High School Admin Assistant

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Posted:

September 04, 2023

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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 LIGTAS

FIRST NAME ROSELA

NAME EXTENSION (JR., SR)

MIDDLE NAME OLASIMAN

3. DATE OF BIRTH

(mm/dd/yyyy) 24/06/1990 16. CITIZENSHIP

4. PLACE OF BIRTH POB. CANDIJAY, BOHOL If holder of dual citizenship, Pls. indicate country: 5. SEX

please indicate the details.

6 CIVIL STATUS 17. RESIDENTIAL ADDRESS LOOC

House/Block/Lot No. Street

POBLACION

Subdivision/Village Barangay

7. HEIGHT (m) 5'2 CANDIJAY BOHOL

City/Municipality Province

8. WEIGHT (kg) 48KGS ZIP CODE 6312

9. BLOOD TYPE AB+ 18. PERMANENT ADDRESS LOOC

House/Block/Lot No. Street

10. GSIS ID NO. n/a POBLACION

Subdivision/Village Barangay

11. PAG-IBIG ID NO. n/a CANDIJAY BOHOL

City/Municipality Province

12. PHILHEALTH NO. n/a ZIP CODE 6312

13. SSS NO. n/a 19. TELEPHONE NO.

14. TIN NO. n/a 20. MOBILE NO. 090*-***-****

15. AGENCY EMPLOYEE NO. n/a 21. E-MAIL ADDRESS (if any) ************@*****.*** II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME n/a 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH

FIRST NAME n/a

NAME EXTENSION (JR., SR)

MIDDLE NAME n/a

OCCUPATION n/a

EMPLOYER/BUSINESS NAME n/a

BUSINESS ADDRESS n/a

TELEPHONE NO. n/a

24. FATHER'S SURNAME LIGTAS

FIRST NAME VICENTE

NAME EXTENSION (JR., SR)

MIDDLE NAME CALIHAN

25. MOTHER'S MAIDEN NAME OLASIMAN

SURNAME LIGTAS

FIRST NAME URBANA

MIDDLE NAME (Continue on separate sheet if necessary) III. EDUCATIONAL BACKGROUND

26.

LEVEL NAME OF SCHOOL

(Write in full)

BASIC EDUCATION/DEGREE/COURSE

(Write in full)

PERIOD OF ATTENDANCE HIGHEST LEVEL/

UNITS EARNED

(if not graduated)

YEAR

GRADUATED

From To

ELEMENTARY CANDIJAY CENTRAL ELEM. SCHOOL 19/06/1905 25/03/2003 n/a 2003 SECONDARY SAINJT JOSEPH ACADEMY 12/06/2003 30/03/2007 n/a 2007 VOCATIONAL /

TRADE COURSE n/a n/a

COLLEGE BOHOL ISLAND STATE UNIVERSITY-Main Campus Bachelor in Secondary Education Major in Social Studies (QUAL) 02/11/2017 17/09/2018 n/a 2018 GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/23/23

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

CS Form No. 212

Revised 2017

Filipino Dual Citizenship

Male Female

Single Married

Widowed

Other/s:

Separated

by birth by naturalization

IV. CIVIL SERVICE ELIGIBILITY

27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER

SPECIAL LAWS/ CES/ CSEE

BARANGAY ELIGIBILITY / DRIVER'S LICENSE

RATING

(If Applicable)

DATE OF

EXAMINATION /

CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

LICENSE (if applicable)

NUMBER Date of

Validity

PROFESSIONAL TEACHER 79.9 24/03/2019 MABOLO, CEBU, CITY 1788662 24/06/2022

(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. 28. INCLUSIVE DATES

(mm/dd/yyyy) POSITION TITLE

(Write in full/Do not abbreviate)

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full/Do not abbreviate)

MONTHLY

SALARY

SALARY/ JOB/ PAY

GRADE (if

applicable)& STEP

(Format "00-0")/

INCREMENT

STATUS OF

APPOINTMENT

GOV'T

SERVICE

(Y/ N)

From To

08/26/22 11/01/2022 Substitute Teacher Candijay National High School 27000.00 sub 01/09/2020 31/12/2021 Admin Assistant III PhilSys (National ID) 18000.00 COWS 02/06/2018 31/07/2020 Municipal Paid Teacher Candijay National High School casual 03/03/2015 30/09/2017 Administrative Section Head Access E-Talk Plus-Japanese Int. School 22,000 regular 02/04/2013 30/11/2014 Admin Aide Staff LGU-Candijay casual

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/23/23

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 29. NAME & ADDRESS OF ORGANIZATION

(Write in full)

INCLUSIVE DATES

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

PYM- Member 01/03/2007 present n/a n/a

COLL Member Sept. 2006 present 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) 30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS

(Write in full)

INCLUSIVE DATES OF

ATTENDANCE

(mm/dd/yyyy)

NUMBER OF HOURS

Type of LD

( Managerial/

Supervisory/

Technical/etc)

CONDUCTED/ SPONSORED BY

(Write in full)

From To

Midyear Assessment in Service Training Oct.21 Oct. 25, 2019 40 hrs n/a Urbano M. Bernasor Values Formation Seminar Oct.29 Oct.29, 2018 8 hrs n/a Urbano M. Bernasor Candijay, District on RPMS Aug. 03 Aug.4, 2018 16 hrs n/a Urbano M. Bernasor Orientation for PPST 27/07/2018 28/07/2018 16 hrs n/a Urbano M. Bernasor Orientation for ISO 05/03/2015 15/03/2015 120 hrs. n/a Dennis Oliverio

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION

(Write in full)

MEMBERSHIP IN

ASSOCIATION/ORGANIZATION

(Write in full)

Computer Literate n/a n/a

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/23/23

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 out (abolition) in the public or private sector?

If YES, give details:

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.

Kristine Alexie B. Tutor 3rd District Representative Gregoria B. Dabalos CNHS- Principal

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: PRC

ID/License/Passport No.: 1788662 Signature (Sign inside the box) Date/Place of Issuance: Cebu City

04/23/23

Date Accomplished Right Thumbmark

ID picture taken within

the last 6 months

3.5 cm. X 4.5 cm

(passport size)

With full and handwritten

name tag and signature over

printed name

Computer generated

or photocopied picture

YES NO

YES

YES NO

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

If YES, give details (country):

, affiant exhibiting his/her validly issued government ID as indicated above. CS FORM 212 (Revised 2017), Page 4 of 4

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