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 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 GARCIA
NAME EXTENSION (JR., SR) N/A
FIRST NAME EVA

MIDDLE NAME AYCARDO

3. DATE OF BIRTH
(mm/dd/yyyy) 6/5/1991 16. CITIZENSHIP
✘

4. PLACE OF BIRTH LEGAZPI CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘

✘ 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
House/Block/Lot No. Street
DREAMLAND TAYSAN
Subdivision/Village Barangay
LEGAZPI ALBAY
7. HEIGHT (m) 160
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 4500

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
DREAMLAND TAYSAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LEGAZPI ALBAY
11. PAG-IBIG ID NO. 1211 3097 0424
City/Municipality Province

12. PHILHEALTH NO. 1020 1683 2550 ZIP CODE 4500

13. SSS NO. 8688 9267 19. TELEPHONE NO. N/A

14. TIN NO. 389 015 406 000 20. MOBILE NO. 0946 1535 424

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

FIRST NAME JOHNRAY

NAME EXTENSION (JR., SR) N/A KURT LEUIS AXELLE A. GARCIA 4/18/2013

MIDDLE NAME MAGALONA

OCCUPATION OFFICE CLERK

EMPLOYER/BUSINESS NAME JHONSUNS BUILDERS AND DEVELOPMENT CORP.

BUSINESS ADDRESS JBDC BLDG. PENARANDA EXT., BRGY. 39 BONOT LEGAZPI, CITY

TELEPHONE NO. (052) 480 1297

24. FATHER'S SURNAME AYCARDO

NAME EXTENSION (JR., SR) SR.
FIRST NAME FEDERICO

MIDDLE NAME ARINGO

25. MOTHER'S MAIDEN NAME

SURNAME MONTENEGRO

FIRST NAME MAGDALENA

MIDDLE NAME NAPOD (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY BARIIS ELEMENTARY SCHOOL 6/1/1998 4/1/2004 2004

SECONDARY /
VOCATIONAL BANQUEROHAN NATIONAL HIGH SCHOOL 6/1/2004 4/1/2008 2008

TRADE
DIVINE WORD COLLEGE OF LEGAZPI (DWCL) BACHELOR OF SCIENCE IN ACCOUNTANCY (BSA) 6/1/2011 4/1/2013
COURSE
COLLEGE
DARAGA COMMUNITY COLLEGE (DCOMC) BACHELOR OF ELEMENTARY EDUCATION (BEED) 6/2014 4/2018
95 UNITS 2018 CHED

GRADUATE STUDIES

(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 TEACHER 75.2 9/30/2018 LEGAZPI CITY 1701975 6/5/2025

(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)

6/1/2019 7/31/2022 ELEMENTARY TEACHER SAINT ROCHE LEARNING CENTER, INC. LEGAZPI CITY 8000.00 CONTRACTUAL N

6/1/2021 10/31/2021 VOLUNTEER TEACHER TAYSAN ELEMENTARY SCHOOL, LEG. CITY N/A VOLUNTEER Y
TAYSAN RESSETLEMENT INTEGRATED SCHOOL, LEGAZPI
9/1/2017 8/30/2018 GRADE SIX STUDENT TEACHER CITY
N/A INTERN Y
STAFF SEARCH ASIA JOLLIBEE LCC,
8/1/2015 8/30/2017 SERVICE CREW/CREW TRAINOR LEGAZPI CITY
8000.00 CONTRACTUAL N

9/1/2014 3/30/2015 SERVICE CREW/CASHIER GRACELAND FOOD INDUSTRIES, INC. 7000.00 CONTRACTUAL N

(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) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

DEPARTMENT OF EDUCATION, TAYSAN ELEMENTARY SCHOOL 6/1/2021 10/31/2021 BRIGADA PAGBASA VOLUNTEER TUTOR/TEACHER

DEPARTMENT OF ENVIRONMENT AND NATURAL RESOURCES (DENR) and

2/24/2018 ADOPT A RIVER CLEANUP ACTIVITY, TAYSAN LEGAZPI CITY
DEPARTMENT OF EDUCATION , LEGAZPI DIVISION (DEPED)

