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 aga
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 ABARQUEZ
NAME EXTENSION (JR., SR
FIRST NAME ELISA

MIDDLE NAME MAG-UYON

3. DATE OF BIRTH
(mm/dd/yyyy) November 19,1961 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH Pob.Dimiao, Bohol If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
✘ Widowed Separated House/Block/Lot No. S
PUAN
Other/s:
Subdivision/Village Ba
DIMIAO BO
7. HEIGHT (m) 1.48 m
City/Municipality Pr
8. WEIGHT (kg) 63 kg ZIP CODE 6305

18. PERMANENT ADDRESS

9. BLOOD TYPE B
House/Block/Lot No. S
PUAN
10. GSIS ID NO. P
Subdivision/Village Ba
DIMIAO
11. PAG-IBIG ID NO. 16700000670
City/Municipality Pr

12. PHILHEALTH NO. 120000305117 ZIP CODE 6305

13. SSS NO. NONE 19. TELEPHONE NO.

14. TIN NO. 169101845 20. MOBILE NO. 09985367706

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
HES2009001 21. E-MAIL ADDRESS (if any) elaiabz@yahoo.com
ABARQUEZ 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) ABARQUEZ, CIELO NOELLE
ANECITO

MIDDLE NAME JABAHAB

OCCUPATION OFW

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME MAG-UYON

NAME EXTENSION (JR., SR)
FIRST NAME ARSENIO
 MIDDLE NAME ABADEJOS

25. MOTHER'S MAIDEN NAME

SURNAME TRUMPETA

FIRST NAME ROSARIO

MIDDLE NAME ADECER (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BONBON ELEMENTARY SCHOOL PRIMARY EDUCATION 1973 1974 GRADUATED

SECONDARY /
VOCATIONAL ST. NICHOLAS ACADEMY HIGHSCHOOL 1978 1979 GRADUATED

N/A

TRADE
COURSE BACHELOR IN SECONDARY EDUCATION
COLLEGE UNIVERSITY OF SAN CARLOS
Major in Physical Education
1987 1988 GRADUATED

GRADUATE STUDIES UNIVERSITY OF BOHOL MAT-Physical Education 2012 2014 GRADUATED

(Continue on separate sheet if necessary)

SIGNATURE DATE September 6, 2019 CS FORM 212 (Re

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

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

Street
PUANGYUTA
Barangay
BOHOL
Province
6305

Street
PUANGYUTA
Barangay
BOHOL
Province

09985367706

elaiabz@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

12/28/2010
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1974 NONE

1979 NONE

1988 NONE

MAGNA
2014 CUMLAUDE

parate sheet if necessary)

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

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
ELIGIBILITY WITHOUT EXAMINATION-Res.No.169
0501961
(April 29, 1998)

(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 GOV'T SERVICE
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 (Y/ N)

01/01/2017 To Present Asst. Prof 1 Bohol Island State University-Bilar 27,565.00 Permanent YES

01/10/2016 12/13/2016 Asst. Prof 1 Bohol Island State University-Bilar 24,396.00 Permanent YES

01/01/2016 01/09/2016 Asst. Prof 1 Bohol Island State University-Bilar 24,141.00 Permanent YES

05/04/2015 12/31/2015 Asst. Prof 1 Bohol Island State University-Bilar 23,044.00 Permanent YES

06/01/2013 Granted Study Leave w/ pay two years

02/28/2013 05/31/2013 Instructor III Bohol Island State University-Bilar 23,044.00 12 Permanent YES

02/28/2013 02/28/2013 Instructor III Bohol Island State University-Bilar 21,867.00 12 Permanent YES

06/01/2012 02/27/2013 Instructor III Bohol Island State University-Bilar 21,650.00 13-2 Permanent YES

6/1/2011 2/27/2013 Instructor III Bohol Island State University-Bilar 19,908.00 12 Permanent YES

6/24/2010 5/31/2010 Instructor III Bohol Island State University-Bilar 18,166.00 12 Permanent YES

2/28/2010 6/23/2010 Instructor III Bohol Island State University-Bilar 16,424.00 12 Permanent YES

