N A High School

CS Form No. ***

Revised ****

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 MESINA

NAME EXTENSION (JR., SR)

FIRST NAME MARIA CHILAINE

MIDDLE NAME AMASCUAL

3. DATE OF BIRTH

(mm/dd/yyyy) 12/26/1983 16. CITIZENSHIP

Filipino Dual Citizenship

by by

birth naturalization

4. PLACE OF BIRTH BASEY,SAMAR If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX

Male Female

### CIVIL STATUS Single Married

17. RESIDENTIAL ADDRESS BLK.4 LOT 8

House/Block/Lot No. Street

Widowed Separate BASEY POINTE 2-A TINGIB

Other/s: d

Subdivision/Village Barangay

7. HEIGHT (m) 5"3' BASEY SAMAR

City/Municipality Province

8. WEIGHT (kg) 72 KG ZIP CODE 6500

9. BLOOD TYPE O

18. PERMANENT ADDRESS BLK. 4 LOT 8

House/Block/Lot No. Street

10. GSIS ID NO. 021-1580-5534-6 BASEY POINTE 2-A TINGIB

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 200-***-**** BASEY SAMAR

City/Municipality Province

12. PHILHEALTH NO. 13-025072156-1 ZIP CODE 6720

13. SSS NO. 19. TELEPHONE NO. NONE

14. TIN NO. 249-***-***-**. MOBILE NO. 093********

15. AGENCY EMPLOYEE NO. OSEC-DECSB-TCH1-542061-2012 21. E-MAIL ADDRESS (if any) **.***@*****.***

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME MESINA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME PAUL MARY CHISCA A. MESINA 12/7/2008

MIDDLE NAME BOLECHE PAUL GERRO A. MESINA 2/18/2010

OCCUPATION NONE CELESTINE MARIE A. MESINA 8/13/2014

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME AMASCUAL

NAME EXTENSION (JR., SR)

FIRST NAME

FELECITO

MIDDLE NAME PRISNO

25. MOTHER'S MAIDEN NAME

SURNAME SABONG

FIRST NAME LILINA

MIDDLE NAME BENEDECTO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ SCHOLARSHIP/

26. PERIOD OF ATTENDANCE YEAR

LEVEL (Write in (Write in full) UNITS ACADEMIC

GRADUATED HONORS

full) EARNED

(if not graduated) RECEIVED

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ SCHOLARSHIP/

YEAR

LEVEL (Write in (Write in full) UNITS ACADEMIC

GRADUATED HONORS

full) EARNED

(if not graduated) RECEIVED

From To

BASEY 1CENTRAL ELEMENTARY

ELEMENTARY

SCHOOL COMPLETED 6/2/1990 4/3/1996 1996

SECONDARY

VOCATIONAL / BASEY NATIONAL HIGH SCHOOL COMPLETED 6/3/1996 4/7/2000 2000

HOLY ROSARY DEVELOPMENT FOOD AND BEVERAGE SERVICES MAY

FOUNDATION INCORPORATED NC11 15,2013 2013

TRADE

COURSE BACHELOR OF SCIENCE IN

JUNE

COLLEGE LEYTE COLLEGES COMMERCE MAJOR IN BUSINESS 12,2000 4/7/2006 2006

MANAGEMENT

18 UNITS BACHELOR OF SCIENCE APRIL OCTOBER24,2

IN SECONDARY EDUCATION 8,2013 013 18 UNITS

GRADUATE STUDIES HOLY INFANT COLLEGE MAED JUNE,2018 MARCH,2018 24 UNITS

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 2,2022

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

27. LICENSE (if applicable)

CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF

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 TEACHER 76.2 3/10/2013 TACLOBAN CITY 1221495 6/11/2013

FOOOD AND BEVERAGE SERVICES NCII NCII OCTOBER,2012

ASIAN DEVELOPMENT FOUNDATION 130********** 5/25/2018

TACLOBAN CITY 7

(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 (mm/dd/ SALARY/ JOB/ PAY SERVICE

yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if

MONTHLY STATUS OF

(Write in full/Do not (Write in SALARY

applicable)& STEP

APPOINTMENT

abbreviate) full/Do not abbreviate) (Format "00-0")/

INCREMENT

From To

(Y/ N)

DEPARTMENT OF EDUCATION SAMAR DIVISION/

8/12/2013 9/31/2014 SECONDARY SCHOOL TEACHER 1 18549.00 11 PERMANENT Y

CALBIGA NATIONAL HIGH SCHOOL

DEPARTMENT OF EDUCATION SAMAR DIVISION/

10/1/2014 7/20/2017 SECONDARY SCHOOL TEACHER 1 CALBIGA NATIONAL HIGH SCHOOL 19853.00 11 PERMANENT Y

DEPARTMENT OF EDUCATION SAMAR DIVISION/

7/21/2017 9/1/2018 SECONDARY SCHOOL TEACHER 1 VALERIANO C. YANCHA MEMORIAL AGRICULTURAL 19853.00 11 PERMANENT Y

SCHOOL

DEPARTMENT OF EDUCATION SAMAR DIVISION/

9/2/2018 PRESENT SECONDARY SCHOOL TEACHER 1 CALBIGA NATIONAL HIGH SCHOOL 24450.00 11 PERMANENT Y

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 2, 2022

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

SAINT MICHEAL PARISH CHOIR-ARTE TEATRO KONG SAMAHAN-SAINT 8/1/1997 PRESENT MEMBER

MICHEAL PARISH BASEY, SAMAR

(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

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD

NUMBER OF HOURS

( Managerial/ CONDUCTED/ SPONSORED BY

(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)

