Nursing Assistant Elementary School

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 CAGANDA

FIRST NAME MARYGRACE

NAME EXTENSION (JR., SR)

MIDDLE NAME HITOSIS

DATE OF BIRTH

(mm/dd/yyyy) 04/15/1983 16. CITIZENSHIP

4. PLACE OF BIRTH TAGKAWAYAN, QUEZON If holder of dual citizenship, Pls. indicate country: 5. SEX

please indicate the details.

6 CIVIL STATUS 17. RESIDENTIAL ADDRESS PUROK 2 PABUSTAN STREET House/Block/Lot No. Street

MAGSAYSAY

Subdivision/Village Barangay

7. HEIGHT (m) 5'2 TAGKAWAYAN QUEZON

City/Municipality Province

8. WEIGHT (kg) 50KG ZIP CODE 4321

9. BLOOD TYPE "O" 18. PERMANENT ADDRESS PUROK 2 PABUSTAN STREET House/Block/Lot No. Street

10. GSIS ID NO. MAGSAYSAY

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121*********

TAGKAWAYAN QUEZON

City/Municipality Province

12. PHILHEALTH NO. 09-050242726-0 ZIP CODE 4321

13. SSS NO. 33-899****-*-**. TELEPHONE NO.

14. TIN NO. 285-970-446-00000 20. MOBILE NO. 091********-**. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) *****.*******@*****.*** 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 JORALD

NAME EXTENSION (JR., SR) AYEZHA JHEMEA C. ABALA 5/19/2007 MIDDLE NAME ADULTA MIG TREVOR C. CARANDANG 05/06/2012 OCCUPATION DRIVER ARGEN MARIE C. CARANDANG 9/13/2013 EMPLOYER/BUSINESS NAME CMKO GEOTECHNICAL SERVICES JAMIR C. GARCIA 01/05/2020 BUSINESS ADDRESS LUCENA CITY KALLISTA C. GARCIA 04/25/2021 TELEPHONE NO. 926-***-****

24. FATHER'S SURNAME CAGANDA

FIRST NAME SIMEON

NAME EXTENSION (JR., SR)

MIDDLE NAME ASMA

25. MOTHER'S MAIDEN NAME HITOSIS

SURNAME CAGANDA

FIRST NAME PRAXEDES

MIDDLE NAME ESCULTURA (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

SCHOLARSHIP/

ACADEMIC

HONORS

From To RECEIVED

ELEMENTARY MAGSAYSAY ELEMENTARY SCHOOL PRIMARY 1990 1996 GRADUATE 1996 3RD HONOR SECONDARY JUDGE GUILLERMO ELEAZAR POLYTECHNIC

COLLEGE SECONDARY 1996 2000 GRADUATE 2000

VOCATIONAL /

TRADE COURSE FUKUMOTO INTERNATIONAL TRAINING INSTITUTE NURSING ASSISTANT / CAREGIVER 2005 2006 CERTIFIED 2006 COLLEGE CENTRO ESCOLAR UNIVERSITY BACHELOR OF SCIENCE IN COMMERCE MAJOR IN MANAGEMENT 2000 2004 GRADUATE 2004

GRADUATE STUDIES ALFELOR SR. MEMORIAL COLLEGE BACHELOR OF SECONDARY EDUCATION 2018 2018 COMPLETED 2018

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 2024 CS FORM 212 (Revised 2017), Page 1 of 4 CS Form No. 212

Revised 2017

Philippines

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

(Continue on separate sheet if necessary)

(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

03/07/2023 06/30/2024 AREA COORDINATING TEAM - COMMUNITY EMPOWERMENT FACILITATOR KALAHI - CIDSS 36,641

END OF

CONTRACT Y

07/16/2019 06/30/2023 MUNICIPAL COORDINATING TEAM - COMMUNITY EMPOWERMENT FACILITATOR KALAHI - CIDSS 15,461 END OF

CONTRACT Y

7/15/2018 12/28/2018 PROFESSIONAL SALES

REPRESENTATIVE VIZCARRA PHARMACEUTICAL INC. 16,000 END OF PROJECT N 02/05/2018 7/13/2018 PROFESSIONAL MEDICAL

REPRESENTATIVE FERN INC. 16,500 END OF PROJECT N

12/12/2012 08/31/2017 PRODUCT SPECIALIST TRAINING AND MARKETING PROFESSIONALS INC. - NESTLE PHILS. 18,200

END OF PROJECT

/ CONTRACT N

1/15/2011 6/30/2011 WHOLESALE CHECKER DAILY NEEDS TRAIDING CORPORATION - LIANAS CALAMBA 10,000

END OF

CONTRACT N

10/01/2008 12/01/2008 CHECKER TJ MARC SALES INC. 10,000 END OF

CONTRACT N

06/01/06 8/30/2008 CLINICIANS PROTEMPO PROMOTIONS AND MARKETING CORPORATION - UNILAB 10,000 END OF PROJECT N

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 2024 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

