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 a
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

I. PERSONAL INFORMATION
2. SURNAME ASIO
NAME EXTENSION (JR., SR)
FIRST NAME PERIDA

MIDDLE NAME ROSALITA

3. DATE OF BIRTH
(mm/dd/yyyy) 7/1/1980 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
02/28/1980 ✘ by natu
birth
4. PLACE OF BIRTH LIBAS, JABONGA, AGUSAN DEL NORTE If holder of dual citizenship, Pls. indicate country
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS N/A PURO

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Stre
N/A KITACU
Other/s:
Subdivision/Village Baran
ALAMADA COTA
7. HEIGHT (m) 1.6
City/Municipality Prov
8. WEIGHT (kg) 65 ZIP CODE 9413
18. PERMANENT ADDRESS N/A PURO
9. BLOOD TYPE B
House/Block/Lot No. Stre
N/A KITACU
10. GSIS ID NO. NONE
Subdivision/Village Baran
ALAMADA
11. PAG-IBIG ID NO. 916145938770
City/Municipality Prov

12. PHILHEALTH NO. 172011320614 ZIP CODE 9413

13. SSS NO. 0931919121 19. TELEPHONE NO. NONE

14. TIN NO. 490-353-634-000 20. MOBILE NO. 09073917295

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) asiorosalitaperida@gmail.co
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ASIO

NAME EXTENSION (JR., SR) N/A
FIRST NAME NEHEMIAS

MIDDLE NAME MONGAYA

25. MOTHER'S MAIDEN NAME

SURNAME ROSALITA

FIRST NAME JANE

MIDDLE NAME ROSA (Continue on separate sheet if necessar

III. EDUCATIONAL BACKGROUND

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

ALAMADA CENTRAL ELEMENTARY

ELEMENTARY 1988 1993
SCHOOL

SECONDARY /
VOCATIONAL NORTH COTABATO ACADEMY 1993 1997

i-LINK COLLEGE OF SCIENCE AND

TECHNOLOGY
HEALTH CARE SERVICE NC II July 2017 Sept 2017

TRADE
COURSE COTABATO CITY STATE POLYTECHNIC BACHELOR OF SECONDARY EDUCATION
COLLEGE MAJOR IN MAPEH 2012 2015
COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/15/2018 CS FORM 212 (Revis

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

DS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship
by naturalization

Pls. indicate country:

PUROK 8
Street
KITACUBONG
Barangay
COTABATO
Province
9413
PUROK 8
Street
KITACUBONG
Barangay
COTABATO
Province

NONE

09073917295

asiorosalitaperida@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
 SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

1993 NONE

1997 NONE

NONE

2015 NONE

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 applicable)
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 01/07/201
77.8 03/20/2016 ATENEO DE DAVAO - DAVAO CITY 1467410 9
TEACHERS

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE
GOV'T
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) full/Do not abbreviate) INCREMENT
From To
06/08//201 (Y/ N)
5
08/28/2015 TEACHER NOTRE DAME OF GENIO EDCOR, INC. 6600.00 N/A CONTRACTUAL No

06/13/2016 03/21/2017 TEACHER NOTRE DAME OF GENIO EDCOR, INC. 6600.00 N/A CONTRACTUAL No
 (Continue on separate sheet if necessary)
SIGNATURE DATE 01/15/2018 CS FORM 212 (Revised 2017), Page 2 of 4
Barangay
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION NUMBER OF HOURS POSITION / NATURE
(Write in full) (mm/dd/yyyy)
From To

ALPHA MU PHI 1999 2018 MEMBER (ALAMADA CHAPTER)

(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
Type of LD
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING ATTENDANCE CONDUCTED/ SPONSO
30. NUMBER OF HOURS
( Managerial/
PROGRAMS (Write in full) Supervisory/
(mm/dd/yyyy) Technical/etc)
From To
COTABATO CITY
SEMINAR WORKSHOP ON COACHING AND OFFICIATING VOLLEYBALL 08/09/2013 09/09/2013 16.0
C
SEMINAR ON EMERGENCE OF SPORTS MARKETING IN THE COTABATO CITY
INDUSTRY
07/09/2013 07/12/2013 8.0
C
BASIC LEADERSHIP TRAINING 06/02/2004 07/02/2004 16

TEACHERS PRACTICES ENHANCEMENT SEMINAR/WORKSHOP 01/28/2015 01/30/2015

EMERGENCY PREPAREDNESS: FIRST AID AND S.T.A.R.T PROMPT C.A.R.
12/20/2013 12/22/2013
TRIAGE
PROMPT C.A.R.
BASI LIFE SUPPORT (CPR WITH AED) 12/20/2013 12/22/2013
SEMINAR-WORKSHOP ON PREPARATION, UTILIZATION AND
MINDANAO S
EVALUATION OF INSTRUCTION MATERIAL IN TEACHING 07/22/2017 07/22/2017
MAG
ENGLISH

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
MEMBERSHIP IN A
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

SINGING

COOKING

COMPUTER LITERATE( MS OFFICE)

TSHIRT PRINTING

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/15/2018

 POSITION / NATURE OF WORK

MEMBER (ALAMADA CHAPTER)

separate sheet if necessary)

ING PROGRAMS ATTENDED

or the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

COTABATO CITY STATE POLYTECHNIC

COLLEGE
COTABATO CITY STATE POLYTECHNIC
COLLEGE

DEPED
PROMPT C.A.R.E LEARNING CENTER,
INC.
PROMPT C.A.R.E LEARNING CENTER,
INC.
MINDANAO STATE UNIVERSITY -
MAGUINDANAO

separate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

separate 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 YES ✘ NO
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
SR. ALEJANDRA B. VILLAROSA, OND MIRASOL, ALAMADA, COTABATO 9058495495 3.5 cm. X 4.5 cm
(passport size)

NELITA A. CALE KITACUBONG, ALAMADA, COTABATO 9303048641 With full and handwritten
name tag and signature over
printed name
CEASAR - IAN G. DELA CRUZ MIRASOL, ALAMADA, COTABATO 9153538431
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: PRC

ID/License/Passport No.: 1467410

Signature (Sign inside the box)
01/15/2018
Date/Place of Issuance: 09/10/2016
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