YOUTH HEALTH CORP 6/1/2004 8/1/2008 PEER EDUCATOR

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
PHILLIPPINE CONTINUING PROFESSIONAL
10 DAY INTERNATIONAL ONLINE TRAINING PROGRAM FOR 21st CENTURY EDUCATION 1/10/2022 1/19/2022 90 hours
DEVELOPMENT-PCPD
NATIONAL TRAINING ON INTERACTIVE TECHNOLOGICAL TOOLS TO ENGAGE STUDENTS PHILLIPPINE CONTINUING PROFESSIONAL
1/19/2022 1/19/2022
IN MATHEMATICS LEARNING IN THE NEW NORMAL DEVELOPMENT-PCPD
UNDERSTANDING THE INS AND OUT OF HOME SCHOOLING PHILLIPPINE CONTINUING PROFESSIONAL
1/19/2022 1/19/2022
NAVIGATING MENTAL HEALTH FOR TEACHERS DEVELOPMENT-PCPD
NATIONAL TRAINING ON 21st CENTURY TEACHING LEARNING PEDAGOGIES AND PHILLIPPINE CONTINUING PROFESSIONAL
1/16/2022 1/18/2022
TEACHERS ROLE DURING PANDEMIC TIME DEVELOPMENT-PCPD
ANG TEATRO SA MUNDO NG PAGTUTURONG ONLINE: MGA MABISANG GAWAIN PARA SA PAGTUTURO NG PHILLIPPINE CONTINUING PROFESSIONAL
1/14/2022 1/16/2022
FILIPINO AT MAPEH DEVELOPMENT-PCPD
NATIONAL SEMINAR WORSHOP ON LEADERSHIP: THE TOTAL LEADER ESSENTIAL PHILLIPPINE CONTINUING PROFESSIONAL
1/13/2022 1/13/2022
SKILLS FOR SUCCESSFUL SCHOOL MANAGEMENT DEVELOPMENT-PCPD
NATIONAL TRAINING ON MODULE AND BOOK WRITING FOR THE 21st CENTURY PHILLIPPINE CONTINUING PROFESSIONAL
1/10/2022 1/12/2022
EDUCATORS DEVELOPMENT-PCPD

SCHOOL FORMS 6/3/2021 DEPARTMENT OF EDUCATION

ORTOGRAPIYANG PAMBANSA AT KWK MASINOP NA PAGSULAT PARA SA MGA EDITOR

4/28/2021 4/29/2021 118 hours INTELLIGENCE PUBLISHING INC.
SA FILIPINO
THE TASTE OF BLENDED LEARNING REIMAGINING THE SCHOOL YEAR IN BLENDED
4/1/2021 4/1/2021 4 hours VIBAL
LEARNING

EASING THE PATHWAYS TO DISTANCE LEARNING 6/19/2020 6/22/2020 24 hours VIBAL

ADDRESSING LEARNERS DIFFICULTIES IN

5/6/2020 5/9/2020 24 hours VIBAL
MATHEMATICS
DISTANCE LEARNING: ONLINE TEACHING
5/5/2020 5/8/2020 24 hours VIBAL
TECHNIQUES AND APPROACHES
AUGMENTED REALITY: VISUALIZING LEARN LIVE AR FOR
BETTER VIRTUAL LEARNING EXPERIENCES 5/4/2020 5/7/2020 24 hours VIBAL

5/3/2020 5/6/2020 24 hours VIBAL

COLLABORATIVE LEARNING STRATEGIES FOR TEACHERS
INTRODUCING RESTORATIVE DISCIPLINE AS
5/2/2020 5/5/2020 24 hours VIBAL
TEACHERS COMFORT ZONE
EMOTION: AN AVENUE FOR IMPROVING
5/1/2020 5/4/2020 24 hours VIBAL
STUDENTS LEARNING AND BEHAVIOR

DRIVING NCII 11/26/2018 12/14/2018 118 hours AKO BOKOL/TESDA

BREAD AND PASTRY PRODUCTION NCII 10/14/2018 11/10/2018 144 hours TESDA

CONTACT CENTER SERVICES NCII 4/12/2018 5/8/2018 116 hours TESDA

INSTRUCTIONAL COVERAGE SYSTEM PUBLISHING

WEBINAR SERIES: EASING THE PATHWAYS TO DISTANCE LEARNING 6/17/2020 6/19/2020 24 hours
INC.
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

BAKING RESILIENT TEACHER AWARD SY 2021-2022 DWCL CHOIR

COMPUTER LITERATE BEST IN PANTRY STATION (JOLLIBEE LCC) YOUTH HEALTH CORP

HOSTING EARLY BIRD AWARD (GRACELAND FOOD INDUSTRIES)

WALANG KUPAS AWARD (JOLLIBEE LCC)

(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? ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? ✘

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘

If YES, give details:

________________________________
________________________________
b. Have you been criminally charged before any court? ✘

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 court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘
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? ________________________________
RESIGNATION/FINISHED CONTRACT
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except ✘
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before 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? ✘

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? ✘
If YES, please specify:
b. Are you a person with disability? ✘
If YES, please specify ID No:
c. Are you a solo parent? ✘
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
MARITES A. GOYENA TAYSAN LEGAZPI CITY 0927315 0858 4.5 cm. X 3.5 cm
(passport size)

REGGIE BAILE LEGAZPI CITY 0917 707 0299

Computer generated
or photocopied picture
is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct 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 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: UNIFIED MULTI_PURPOSE ID

ID/License/Passport No.: 0111 8688 9267

Signature (Sign inside the box)

Date/Place of Issuance: LEGAZPI 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 of 4