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 PANAGA
NAME EXTENSION (JR., SR) N/A
FIRST NAME EFREN
MIDDLE NAME CABANSI
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
9/6/1958 by
✘ by naturalization
birth
4. PLACE OF BIRTH ECHAGUE, ISABELA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS Single ✘ Married
Widowed Separated House/Block/Lot No. Street
SINABBARAN
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.67 ECHAGUE ISABELA
City/Municipality Province
8. WEIGHT (kg) 65 kg ZIP CODE 3309

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
SINABBARAN
10. GSIS ID NO. CRN-006-0125-4543-4
Subdivision/Village Barangay
ECHAGUE ISABELA
11. PAG-IBIG ID NO. 1340-0016-1853
City/Municipality Province

12. PHILHEALTH NO. 06-000027142-2 ZIP CODE 3309

13. SSS NO. 7166-625-W 19. TELEPHONE NO. N/A

14. TIN NO. 140-845-038 20. MOBILE NO. 0928-7822-427

15. AGENCY EMPLOYEE NO. 4205794 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PANAGA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME NORMA

NAME EXTENSION (JR., SR) N/A
FRENOR A. PANAGA 2/12/1983
MIDDLE NAME AQUINO ELISHA DANIKA A. PANAGA 2/10/2005
OCCUPATION TEACHING
EMPLOYER/BUSINESS NAME DEPED ECHAGUE EAST DISTRICT
BUSINESS ADDRESS SAN FABIAN, ECHAGUE, ISABELA
TELEPHONE NO. N/A
24. FATHER'S SURNAME PANAGA
NAME EXTENSION (JR., SR)
FIRST NAME JOSE N/A

MIDDLE NAME BABARAN

25. MOTHER'S MAIDEN NAME

SURNAME CABANSI

FIRST NAME ROSA

MIDDLE NAME VINARAO (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

TUGUEGARAO-STO.DOMINGO ELEMENTARY
ELEMENTARY
SCHOOL
GRADE SCHOOL 6/4/1965 /0325/1971 GRADUATED 1971 N/A

SECONDARY /
VOCATIONAL ISABELA STATE UNIVERSITY ECHAGUE ISABELA HIGH SCHOOL 6/3/1971 3/20/1976 GRADUATED 1976 N/A

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

TRADE
COURSE ISABELA STATE UNIVERSITY CABAGAN, ISABELA AND BACHELOR OF SCIENCE IN FORESTRY AND 6/2/1978 04/02/1984 GRADUATED 38
COLLEGE 1984 N/A
NORTHEASTERN COLLEGE SANTIAGO ISABELA BEED UNITS 06/05/1985 04/03/1986 UNITS

NORTHEASTERN COLLEGE SANTIAGO ISABELA AND IC

GRADUATE STUDIES CAUAYAN CITY
MASTER OF ARTS IN EDUCATION 6/2/1989 4/3/1998 GRADUATED 1998 N/A

(Continue on separate sheet if necessary)

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 BOARD OF EXAMINATION 74.2 11/22/1987 ILAGAN, ISABELA 0396673 9/6/2021

