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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 ALAGANO
NAME EXTENSION (JR., SR
FIRST NAME MA. THERESA

MIDDLE NAME PAHAMOTANG


3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/7/1965 ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH TAGUM CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS 1756 QU


6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
N/A STO
Other/s:
Subdivision/Village Ba
7. HEIGHT (m) 1.55 PANABO DAVAO D
City/Municipality Pr
8. WEIGHT (kg) 70 ZIP CODE 8105

18. PERMANENT ADDRESS 1756 QU


9. BLOOD TYPE "O"
House/Block/Lot No. S

10. GSIS ID NO. 65071201265 N/A STO


N/ASubdivision/Village Ba
PANABO
11. PAG-IBIG ID NO. 190000002911
City/Municipality Pr

12. PHILHEALTH NO. 160000289474 ZIP CODE 8105

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

14. TIN NO. 185-665-454 20. MOBILE NO. N/A 09308183345

15. AGENCY EMPLOYEE NO. 8100550 21. E-MAIL ADDRESS (if any) matheresa.alagano@deped.go
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ALAGANO 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) KRISTEL FAYE P. ALAGANO
FIRST NAME ORLANDO

MIDDLE NAME URBANO JAMES CARLO P. ALAGANO

OCCUPATION SELF-EMPLOYED SHAIRA MARIE P. ALAGANO

EMPLOYER/BUSINESS NAME N/A ****NOTHING FOLLOWS****

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PAHAMOTANG


NAME EXTENSION (JR., SR)
FIRST NAME ESTEBAN

MIDDLE NAME SUMAPIG

25. MOTHER'S MAIDEN NAME


SURNAME SUANSING

FIRST NAME LOURDES

MIDDLE NAME LOPEZ (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 PANABO CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 6//1972 3//1978 GRADUATED
VOCATIONAL /
SECONDARY PANABO PROVINCIAL HIGH SCHOOL HIGH SCHOOL 6//1979 3//1983 GRADUATED

N/A N/A N/A N/A GRADUATED

COLLEGE TRADE HOLY CROSS COLLEGE OF DAVAO BACHELOR OF SECONDARY EDUCATION 6//1986 3//1990 GRADUATED
COURSE
GRADUATE STUDIES N/A N/A N/A N/A GRADUATED
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/2

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) N/A

Dual Citizenship

by naturalization
Pls. indicate country:

QUIRINO
Street
STO. NIÑO
Barangay
DAVAO DEL NORTE
Province
8105

QUIRINO
Street
STO . NIÑ O
Barangay
DAVAO DEL NORTE
Province

N/A

09308183345

matheresa.alagano@deped.gov.ph

DATE OF BIRTH (mm/dd/yyyy)

10/8/1992

10/27/1993

6/3/2000
(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1978 N/A

1983 N/A

N/A N/A

1990 N/A

N/A N/A
parate sheet if necessary)

01/27/2020

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

PROFESSIONAL BOARD EXAMINATION FOR


72.5 MAY 30,1993 DAVAO CITY 933211811P
TEACHERS

***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.
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
DEPARTMENT OF EDUCATION /ALEJAL
NATIONAL HIGH SCHOOL
01/01/2019 12/31/19 TEACHER-1 P 22,829.00 11-8 PERMANENT
DEPARTMENT OF EDUCATION /ALEJAL
1/1/2018 NATIONAL HIGH SCHOOL
12/31/2018 TEACHER-1 P 22,055.00 11-8 PERMANENT
DEPARTMENT OF EDUCATION/ ALEJAL NATIONAL
1/1/2017 12/31/2018 TEACHER-1 HIGH SCHOOL P 21,307.00 11-8 PERMANENT
DEPARTMENT OF EDUCATION/ ALEJAL NATIONAL
08/30/2016 12/31/2016 TEACHER-1 HIGH SCHOOL P 20, 585.00 11-8 PERMANENT
DEPARTMENT OF EDUCATIONA/ ALEJAL
1/1/2016 08/29/2016 TEACHER-1 NATIONAL HIGH SCHOOL P 20,142.00 11-7 PERMANENT
DEPARTMENT OF EDUCATION / ALEJAL
1/1/2014 12/31/2015 TEACHER-1 NATIONAL HIGH SCHOOL P 19,495.00 11-7 PERMANENT
DEPARTMRNT OF EDUCATION/ ALEJAL NATIONAL
08/30/2013 12/31/2013 TEACHER-1 HIGH SCHOOL
P 19,690.00 11-7 PERMANENT
DEPARTMENT OF EDUCATION/ ALEJAL
1/6/2012 08/29/2013 TEACHER-1 NATIONAL HIGH SCHOOL P 19,495.00 11-6 PERMANENT
DEPARTMENT OF EDUCATION/ ALEJAL NATIONAL
1/6/2011 05/31/2012 TEACHER-1 HIGH SCHOOL P 18,227.00 11-6 PERMANENT
DEPARTMENT OF EDUCATION / ALEJAL
08/30/2010 05/31/2011 TEACHER-1 NATIONAL HIGH SCHOOL P 16,959.00 11-6 PERMANENT
DEPARTMENT OF EDUCATION / ALEJAL
06/24/2010 08/29/2010 TEACHER-1 NATIONAL HIGH SCHOOL P 16,687.00 10-5 PERMANENT
DEPARTMENT OF EDUCATION /ALEJAL NATIONAL
1/7/2009 06/23/2010 TEACHER-1 HIGH SCHOOL P 15,379.00 10-5 PERMANENT
DEPARTMENT OF EDUCATION / ALEJAL
1/7/2008 06/30/2009 TEACHER-1 NATIONAL HIGH SCHOOL P 13,275.00 10-5 PERMANENT
DEPARTMENT OF EDUCATION /ASUNCION
08/30/2007 06/30/2008 TEACHER-1 NATIONAL HIGH SCHOOL P 12,068.00 10-5 PERMANENT
DEPARTMENT OF EDUCATION / ASUNCION
1/7/2007 08/29/2007 TEACHER-1 NATIONAL HIGH SCHOOL P 11,774.00 10-4 PERMANENT
DEPARTMENT OF EDUCATION ASUNCION
1/9/2004 06/30/2007 TEACHER-1 NATIONAL HIGH SCHOOL P 10,704.00 10-4 PERMANENT
DEPARTMENT OF EDUCATION / ASUNCION
08/30/2001 08/31/2004 TEACHER-1 NATIONAL HIGH SCHOL P 10,442.00 10-3 PERMANENT
DEPARTMENT OF EDUCATION/ ASUNCION
1/7/2001 08/29/2001 TEACHER-1 NATIONAL HIGH SCHOOL P 10,188.00 10-2 PERMANENT
DEPARTMENT OF EDUCATION /ASUNCION
1/1/2000 06/30/2001 TEACHER-1 NATIONAL HIGH SCHOOL P 9,703.00 10-2 PERMANENT
DEPARTMENT OF EDUCATION / ASUNCION
08/30/1998 12/31/1999 TEACHER-1 NATIONAL HIGH SCHOOL P 8,851.00 10-2 PERMANENT
DEPARTMENT OF EDUCATION / ASUNCION
1/11/1997 08/29/1998 TEACHER-1 NATIONAL HIGH SCHOOL P 8,605.00 10-1 PERMANENT
DEPARTMENT OF EDUCATION/ ASUNCION
1/1/1997 10/31/1997 TEACHER-1 NATIONAL HIGH SCHOOL P 7,309.00 10-1 PERMANENT
DEPARTMENT OF EDUCATION /ASUNCION
1/1/1996 12/31/1996 TEACHER-1 NATIONAL HIGH SCHOOL P 6, 013.00 10-1 PERMANENT
DEPARTMENT OF EDUCATION ASUNCION
08/30/1995 12/31/1995 TEACHER-1 NATIONAL HIGH SCHOOL P 4,902.00 10-1 PERMANENT

