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 ag
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

I. PERSONAL INFORMATION
2. SURNAME SABENIANO
NAME EXTENSION (JR., SR
FIRST NAME RONA

MIDDLE NAME DAVID

3. DATE OF BIRTH
(mm/dd/yyyy) 11/29/1979 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH DAET,CAMARINES NORTE If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS BLK. 4 LOT 18 MANAN

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
HAPPY HOMES FAIRVIEW I MA
Other/s:
Subdivision/Village Ba
DAET CAMARI
7. HEIGHT (m) 163
City/Municipality Pr
8. WEIGHT (kg) 56 ZIP CODE 4600

18. PERMANENT ADDRESS BLK. 4 LOT 18 MANAN

9. BLOOD TYPE "O"
House/Block/Lot No. S
HAPPY HOMES FAIRVIEW I MA
10. GSIS ID NO. 006-0032-3699-8
Subdivision/Village Ba
DAET
11. PAG-IBIG ID NO. 353001023518
City/Municipality Pr

12. PHILHEALTH NO. 10-000063794-1 ZIP CODE 4600

13. SSS NO. 057742683 19. TELEPHONE NO. NONE

14. TIN NO. 924-527-836 20. MOBILE NO. 09076249077

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) rona.dvd@gmail.com
SABENIANO 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) JOSH GABRIEL DAVID SABENIANO
EMERSON

MIDDLE NAME LAMADRID RAPHAEL WALDO DAVID SABENIANO

OCCUPATION SEAMAN

EMPLOYER/BUSINESS NAME OSM MARITIME INC.

BUSINESS ADDRESS PEDRO GIL, MANILA

TELEPHONE NO.

24. FATHER'S SURNAME DAVID

NAME EXTENSION (JR., SR)
FIRST NAME ROLANDO
 MIDDLE NAME OCO

25. MOTHER'S MAIDEN NAME

SURNAME ASIS

FIRST NAME ROSARIO

MIDDLE NAME BARCENA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PARACALE ELEMENTARY SCHOOL PRIMARY 6/1/1986 ### GRADUATED

SECONDARY /
VOCATIONAL PARACALE NATIONAL HIGH SCHOOL SECONDARY 6/4/1992 ### GRADUATED

NONE

TRADE
COURSE
COLLEGE CAMARINES NORTE STATE COLLEGE BACHELOR OF ELEMENTARY EDUCATION ### 4/3/2001 GRADUATED

GRADUATE STUDIES MABINI COLLEGES MASTER OF ARTS IN EDUCATION 2001 2003.00 27 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE Januar

CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

MANANAP FALLS
Street
MAGANG
Barangay
CAMARINES NORTE
Province
4600

MANANAP FALLS
Street
MAGANG
Barangay
CAMARINES NORTE
Province

NONE

09076249077

rona.dvd@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

6/23/2011
1/23/2015
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1992 NONE

1997 NONE

2001 NONE

parate sheet if necessary)

January 23, 2018

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHER 77.8 8/23/2001 ALBAY 715633

(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. INCLUSIVE DATES SALARY/ JOB/ PAY
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

REGULAR
1/1/2017 Present TEACHER III DEPARTMENT OF EDUCATION 23780.00 13
PERMANENT
REGULAR
1/2/2016 12/31/2016 TEACHER III DEPARTMENT OF EDUCATION 22804.00 13
PERMANENT
13 W/ 1 REGULAR
3/26/2015 12/31/2015 TEACHER III DEPARTMENT OF EDUCATION 21867.00
STEP PERMANENT
REGULAR
6/1/2012 3/25/2015 TEACHER III DEPARTMENT OF EDUCATION 21650.00 13
PERMANENT
13 W/ 1 REGULAR
3/26/2012 5/31/2012 TEACHER III DEPARTMENT OF EDUCATION 19908.00
STEP PERMANENT
REGULAR
6/1/2011 3/25/2012 TEACHER III DEPARTMENT OF EDUCATION 19658.00 13
PERMANENT
REGULAR
6/24/2010 5/31/2011 TEACHER III DEPARTMENT OF EDUCATION 17880.00 13
PERMANENT
REGULAR
7/1/2009 6/23/2010 TEACHER III DEPARTMENT OF EDUCATION 16101.00 13
PERMANENT
REGULAR
3/26/2009 6/30/2009 TEACHER III DEPARTMENT OF EDUCATION 13512.00 13
PERMANENT
REGULAR
7/1/2008 3/25/2009 TEACHER II DEPARTMENT OF EDUCATION 12748.00 12
PERMANENT
REGULAR
7/1/2007 6/30/2008 TEACHER II DEPARTMENT OF EDUCATION 11589.00 12
PERMANENT
REGULAR
2/22/2007 6/30/2007 TEACHER II DEPARTMENT OF EDUCATION 10535.00 12
PERMANENT
11 W/ 1 REGULAR
9/1/2006 2/21/2007 TEACHER I DEPARTMENT OF EDUCATION 10188.00
STEP PERMANENT
REGULAR
9/1/2003 8/31/2006 TEACHER I DEPARTMENT OF EDUCATION 9939.00 11
PERMANENT
 (Continue on separate sheet if necessary)

SIGNATURE DATE January 23, 2018

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES
arate sheet if necessary)

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 /
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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

School to School Partnership 2016 September, 2016 November, 2016 40 D

Cluster-Based Training on Gender and Development (GAD) and Violence Against

10/27/2016 10/28/2016 24 D
Women and Children (VAW-C) and Anti Bullying Act

Three-Day In-Service Training Activity for Public Elementary Teachers 10/24/2016 10/26/2016 24 D

Training of Trainors on Drug Prevention 3/6/2016 3/7/2016 16 D

Cluster-Based Seminar Workshop on PRIME GOLD (Production and Utilization of Relevant

Instructional Materials for Enhancement and Galvanization of Learning Directions
10/28/2015 10/30/2015 24 D

Cluster-Based Training on Gender and Development (GAD) and Violence Against

10/27/2015 10/27/2015 8 D
Women and Children (VAW-C)

Cluster - Based Training on ICT 10/23/2004 10/24/2014 16 D

Roll Out of System Results-Based Performance Management (RPMS) 7/31/2014 8/1/2014 16 D

Division Seminar Workshop on Supreme Pupil Government Leaders and Teachers

9/21/2013 9/22/2013 16 D
Advisers

District Seminar Workshop on Campus Journalism on Pupils and Teacher Adviser 9/12/2013 9/13/2013 16 D
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

AWITA
COMPUTER ENCODING, READING NONE
TE
PARENT

DAET NOR
CAMA

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education

Department of Education
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
AWITAN ELEMENTARY SCHOOL
TEACHERS ASSOCIATION
PARENTS TEACHERS ASSOCIATION

DAET NORTH TEACHERS ASSOCIATION

CAMARINES NORTE TEACHERS
ASSOCIATION

eparate sheet if necessary)

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? ________________________________
________________________________
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
MANUEL A. ONATE LAG-ON, DAET, CAMARINES NORTE NONE 3.5 cm. X 4.5 cm
(passport size)

JIJI MARICEL A. LACSON LAG-ON, DAET, CAMARINES NORTE NONE With full and handwritten
name tag and signature over
printed name
NERI V. RIEZA LAG-ON, DAET, CAMARINES NORTE NONE
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.: 0715633

Signature (Sign inside the box)

Date/Place of Issuance: 10/31/2001 - LEGASPI 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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

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