(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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
(Y/ N)
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2020 PRESENT ESHT-3 WEST DISTRICT
₱36, 369 16-4 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2019 1/31/2019 ESHT-3 WEST DISTRICT
₱32, 147 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2018 12/31/2018 ESHT-3 WEST DISTRICT
₱32, 147 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2017 12/31/2017 ESHT-3 WEST DISTRICT
₱30, 396 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2016 12/31/2016 ESHT-3 WEST DISTRICT
₱28,740 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
6/1/2012 12/31/2015 ESHT-3 WEST DISTRICT
₱27, 174 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
6/1/2011 5/31/2012 ESHT-3 WEST DISTRICT
₱24, 423 16-2 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
6/24/2010 5/31/2011 ESHT-3 WEST DISTRICT
₱21, 969 16-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/2009 6/23/2010 ESHT-3 WEST DISTRICT
₱19, 513 16-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/2008 6/30/2009 ESHT-3 WEST DISTRICT
₱16, 093 15-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
3/14/2008 6/30/2008 ESHT-3 WEST DISTRICT
₱14,630 15-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/2007 3/13/2008 MASTER TEACHER 1 WEST DISTRICT
₱15, 508 16-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
3/5/2005 6/30/2007 MASTER TEACHER 1 WEST DISTRICT
₱14, 098 16-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/2003 3/4/2005 TEACHER 3 WEST DISTRICT
₱11, 446 12-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/2001 6/30/2003 TEACHER 3 WEST DISTRICT
₱11, 167 12-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/2000 6/30/2001 TEACHER 3 WEST DISTRICT
₱9,945 12-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
7/1/1998 12/31/1999 TEACHER 3 WEST DISTRICT
₱9,668 12-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
6/18/1998 6/30/1998 TEACHER 1 WEST DISTRICT
₱9, 040.17 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
11/1/1997 6/17/1998 TEACHER 1 WEST DISTRICT
₱8,821 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/1997 10/31/1997 TEACHER 1 WEST DISTRICT
₱7,433 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/1996 12/31/1996 TEACHER 1 WEST DISTRICT
₱6,044 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/1995 12/31/1995 TEACHER 1 WEST DISTRICT
₱4,902 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
1/1/1994 12/31/1994 TEACHER 1 WEST DISTRICT
₱3, 902 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
0102/1991 12/31/1993 TEACHER 1 WEST DISTRICT
₱3, 102 10-1 PERMANENT Y
DEPARTMENT OF EDUCATION ECHAGUE
6/11/1990 12/311990 TEACHER 1 WEST DISTRICT
₱3, 102 10-1 SUBSTITUTE Y
DEPARTMENT OF EDUCATION ECHAGUE
11/1/1989 12/31/1989 TEACHER 1 EAST DISTRICT
₱3, 102 10-1 SUBSTITUTE Y
DEPARTMENT OF EDUCATION ECHAGUE
7/18/1989 10/31/1989 TEACHER 1 EAST DISTRICT
₱1, 764 10-1 SUBSTITUTE 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
INCLUSIVE DATES
29.
NAME & ADDRESS OF ORGANIZATION (Write in full) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

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

38TH PRINCIPALS TRAINING AND DEVELOPMENT PROGRAM AND NATIONAL BOARD CONFERENCE
3/3/2019 3/5/2019 24 hours DepEd Region
(PTDP-NBC)

2018 MIND EDUCATION SPECALIST TRAINING(MEST) INTERNATIONAL SEMINAR-WORKSHOP ON

12/1/2018 12/2/2018 16 HOURS DepEd Region
TRANSFORMATIONAL LEADERSHIP AMONG EDUCATORS

CULSULTATIVE CONFERENCE CUM DEBRIEFING ON TIP AND RPMS-PPST QUALITY ASSURANCE

11/25/2018 11/26/2018 16 HOURS DepEd Region
AND MONITORING EVALUATION

3-DAY TRAINING WORKSHOP ON THE DEVELOPMENT OF IPED LESSON EXEMPLARS FOR GRADE 3-4
FOR AGTA, IBANAG AND YOGAD LEARNERS CUM CRAFTING OF MONITORING AND EVALUATING 8/22/2018 8/24/2018 24 HOURS
TOOL DepEd -Division

STRATEGIC AND TRANSFORMATION LEADERSHIP AND ADMINISTRATION (STLA) PROGRAM BATCH 5 7/30/2018 8/1/2018 24 HOURS
DepEd -Division
DIVISION ROLL-OUT OF THE RESULTS-BASED PERFORMANCE APPRAISAL SYSTEM(RPMS) MANUAL
7/5/2018 7/6/2018 16 HOURS
FOR TEACHERS AND SCHOOL HEAD DepEd -Region
BATCH 02 DEVELOPMENTALLY APPROPRIATE PRACTCE IN EARLY LANGUAGE LITERACY AND
3/13/2017 3/202017 64 HOURS
NUMERACY (DAP-ELLN) DepEd -Division

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in
full)
ECHAGUE WEST TEACHERS
CARPENTRY N/A
ASSOCIATION
SINGING ISABELA TEACHERS ASSOCIATION
PHILIPPINE PUBLIC SCHOOL
COOKING
TEACHERS ASSOCIATION

(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 by any
YES ✘ NO
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 the If YES, give details:
public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay
YES ✘ NO
election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last election YES ✘ NO
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: YOGAD
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
CRISPO E. GAFFUD SINABBARAN, ECHAGUE, ISABELA 9669088872 3.5 cm. X 4.5 cm
(passport size)
AMERPHIL R. RUDIO SOYUNG, ECHAGUE, ISABLELA 9063562587
With full and handwritten
name tag and signature over
DARWIN J. MANGUNAY ROXAS, ISABELA 9175259551 printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete Computer generated
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize or photocopied picture
is not acceptable
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 against PHOTO
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

ID/License/Passport No.: ID NO. 0396673

Signature (Sign inside the box)

Date/Place of Issuance: 7/8/1998-PRC MANILA

Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

DARWIN J. MANGUNAY, EdD

Person Administering Oath

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