Technical/etc)

From To

MASS TRAINING OF SENIOR HIGH SCHOOL TEACHERS FOR THE TECHNICAL

VOCATIONAL-LIVELIHOOD TRACK (AFA/HE/IA/ICT)

JULY 9,2017 JULY15,2017 56 PROFESSIONAL DEPED REGIONAL OFFICE VIII

TLE TEACHERS IN-SET ON THE CONSTRUCTION OF TLE BANNER AND

COMMUNITY EXTENSION PROGRAM

JUNE 24,2017 JUNE 24,2017 8 PROFESSIONAL CALBIGA NATIONAL HIGH SCHOOL

6TH MONTHLY PROFESSIONAL CONFERENCE AND IN-SERVICE EDUCATION FOR JANUARY JANUARY PROFESSIONAL

24 GROWTH CALBIGA NATIONAL HIGH SCHOOL

TEACHERS 29,2016 31,2016

5THMONTHLY PROFESSIONAL CONFERENCE: RPMS MID-YEAR REVIEW EVALUATION DECEMBER DECEMBER 24 TECHNICAL CALBIGA NATIONAL HIGH SCHOOL

AND TIAIP/IPCRF RATING PROCESS/SYSTEM 4,2015 6,2015

4th MONTHLY PROFESSIONAL CONFERENCE ON RPMS REVIEW OF THE TIAIP/IPCRF OCTOBER OCTOBER PROFESSIONAL

24 GROWTH CALBIGA NATIONAL HIGH SCHOOL

AND CULTURE-BASED EDUCATION 26,2016 28,2016

IKATLONG BUWANANG PAMPROPESYONAL NA KUMPERMASYON UPANG

MAKATULONG SA PAGTUTURO NG ISANG ESKELENTING PANURUAN,MGA ADHIKAIN AT SEPTEMBER SEPTEMBER PROFESSIONAL

24 GROWTH CALBIGA NATIONAL HIGH SCHOOL

4,2015 6,2015

PROGRAMA NG PAARALAN

AUGUST AUGUST PROFESSIONAL

2ND TLE DEARTMENT InSET ON CONSTRUCTION OF INSTRUCTIONAL MATERIALS 16 GROWTH CALBIGA NATIONAL HIGH SCHOOL

1,2015 2,2015

CONSULTATIVE-CONFERENCE FOR (TECHNICAL - VOCATIONAL AND LIVELIHOOD) TLE FEBRUARY FEBRUARY PROFESSIONAL

8 GROWTH DEPARTMENT OF EDUCATION SAMAR DIVISION

TEACHER 25,2015 25,2016

SCHOOL BASED IN-SERVICE EDUCATION FOR TEACHERS ON ACTION RESEARCH JANUARY JANUARY PROFESSIONAL

24 GROWTH CALBIGA NATIONAL HIGH SCHOOL

PROPOSAL/REPORT WRITING AND COOPERATIVISM IN SCHOOL 22,2015 24,2015

DECEMBER DECEMBER PROFESSIONAL

2014 SCHOOL IN-SERVICE EDUCATION FOR TEACHERS (INSET) 16 GROWTH CALBIGA NATIONAL HIGH SCHOOL

15,2014 16,2014

2ND TLE DEPARTMENT INSET ON TEST CONSTRUCTION AND ITEM ANALYSIS SEMINAR OCTOBER OCTOBER PROFESSIONAL

8 GROWTH CALBIGA NATIONAL HIGH SCHOOL

WORKSHOP 10,2014 10,2015

OCTOBER OCTOBER DEPARTMENT OF EDUCATION REGIONAL OFFICE

REGIONAL DIVISION-BASED TRAINING OF COACHES ON SCHOOL SPORTS(BATCH 2) 24 SPORTS

18,2013 20,2013 NO.VIII

JANUARY JANUARY

JOB ORIENTATION/SEMINAR OF NEWLY HIRED TEACHERS 2013 24 JOB ORIENTATION DEPARTMENT OF EDUCATION SAMAR DIVISION

16,2013 18,2013

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION

31. SPECIAL SKILLS and HOBBIES 32. (Write in full) 33. (Write in

full)

DANCING NONE CALBIGA NATIONAL HIGH SCHOOL MULTI-

PUROSE COOPERATIVE

ST. MICHAEL PARISH CHOIR/ ARTE TEATRO

SINGING KONG SAMAHAN

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 2, 2022

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 court or tribunal? YES NO

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

Barangay election)? YES NO

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.

DR. REBLAYA G. BAJAS CAVITE

MARK GABREIL B. MARANGA METRO MANILA

ATTY. JOEY C. BAJAS LUCENA CITY

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 administrative/

criminal case/s against me. PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of

Issuance

Government Issued ID: GSIS UMID CARD

ID/License/Passport No.: 021-1580-5534-6

Signature (Sign inside the box)

Date/Place of Issuance: APRIL2017 CATBALOGAN 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

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