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CS Form No.

212
Revised 2017

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 ag
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 no

I. PERSONAL INFORMATION
2. SURNAME Mangelen
NAME EXTENSION (JR., S
FIRST NAME Salehk

MIDDLE NAME Benito


3. DATE OF BIRTH
(mm/dd/yyyy) 11/25/1965 16. CITIZENSHIP
Filipino Dual Citizenship
by birth
4. PLACE OF BIRTH Cotabato City If holder of dual citizenship, Pls. indicate co
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS Phase 3 Block 3 Lot 11 Narr


6 CIVIL STATUS
House/Block/Lot No. S
Widowed Separated
San Pablo Village Rosary
Other/s:
Subdivision/Village Ba
Cotabato City Magu
7. HEIGHT (m) 1.68 m
City/Municipality Pr
8. WEIGHT (kg) 60 kgs ZIP CODE 9600

18. PERMANENT ADDRESS Phase 3 Block 3 Lot 11 Narr


9. BLOOD TYPE "0"
House/Block/Lot No. S
San Pablo Village Rosary
10. GSIS ID NO. CM4332877
Subdivision/Village Ba
Cotabato City Magu
11. PAG-IBIG ID NO. 1940-0066-7401
City/Municipality Pr

12. PHILHEALTH NO. 17-000042626-4 ZIP CODE 9600

13. SSS NO. N/A 19. TELEPHONE NO. (064)552-1638

14. TIN NO. 166-641-604 20. MOBILE NO. 0926-7031230

15. AGENCY EMPLOYEE NO. 97-0310 21. E-MAIL ADDRESS (if any) sbmangelen@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Compania 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Nurlailah Nisa C. Mangelen
FIRST NAME Bai Norly
Yusuf Azhar C. Mangelen
MIDDLE NAME Bila
Shairah Aliah C. Mangelen
OCCUPATION Secondary School Teacher
Izdihar C. Mangelen
EMPLOYER/BUSINESS NAME Department of Education
Ayishah C. Mangelen
BUSINESS ADDRESS Sinsuat Avenue, Cotabato City
Husniyyah C. Mangelen
TELEPHONE NO. N/A

24. FATHER'S SURNAME Mangelen


NAME EXTENSION (JR., SR)
FIRST NAME Hadji Usop

MIDDLE NAME Ali

25. MOTHER'S MAIDEN NAME

SURNAME Benito

FIRST NAME Bai Halima

MIDDLE NAME Balabaran (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND


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

ELEMENTARY Sero Central School Primary Education 1972 1978

SECONDARY Cotabato City National High School High School 1978 1982
VOCATIONAL /

System Technology Institute Computer Program and Operation 1996 1996

TRADE
COURSE
COLLEGE Notre Dame University Bachelor of Science in Civil Engineering 1982 1987

GRADUATE STUDIES Notre Dame University Master in Public Administration 1998 2010

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/25/2017 CS FORM 212 (Re


L DATA SHEET
xperience Sheet shall cause the filing of administrative/criminal case/s against the person

S) BEFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship
by birth by naturalization
Pls. indicate country:

Narra Street
Street
Rosary Heights XI
Barangay
Maguindanao
Province
9600

Narra Street
Street
Rosary Heights XI
Barangay
Maguindanao
Province

9600

(064)552-1638

0926-7031230

sbmangelen@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

6/1/2000

12/4/2001

01/23/2003

08/19/2004

09/16/2006

7/10/2008

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

1978 N/A

1982 N/A
1996 N/A

1987 N/A

2010 N/A

separate sheet if necessary)

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 appl
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

Career Service Sub-Professional Examination 74.50% 3/8/1986 Cotabato City N/A

Career Service Professional Examination 80.00% 5/8/1990 Cotabato City

(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 SALARY/ JOB/ PAY
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

Technical Education and Skills Dvelopment Authority -


1/6/2005 Present Supervising TESD Specialist Autonomous Region in Muslim Mindanao
P44,075.00 22-4 Permanent

Technical Education and Skills Dvelopment Authority -


02/27/2003 05/31/2005 Senior TESD Specialist Autonomous Region in Muslim Mindanao
P16,792.00 19-1 Permanent

Technical Education and Skills Dvelopment Authority -


2/1/1998 02/26/2003 TESD Specialist I Autonomous Regio in Muslim Mindanao
P12,143.00 13-2 Permanent

Regional Legislative Assembly - Autonomous Region in


4/1/1997 12/31/1997 Legislative Staff Officer III Muslim Mindanao
P8,202.00 16-1 Contractual

1/6/1993 05/31/1996 Instructor/Trainor Sultan Kudarat Islamic Academy P3,900.00 N/A Contractual

Department of Environment and Natural Resources -


4/9/1989 4/4/1990 Special Investigator Investigator Region XII
P3,300.00 11-1 Temporary
(Continue on separate sheet if necessary)