PHILIPPINE RED CROSS 1/15/2005 10/30/2006 540 VOLUNTEER / NURSING ASSISTANT

(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

GRIEVANCE REDRESS SYSTEM TRAINING 9/09/2022 9/11/2022 24 TAGAYTAY CITY DRRM TRAINING 8/22/2019 8/22/2019

MUNICIPALITY OF TAGKAWAYAN - MUNICIPAL DISASTER RISK REDUCTION AND MANAGEMENT OFFICE

SEMINAR ON SOCIAL WELFARE AND DEVELOPMENT 04/10/2019 04/10/2019 OFFICE OF THE MUNICIPAL SOCIAL WELFARE AND DEVELOPMENT

COMPLETION OF OPERATION AND MAINTENANCE WORKSHOP THROUGH KALAHI CIDSS ACCELERATED CEAC 4/24/2015 4/24/2015 KALAHI - CIDSS NCDDP CERTIFICATE OF RECOGNITION - HIGHEST CALL ACHIEVER DISTRICT 16 CYCLE 1 07/07/2014 07/07/2014 TRAINING AND MARKETING PROFESSIONALS, INC. CERTIFICATE OF RECOGNITION - HIGHEST BHW HITS DISTRICT 16 CYCLE 1 07/07/2014 07/07/2014 TRAINING AND MARKETING PROFESSIONALS, INC. CERTIFICATE OF RECOGNITION - HIGHEST BHW ATTENDEES DISTRICT 16 CYCLE 1 07/07/2014 07/07/2014 TRAINING AND MARKETING PROFESSIONALS, INC. DRUG ABUSE PREVENTION EDUCATION SYMPOSIUM 6/25/2005 6/25/2005 RED CROSS YOUTH DEPARTMENT, NHQ; BANKER'S

INSTITUTE OF THE PHILIPPINES (BAIPHIL)

COMMON DENTAL PROBLEMS OF STROKE PATIENTS 05/06/2005 05/06/2005 THE STROKE SURVIVORS SUPPORT FOUNDATION, INC. BASIC LIFE SUPPORT 4/28/2005 4/29/2005 16 THE PHILIPPINE NATIONAL RED CROSS FIRST AID TRAINING (STANDARD) 4/25/2005 4/30/2005 32 THE PHILIPPINE NATIONAL RED CROSS KILOS LAYA LABAN SA DROGA

NATIONAL DRUG LAW ENFORCEMENT AND

PREVENTION COORDINATING CENTER

ENHANCING CAREGIVER SKILLLS IN THE MANAGEMENT OF PARKINSON'S DISEASE 4/14/2005 4/14/2005 8 SUMMIT HEALTH CARE INSTITUTION ENHANCING CAREGIVER SKILLLS IN THE MANAGEMENT OF ALZHEIMER'S DISEASE 4/14/2005 4/14/2005 8 SUMMIT HEALTH CARE INSTITUTION OFFICE PRACTICUM - HUMAN RESOURCE ASSISTANT @ CHINATRUST BANKING CORPORATION 2/28/2004 2/28/2004 200 CENTRO ESCOLAR UNIVERSITY - SCHOOL OF ACCOUNTANCY, BUSINESS, SECRETARIAL AND PUBLIC ADMINISTRATION

COMMUNICATION INTERACTION SKILLS SEMINAR 2/28/2004 2/28/2004 ROTARY CLUB OF MAKATI JUPITER INTEGRATED MARKETING COMMUNICATIONS "BRAND MANAGEMENT OF HIGH - TECH PRODUCTS 08/10/2002 08/10/2002 ASSOCIATION OF MARKETING EDUCATORS OF THE

PHILIPPINES, INC.

THE VALUE OF PEOPLE IN THE ORGANIZATION 3/20/2001 3/20/2001 ACER COMPANY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

(Write in full) 33. MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

KNOWLEDGABLE IN MICROSOFT OFFICE,

EXCEL, POWERPOINT

CERTIFICATE OF RECOGNITION - 2015 TMPI BEST IN NESTOGEN ACTIVATIONS SOUTHEAST LUZON (TRAINING AND MARKETING PROFESSIONALS INC. - NESTLE PHILS.) MATH CLUB 2002 CERTIFICATE OF RECOGNITION - 2015 TMPI - NPI BEST TEAM IN DAILY BOOSTER DOSE GIRL SCOUT OF THE PHILS. PLAYING BADMINTON CERTIFICATE OF RECOGNITION - 2015 TMPI - NPI BEST IN CALL PERFORMANCE SOUTHEAST LUZON (TRAINING AND MARKETING PROFESSIONALS INC. - NESTLE PHILS.) PLAYING VOLLEYBALL CERTIFICATE OF ACHIEVEMENT AWARDED - BEST PS IN 2015 H1 CALL AND REACH SOUTHEAST LUZON (TRAINING AND MARKETING PROFESSIONALS INC. - NESTLE PHILS.) DANCING CERTIFICATE OF RECOGNITION - 2014 TMPI - HIGHEST BHW ATTENDEES DISTRICT 16 CYCLE 1, HIGHEST BHW HITS DISTRICT 16 CYCLE 1, HIGHEST CALL ACHIEVER DISTRICT 16 CYCLE 3RD PLACE 1 (TRAINING MATHEMATICS AND MARKETING QUIZ BEE PROFESSIONALS IN CENTRAL ELEM. INC. SCHOOL - NESTLE (1996) PHILS.) 3RD HONOR STUDENT (PRIMARY)

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 2024 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.

Merly C. Abelilia Brgy. Aldavoc Tagkawayan, Quezon 092******** Glenn Tolentino Brgy. Muntingparang Tagkawayan,

Quezon 091********

Luz A. Desamero Lucena City 094********

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: SSS

ID/License/Passport No.: 33-8998237-0 Signature (Sign inside the box) Date/Place of Issuance: 07/26/2005/ SAMPALOC MANILA MAY 2024 Date Accomplished Right Thumbmark

Person Administering Oath

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

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

is not acceptable

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES NO

YES

YES

YES

NO

NO

NO

YES NO

YES NO

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