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 ALINGOG
NAME EXTENSION (JR., SR)
FIRST NAME MARIE JOY

MIDDLE NAME LUCZON

3. DATE OF BIRTH
MAY 22, 1992 16. CITIZENSHIP Dual
(mm/dd/yyyy) ✘ Filipino by
by
Citizenship
naturalization
birth
4. PLACE OF BIRTH MALLIG,ISABELA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘
Female
6 CIVIL STATUS Single ✘ Marrie 17. RESIDENTIAL ADDRESS #97 PILAR STREET

Widowe Separa
d
House/Block/Lot No. Street
DISTRICT 3
Other/s
d ted Subdivision/Village Barangay
7. HEIGHT (Cm)
: 175 CM CAUAYAN CITY ISABELA
City/Municipality Province
8. WEIGHT (kg) 95 KGS ZIP CODE 3305

18. PERMANENT ADDRESS # 97 PILAR STREET

9. BLOOD TYPE B (-)
House/Block/Lot No. Street
DISTRICT 3
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A CAUAYAN CITY ISABELA

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 3305

13. SSS NO. N/A 19. TELEPHONE NO. (078) 652 -0118

14. TIN NO. N/A 20. MOBILE NO. 09758263482

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) senseimajoy@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME ALINGOG 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR) JIREH MATHEUXS L. ALINGOG
FIRST NAME MARK AURELIUS 09/14/2014
ELIJAH ASHZRYIEL L. ALINGOG
MIDDLE NAME PASCUAL 05/28/2019

OCCUPATION TAEKWONDO INSTRUCTOR

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. (078) 652- 0118

24. FATHER'S SURNAME LUCZON

NAME EXTENSION (JR., SR)
FIRST NAME ROMEO

MIDDLE NAME RAMIREZ

25. MOTHER'S MAIDEN NAME

SURNAME RAMOS

FIRST NAME MARILOU

MIDDLE NAME DELA PAZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MALLIG CENTRAL SCHOOL 5/6/1996 1/4/2004 2004

SECONDARY /
VOCATIONAL MALLIG PLAINS COLLEGES,INC. 10/6/2004 5/4/2008 2008

TRADE
COURSE UNIVERSITY OF PERPETUAL HELP SYSTEM
COLLEGE
LAGUNA-ISABELA CAMPUS
BACHELOR OF SCIENCE IN NURSING 5/11/2008 4/4/2013 2013

BACHELOR OF SCIENCE IN SECONDARY

COLLEGE ISABELA COLLEGES INC.
EDUCATION
4/11/2018 10/4/2019 2019

SIGNATURE
DATE 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

PROFESSIONAL TEACHER 78.0 MARCH,2019 TUGUEGARAO 1773327 05/22/2022

(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
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / PAY GRADE
POSITION TITLE
(mm/dd/yyyy) COMPANY MONTHLY (if applicable)& STATUS OF
(Write in full/Do not SALARY STEP (Format APPOINTMENT
(Write in full/Do not
abbreviate) "00-0")/
From To abbreviate) INCREMENT
(Y/ N)
PHILIPPINE TAEKWONDO
04/27/2017 PRESENT TAEKWONDO INSTRUCTRESS 100/session PER SESSION N
ASSOCIATION
4/3/2012 PRESENT PRIVATE TUTOR SELF EMPLOYED 100/session PER SESSION N
2000
01/25/2017 03/14/2018 EMERGENCY MEDICAL RESPONDER RESCUE 922 (Allowance) VOLUNTEER Y
COMMUNITY BASED MONITORING
5/3/2017 11/30/2018 LGU CAUAYAN 5000.00 VOLUNTEER Y
SYSTEM

(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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION NUMBER OF
(Write in full) (mm/dd/yyyy) HOURS POSITION / NATURE OF WORK
From To
UNITED PENTECOSTAL CHUCH PHILS (UPC
3/3/2019 PRESENT UPC CMP PADILLA CHURCH SECRETARY/ TREASURER
CMP PADILLA CHURCH)
PHILIPPINE TAEKWONDO ASSOCIATION
4/6/2018 PRESENT TBS BATCH 29 (LEADER)
(TBB/TBS BATCH 40-REGION 2)

PHILIPPINE TAEKWONDO FOUNDATION 7/4/2018 PRESENT 2nd DAN BLACKBELT

KUKKIWON WORLD TAEKWONDO

05/21/2018 PRESENT 1st DAN KUKKIWON
HEADQUARTERS

(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

30. TITLE OF LEARNING AND DEVELOPMENT Type of LD
(mm/dd/yyyy) NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY (Write in
INTERVENTIONS/TRAINING PROGRAMS Supervisory/
HOURS full)
(Write in full) Technical/etc)
From To

EMERGENCY MEDICAL RESPONDER'S TRAINING January 16 2017 January 22 2017 3 Days Managerial RESCUE 922 CAUAYAN

R2 NATIONAL REFEREE AND REFRESHER COURSE November 16 2018November 18 2018 3 Days Managerial
Philippine Taekwondo Federation

BASIC COMPUTER January 12 2019 April 5, 2019 3 Months Technical

Alternative Learning System
NEW TEACHING METHODOLOGIES INCLUDING
May 28 2020 May 28 2020 1 Day Managerial
FLEXIBLE LEARNING OPTIONS St. Bernadette Publishing House Corporation
TECHNOLOGY ENHANCED LEARNING MODES FOR
May 29 2020 May 29 2020 1 Day Managerial
NEW NORMAL St. Bernadette Publishing House Corporation

PSYCHOSOCIAL INTERVETIONS IN SCHOOL May 30 2020 May 30 2020 1 Day Managerial

St. Bernadette Publishing House Corporation
OPTIMIZING THE CURRICULUM AND LEARNING
June 9, 2020 June 9, 2020 1 Day Managerial
EXPERIENCE THROUGH MODULAR APPROACH Vibal Group
STUDENT GOVERNMENT ONLINE:STUDENT
September 25, 202September 25, 2020 1 Day Managerial
LEADERSHIP IN DISTANCE LEARNING Vibal Group
CODE OF ETHICSFOR PROFESSIONAL TEACHERS
RELEVANT TO DISTANT LEARNING MODALITIES
November 30, 202November 30, 2020 1 Day Managerial Vibal Group

FOUNDATION OF MASSAGE PRACTICE (1 of 4) September 15,202 September 15,2020 1 Day Technical TESDA

SMART TECHNOPRENEURSHIP 101 January 27, 2021 January 27, 2021 1 Day Managerial TESDA

PLAN TRAINING SESSION January 27, 2021 January 27, 2021 1 Day Managerial
TESDA

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3
NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 2 33.
(Write in full) (Write in full)
.
Computer Literate PHILIPPINE TAEKWONDO ASSOCIATION

Can play the guitar and piano

KUKKIWON WORLD TAEKWONDO HEADQUARTERS

(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 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 CELLPHONE NO.

ID picture taken within
the last 6 months
MS. INGGRID B. JACOBE (RESCUE 922) CABARUAN,CAUAYAN CITY ISABELA 9757731955 3.5 cm. X 4.5 cm
(passport size)

PASTOR MAURO B. UBALDO VILLA CONCEPCION,LUNA ISABELA 9752526275 With full and handwritten
name tag and signature over
printed name
MR. AGUSTIN "JONG" PEREZ JR. TABUK,KALINGA 9171257772
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:

ID/License/Passport No.: 1773327

Signature (Sign inside the box)

Date/Place of Issuance: 06/15/2019/ROBINSON SANTIAGO

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