***NOTHING FOLLOWS***

(Continue on separate sheet if necessary)


SIGNATURE DATE JAN. 27, 2020

CS FORM 212 (Revised 20


LICENSE (if applicable)

Date of
Validity

09/27/1993

NG FOLLOWS***

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

NG FOLLOWS***

arate sheet if necessary)


JAN. 27, 2020

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

N/A N/A N/A N/A

N/A N/A N/A N/A

N/A N/A N/A N/A

N/A N/A N/A N/A

N/A N/A N/A N/A

N/A N/A N/A N/A

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
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
DEPARTM
SCIENCE AND MATH. ENHANCEMENT PROGRAM (SMEP ) 9/21/2018 1/25/2019 16 TECHNICAL

SCHOOL BA
TECHNICAL
SEMINAR-WORKSHOP ON CONTEXTUALIZATION FOR SCIENCE LEARNING AREA 12/26/2016 12/27/2016 16
SCHOOL BA
GENDER AND DEVELOPMENT 12/22/2016 12/22/2016 8.0 TECHNICAL

SCHOOL BA
SIP ENHANCEMENT TRAINING 12/10/2016 12/10/2016 8.0 TECHNICAL

SCHOOL BA
10/27/2016 10/28/2016 16.0 TECHNICAL
PARTNERSHIP TRAINING ON DISASTER PREPAREDNESS AND AWARENESS
SCHOOL BA
ENHANCEMENT TRAINING/WORKSHOP ON READING PROGRAM 10/25/2016 10/26/2016 16.0 TECHNICAL

SCHOOL BA
INFORMATION TECHNOLOGY ENHANCEMENT TRAINING 10/24/2016 10/24/2016 8.0 TECHNICAL

SEMINAR WORKSHOP FOR SPIRITUAL ENHANCEMENT 10/5/2015 10/5/2015 8.0 TECHNICAL AL

SEMINAR WORKSHOP ON CHILD PROTECTION POLICY AND OTHER RELATED ISSUANCES 9/12/2015 9/12/2015 8.0 TECHNICAL AL

***NOTHING FOLLOWS***
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

BAKING/COOKING N/A

GARDENING / PLANTING N/A

SEWING N/A

***NOTHING FOLLOWS*** N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

N/A

N/A

N/A

N/A

N/A

N/A
eparate sheet if necessary)
ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF EDUCATION-DIVISION OF
DAVAO DEL NORTE
SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL
PARTNERSHIP

SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL


PARTNERSHIP

SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL


PARTNERSHIP

SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL


PARTNERSHIP

SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL


PARTNERSHIP

SCHOOL BASED MANAGEMENT/SCHOOL TO SCHOOL


PARTNERSHIP

ALEJAL NATIONAL HIGH SCHOOL

ALEJAL NATIONAL HIGH SCHOOL

NG FOLLOWS***
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

N/A

N/A

N/A

N/A

N/A

N/A
eparate sheet if necessary)

JAN. 27, 2020

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
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
VIRGINIA J. PERANDOS CARMEN, DAVAO 9165943884 3.5 cm. X 4.5 cm
(passport size)

DOMINADOR P. ALAGDON JR. CARMEN, DAVAO 9476922104 With full and handwritten
name tag and signature over
printed name
HAYDEE E. DINO PANABO CITY 9205613716
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
PROFESSIONAL REGULATION COMMISSION
Government Issued ID:

ID/License/Passport No.: 0202538


Signature (Sign inside the box)
Date/Place of Issuance: 11/20/19 , TAGUM CITY JAN. 27, 2020

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

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