO. LP 74111201912 N/A PALKAN
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 1102-29629910 POLOMOLOK SOUTH COTABATO
City/Municipality Province
12. PHILHEALTH NO. 17-025032813-6 ZIP CODE 9504
13. SSS NO. 09-2834207-3 19. TELEPHONE NO. N/A
14. TIN NO. 943-600-119 20. MOBILE NO. 09194245249
15. AGENCY EMPLOYEE NO. 4663478 21. E-MAIL ADDRESS (if any) roberto.gregorio@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NONE 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) HOSEA ROBERT SOLOMON JAY T. GREGORIO
FIRST NAME N/A N/A `02/14/2018

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME GREGORIO

NAME EXTENSION (JR., SR) none
FIRST NAME ROBERTO

MIDDLE NAME MONTEALTO

25. MOTHER'S MAIDEN NAME

SURNAME GARCIA (DECEASED)

FIRST NAME RUTH

MIDDLE NAME BRAZA (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

POLOMOLOK CENTRAL ELEMENTARY

ELEMENTARY ELEMENTARY 1982 1988 NONE 1988 NONE
SCHOOL

SECONDARY
VOCATIONAL / GENERAL SANTOS ACADEMY HIGH SCHOOL 1988 1992 N/A 1992 NONE

NONE NONE NONE NONE N/A N/A N/A

TRADE
COURSE BACHELOR IN SECONDARY EDUCATION
COLLEGE MINDANAO STATE UNIVERISTY MAJOR IN HISTORY
1992 2004 N/A 2004 NONE

GRADUATE STUDIES MINDANAO STATE UNIVERISTY M.A.ED READING 2006 2007 12 N/A NONE

MINDANAO STATE UNIVERISTY M.A. PHILIPPINE STUDIES 2017 2022 N/A 2022 NONE

(Continueon separate sheet if necessary)

SIGNATURE DATE MARCH 25, 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
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

LICENSURE EXAMINATION FOR TEACHER 76.20% `09/29/2004 RMMC GENERAL SANTOS CITY 0847911 11/12/2022

(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) STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
`02/01/2012 PRESENT TEACHER-1 PALKAN NATIONAL HIGH SCHOOL 29,864.00 "11-4" PERMANENT Y

`01/16/2007 `01/31/2012 TEACHER-1 POLOMOLOK NATIONAL HIGH SCHOOL 6,176.00 JOB ORDER CONTRACTUAL Y

`09/04/2006 `01/15/2007 TEACHER-1 POLOMOLOK NHS- PTA 6,700.00 JOB ORDER CASUAL N

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 25, 2024 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

BOYS SCOUT OF THE PHLIPINES `06/01/2010 PRESENT NONE MEMBER

(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
REGIONAL REFRESHER TRAINING COURSE CUM ACCREDITATION FOR SRAA
`02/09/2024 `02/11/2024 24 TECHNICAL DEPED REGIONAL OFFICE
2024 TECHNICAL OFFICIAL
RECALIBRATING LEARNING DELIVERY THROUGH SCALING-UP PRIMALS PLUS `01/19/2024 `01/21/2024 24 TECHNICAL POLOMOLOK DISTRICT 2

REFRESHER TRAINING COURSE FOR SRAA 2023 TECHNICAL OFFICIAL `01/30/2023 `02/01/2023 24 TECHNICAL DEPED REGIONAL OFFICE

(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
(Write in full)
in full)

FOOD & BEVERAGE SERVICES NONE Boy Scout of the Philippines

COMPUTER HARDWARE SERVICING

COOKING

WELDING

MASSAGE THERAPY

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 25, 2024 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
wwwww.facwww

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: MARCH 18, 1998
________________________________
Status of Case/s: ACQUITTED 2002

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by
YES ✘ NO
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, YES ✘ NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in If YES, give details:
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: 9504-1540

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
MR. ANTONIO B. OCTAVIO BRGY. CANNERY SITE, PSC 0949-462-2433 3.5 cm. X 4.5 cm
(passport size)

MRS. JUDIE E.DELA CRUZ POLONOLING, TUPI, SC 0947-771-7096 With full and handwritten
name tag and signature over
printed name
MRS. FE L. SEPAYA AGREVILLE, KORONADAL CITY 0928-494-5855
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
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.: 0847911

Signature (Sign inside the box)
03/25/2024
Date/Place of Issuance: 10/29/2004/GSC
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