SIGNATURE DATE 04/25/2017 CS FORM 212 (Revised 2017), Pa


LICENSE (if applicable)

Date of
Validity

N/A

ate sheet if necessary)

GOV'T
SERVICE

(Y/
N)

Y
ate sheet if necessary)

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 / N
From To

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

(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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SP
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

Quality Management Standard Manual Calibration Session 03/13/2017 03/13/2017 Managerial Technical Education
8

Strategic Planning Workshop 01/19/2017 01/20/2017 Managerial Technical Educatio


16

Executive-Legislative Agenda Planning 10/15/2016 10/17/2016 Managerial Department of Inter


24

15th Human Resource and Skills Development Conference 9/8/2016 11/8/2016 Supervisory Technical Educatio
24
1st Bruni Indonesia Malaysia Philippines-Eest Asian Growth Association Technical
07/19/2016 07/19/2016 Managerial Technical Educa
Vocational Education Training Forum 8

Technical Vocational Education Training Monitoring Workshop 06/21/2016 06/23/2016 Technical Technical Educati
24

4th National Technical Vocational Education Training Congress 12/11/2016 12/11/2015 Supervisory Technical Voca
8

1st National Quality Technival Vocational Education Training Forum 9/9/2015 9/9/2015 Managerial Technical Educa
8
Technical Educat
14th Human Resource and Skills Development Conference 3/9/2015 5/9/2015 Supervisory Mindanao
24

Lead Auditors Training Course 8/6/2015 12/6/2015 Managerial


40
Technical Educatio
Performance and Results Management 1/6/2015 2/6/2015 Technical
16

Dual Training Partnership Forum 05/26/2015 05/26/2015 Technical Technical Educ


8
Regional Planning
1st Autonomous Region in Muslim Mindanao Planners Congress 4/3/2015 5/3/2015 Technical
16

13th Human Resource and Skills Development Conference 08/26/2014 08/28/2014 Supervisory Mindanao
24

3rd International & National Technical Educational Skills Development Congress 10/17/2014 10/17/2014 Supervisory Technical Voca
8
1st Bruni Indonesia Malaysia Philippines-Eest Asian Growth Association Technical Technical Educat
10/22/2014 10/22/2014 Managerial Mindanao
Vocational Education Training Forum 8

National Technical Vocational Congress 10/29/2013 10/29/2013 8 Supervisory Technical Voca

Managing Challenge to Nation Building 10/20/2013 10/27/2013 56 Managerial Malay


Strategic Planning Workshop 09/16/2013 09/18/2013 24 Managerial Department of Inter

Training Program on the Development of Training Plan 9/9/2013 12/9/2013 24 Technical Technical Educati

International Standard Organization Capability Training Program 12/8/2013 08/16/2013 40 Technical Technical Education S

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

Provincial Tech
Driving N/A

Carpentry and Civil Works

Computer Operation

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/25/2017


EOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

te sheet if necessary)

GRAMS ATTENDED
(5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Technical Education and Skills Development Authority - Central Office

Technical Education and Skills Development Authority - Region X1

Department of Interior and Local Government-Maguindanao Province

Technical Education Skills Development Authority-Caraga Region

Technical Education Skills Development Authority - Region XI

Technical Education Skills Development Authority Central Office

Technical Vocational School Association of the Philippines

Technical Education Skills Development Authority - Region VII

Technical Education Skills Development Authority - Region IX &


MindanaoTechnical Vocational Education Training

Tuv Sud/Hong Kong Veritas

Technical Education Skills Development Authority - Central Office &


HURIS

Technical Education Skills Development Authority - Region X

Regional Planning and Development Office - Autonomous Region in


Muslim Mindanao

Mindanao Technical Vocational Education Training

Technical Vocational School Association of the Philippines

Technical Education Skills Development Authority - Region XI &


MindanaoTechnical Vocational Education Training

Technical Vocational School Association of the Philippines

Malaysian Technical Cooperation Program


Department of Interior and Local Government-Maguindanao Province

Technical Education Skills Development Authority Central Office

Technical Education Skills Development Authority Development Institute

te sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

Provincial Technical Education and Skills Development


Committee

te sheet if necessary)

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 NO
YES
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, 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 YES NO
Barangay election)?
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
Attorney Anwar A. Malang Penafrancia Village, Cotabato City N/A 3.5 cm. X 4.5 cm
(passport size)

Datu Ismael V. Mastura Sultan Kudarat, Maguindanao N/A With full and handwritten
name tag and signature over
Don Eduardo Sero Street, Cotabato printed name
Doctor Eduardo Rabago City
N/A
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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: 97-0310

ID/License/Passport No.: M01-98-057115


Signature (Sign inside the box)
04/25/2017
Date/Place of Issuance: Cotabato 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


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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