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 CANABE
NAME EXTENSION (JR., SR)
SURNAME ELFIE

MIDDLE NAME SAYSON

3. DATE OF BIRTH
(mm/dd/yyyy) 07/ 31/1996 16. CITIZENSHIP Dual
✘ Filipino
Citizenship
by by
4. PLACE OF BIRTH PASIG CITY If holder of dual citizenship, Pls. birth
indicate country: naturalization
please indicate the details.
5. SEX
Male ✘
Female
17. RESIDENTIAL ADDRESS BLOCK 3 LOT 2 QUARRY
6 CIVIL STATUS ✘ Single
Married House/Block/Lot No. Street
Widowed Separa RICANATI HOMES MINUYAN PROPER
Other/s: ted Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
7. HEIGHT (m) 1.79832
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 3023

18. PERMANENT ADDRESS BLOCK 3 LOT 2 QUARRY

9. BLOOD TYPE TYPE O
House/Block/Lot No. Street
RICANATI HOMES MINUYAN PROPER
10. GSIS ID NO.
Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
11. PAG-IBIG ID NO. 1211-9816-6076
City/Municipality Province

12. PHILHEALTH NO. 210257260-5 ZIP CODE

13. SSS NO. 346729110-3 19. TELEPHONE NO. N/A

14. TIN NO. 338-753-066 20. MOBILE NO. 0993 - 758 - 9253

15. AGENCY EMPLOYEE NO. 5404391 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A
N/A
MIDDLE NAME N/A
N/A
OCCUPATION N/A
N/A
EMPLOYER/BUSINESS NAME N/A
N/A
BUSINESS ADDRESS N/A
N/A
TELEPHONE NO. N/A
N/A
24. FATHER'S SURNAME CANABE
NAME EXTENSION (JR., SR) N/A
FIRST NAME ELVER
N/A
MIDDLE NAME OMBAY
N/A
25. MOTHER'S MAIDEN NAME
N/A
SURNAME SAYSON
N/A
FIRST NAME PRECILA

MIDDLE NAME QUIMZON (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
From To

ELEMENTARY MINUYAN ELEMENTARY SCHOOL ELEMENTARY GRADUATE 2003 2009 2009

SECONDARY MINUYAN HIGH SCHOOL HIGH SCHOOL GRADUATE 2010 2013 2013
VOCATIONAL /

TRADE
COURSE BACHELOR OF SECONDARY EDUCATION
COLLEGE LA CONCEPCION COLLEGE MAJOR IN FILPINO 2014 2017 2017

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

LICENSURE PROFESSIONAL TEACHER 78.9 2018-03-01 ARELLANO UNIVERSITY 1651172 07/31/2027

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

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

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

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

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

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

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

6/1/2022 UP TO TEACHER I DEPED- SAN JOSE DEL MONTE 27, 000 GRADE 11 PERMANENT
PRESENT TOWERVILLE HIGH SCHOOL
4/11/2020 12/23/2022 FACULTY STI SAN JOSE COLLEGE 28, 900 N/A PROBATINOA
RY
1/4/2018 1/6/2020 FACULTY JARMMETH COLLEGE INC. 8, 000 N/A CONTRACTUA
L

(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

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

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

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

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

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

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

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
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
NAVIGATING CHANGE, CONNECTING CONCEPTS AND INNOVATING APPROACHES THRU 11/25/2024 11/27/2024 24.0 TOWERVILLE HIGH SCHOOL
MATATAG CURRICULUM

FOSTERING GLOBAL CITIZENSHIP: REDIFINING LEARNING HORIZON THROUGH

INCLUSION, EQUITY, AND RESPONSIVE STRATEGIES FOR LEARNERS WITH 01/30/2025 01/25/2025 3.0 TOWERVILLE HIGH SCHOOL
DISABILITIES, GIFTEDNESS, AND TALENTS

BUILDING BRIDGES TO NUMERACY: EMPOWERING LEARNERS ABILITY THROUGH 10/18/2024 10/18/2024 3.0 TOWERVILLE HIGH SCHOOL
ENGAGING ACTIVITY WITH DIFFERENT APPROACHES AND STRATEGIES
EMPOWERING LEARNERS FOR THE FUTURE: INTEGRATING 21ST CENTURY SKILLS IN
ASSESSMENT PRACTICES WITH HOLISTIC APPROACH FOR LIFELONG OPPURTUNITIES 09/30/2024 09/30/2024 3.0 TOWERVILLE HIGH SCHOOL
WITH INTEGRITY IN SERVICE

MATATAG: MONITORING ACHIEVING TUTORING ACCOMPLISHING TASKING APPLYING 08/29/2024 08/29/2024 3.0 TOWERVILLE HIGH SCHOOL
AND GEARING TOWARDS ACADEMIC EXCELLENCE THROUGH 21ST CENTURY SKILLS

CONCIEVING AWARENESS THROUGH REPRODUCTIVE ENGAGEMENT 04/29/2024 04/30/2024 6.0 TOWERVILLE HIGH SCHOOL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

MICROSOFT OFFICE N/A N/A

COMMUNICATION SKILLS N/A N/A

HOSTING

(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 ✘

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

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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
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)? 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.

ID picture taken within
the last 6 months
HERBERT GARCIA GARDNER STA.CLARA LUWASAN STA.MARIA 9234661310 4.5 cm. X 3.5 cm
(passport size)
NOELYN ESELLER ASTURIAS QUARRY MINUYAN PROPER BULACAN 9662552473
Computer generated
MUZON SAN JOSE DEL MONTE or photocopied picture
SHEILA MARIE LLESOL BULACAN 9064668080 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
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.: 1651172

Signature (Sign inside the box)

Date/Place of Issuance: MANILA

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