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 agai
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

I. PERSONAL INFORMATION
2. SURNAME LAMITA
NAME EXTENSION (JR., SR)
FIRST NAME EHNAN JELH

MIDDLE NAME JOVITO

3. DATE OF BIRTH
(mm/dd/yyyy) 12/27/1989 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalizat
4. PLACE OF BIRTH KORONADAL CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS MAGSAYSAY

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
SAN JOSE
Other/s:
Subdivision/Village Barangay
NORALA SOUTH COTABATO
7. HEIGHT (m) 163
City/Municipality Province
8. WEIGHT (kg) 74 ZIP CODE 9508
18. PERMANENT ADDRESS MAGSAYSAY
9. BLOOD TYPE A
House/Block/Lot No. Street
SAN JOSE
10. GSIS ID NO. 2005090191
Subdivision/Village Barangay
NORALA SOUTH COTABATO
11. PAG-IBIG ID NO. 121185767027
City/Municipality Province
12. PHILHEALTH NO. 172016050917 ZIP CODE 9805

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

14. TIN NO. 419942260 20. MOBILE NO. 09352143384

15. AGENCY EMPLOYEE NO. 4921913 21. E-MAIL ADDRESS (if any) ehnanjelh.lamita@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/d
NAME EXTENSION (JR., SR) NONE
FIRST NAME NONE N/A

MIDDLE NAME NONE

OCCUPATION NONE

EMPLOYER/BUSINESS NAME NONE

BUSINESS ADDRESS NONE

TELEPHONE NO. NONE

24. FATHER'S SURNAME LAMITA

NAME EXTENSION (JR., SR)
FIRST NAME HERNANDO

MIDDLE NAME LAMAYO

25. MOTHER'S MAIDEN NAME

SURNAME JOVITO

FIRST NAME EVELYN

MIDDLE NAME SISON (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/
26. PERIOD OF ATTENDANCE YEAR
UNITS
LEVEL (Write in full) EARNED
GRADUATED
(Write in full) (if not
From To
graduated)
ELEMENTARY KOLAMBOG ELEMENTARY SCHOOL PRIMARY EDUCATION 1996 2002 N/A 2002
VOCATIONAL /
SECONDARY LAPUZ NATIONAL HIGH SCHOOL HIGH SCHOOL 2002 2006 N/A 2006

NONE N/A

SULTAN KUDARAT STATE BACHELOR OF SCIENCE IN

COLLEGE TRADE 2007 2014
COURSE UNIVERSITY INFORMATION TECHNOLOGY
 SULTAN KUDARAT STATE
GRADUATE STUDIES
UNIVERSITY
MASTER IN INFORMATION TECHNOLOGY 2016 2016 6 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), P
e/s against the

For CSC use only)

turalization

ry:

AY

BATO

AY

ABATO

RTH (mm/dd/yyyy)

N/A

SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED

NONE

NONE
ed 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 TEACHERS 76.00% 8/17/2014 DAVAO CITY 1352577 12/27/2021

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To (Y/
N)
1/1/2019 PRESENT TEACHER-I SAN JOSE NHS-LAPUZ NHS ANNEX 20754.00 11-1 PERMANENT Y

1/1/2018 12/31/2018 TEACHER-I SAN JOSE NHS-LAPUZ NHS ANNEX 20179.00 11-1 PERMANENT Y

1/1/2017 12/31/2017 TEACHER-I SAN JOSE NHS-LAPUZ NHS ANNEX 19620.00 11-1 PERMANENT Y

7/8/2016 12/31/2016 TEACHER-I SAN JOSE NHS-LAPUZ NHS ANNEX 19620.00 11-1 PERMANENT Y

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

NONE N/A N/A N/A 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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)
INDUCTION AND ORIENTATION PROGRAM OF
NEWLY HIRED TEACHERS & NON-TEACHING 13/2/2015 14/2/2015 16.0 TECHNICAL DEPED SOUTH COTABATO
EMPLOYEES
SEMINAR-WORKSHOP IN UPDATING EHRIS AND
EPDS ENCODING BY SCHOOL PERSONNEL
29/1/2018 30/1/2018 16.0 TECHNICAL DEPED SOUTH COTABATO
CUM CAPACITY BUILDING OF SCHOOL HEADS
ON PERSONNEL ADMINISTRATION
IN-SERVICE TRAINING OF TEACHERS IN
28/6/2018 28/6/2018 8.0 TECHNICAL DEPED SOUTH COTABATO
RESEARCH
IN-SERVICE TRAINING OF TEACHERS IN
EDMODO, CLOUD COMPUTING AND ADVANCED 23/10/2018 23/10/2018 8.0 TECHNICAL DEPED SOUTH COTABATO
SPREADSHEET APPLICATION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write
in full)
COMPUTER LITERACY SKILLS NONE NONE

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 theof bureau or office or to the person who has immediate supervision over you in the
chief
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
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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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
a.
items:
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
Dumaguil, Norala, South the last 6 months
GENIE P. CUBITA Cotabato
NONE 3.5 cm. X 4.5 cm
(passport size)
Simsiman, Norala, South
JULIUS M. FRIALES Cotabato
NONE With full and handwritten
name tag and signature over
printed name
JULIANITO A. BATOY Lapuz,Norala, South Cotabato NONE
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
and 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 PHOTO
filing of 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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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