7/1/2009 2/27/2010 Instructor III Bohol Island State University-Bilar 16101.00 13-1 Permanent YES

7/1/2008 6/30/2009 Instructor III CVSCAFT-MC 14323.00 13-1 Permanent YES

7/1/2007 6/30/2007 Instructor III CVSCAFT-MC 13021.00 12 Permanent YES

2/28/2007 6/30/2007 Instructor II CVSCAFT-MC 11837.00 12-2 Permanent YES

11/5/2004 2/27/2007 Instructor II CVSCAFT-MC 11446.00 12-2 Permanent YES

11/5/2001 11/4/2004 Instructor I CVSCAFT-MC 11167.00 12-1 Permanent YES

7/1/2001 11/4/2001 Teacher II CVSCAFT-MC 10535.00 12 Permanent YES

10/19/2000 6/30/2001 Teacher II CVSCAFT-MC 10033.00 12 Permanent YES

3/9/1999 10/18/2000 Teacher II CVSCAFT-MC 8605.00 12 Prov'l YES

3/28/1998 3/8/1999 Teacher II CVSCAFT-MC 8605.01 12 Temp.Item YES

11/1/1997 3/27/1998 Teacher II CVSCAFT-MC 8605.02 12 Temp.Item YES

9/4/1997 10/31/1997 Teacher II BAC 7309.00 12 Temp.Item YES

1/1/1997 9/3/1997 Teacher II BAC 7309.00 12 Temp.Item YES

6/18/1996 12/31/1996 Teacher II BAC 6013.00 12 Temp.Item YES

7/1/1994 Transferred to Divine Word Colleg Tagbilaran City YES

1/1/1994 6/30/1994 School Teacher Sierra Bullones High School 3902.00 Prov'l YES

7/1/1989 12/31/1993 School Teacher Sierra Bullones High School 3102.00 Prov'l

6/14/1989 6/30/1989 Secondary School Teacher Sierra Bullones High School 1764.00 Prov'l

(Continue on separate sheet if necessary)

SIGNATURE DATE September 6, 2019 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
From To

SNA HEAD, DANCE THEATRE ORGANIZE, Dimiao Bohol 6/2/2013 6/1/2015 Trainer

SNA PPC Night, Choreographer Dimiao, Bohol 8/15/2014 9/5/2014 Trainer

SNA Dance Theatre,Choreographer Feast of Sta. Cecilia, Dimiao Bohol 11/20/2014 11/22/2014 Trainer

SNA Dance Theatre, Trainer and Choreographer Bangon Simbahan Concert 12/1/2014 12/20/2014 Trainer

SNA Dance Theatre, Choreographer, Dimiao Foundation Day, Dimiao Bohol 10/19/2015 10/23/2015 Trainer

(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
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
SHS TEACHER TRAINING FOR STATE UNIVERSITY AND COLLEGES AND LOCAL
05/18/2015 05/22/2015 5 days Technical Phil. FOLK
COLLEGES IN REGION VII
35th NATIONAL FOLKDANCE WORKSHOP 05/18/2015 05/28/2015 4 days Technical CHED, CE
NATIONAL TRAINING IN COACHING TECHNIQUES FOR PASUC CULTURE AND
09/17/2018 09/19/2018 3 days Bulacan S
THE ARTS FESTIVAL COACHES AND TRAINERS
STUDENT-TEACHING MENTOR 03/01/2019 03/01/2019 BISU-Bilar

39th NATIONAL FOLK DANCE WORKSHOP 05/20/2019 05/24/2019 5 days Roxas, Bo

 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

DANCING NONE None

SINGING Trainer and Choreographer (Bantawang Anihan Dancetroup) Phil.Folk D

TRAINER, CHOREOGRAPHER Trainer and Choreographer SNA Dance Theatre Phil. Ass. O

ORGANIZER Choreographer-Bangon Simbahan Concert Dimiao Mu

(Continue on separate sheet if necessary)

SIGNATURE DATE September 6, 2019

LE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

Trainer

Trainer

Trainer

Trainer

Trainer

sheet if necessary)

MS ATTENDED
ars for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Phil. FOLKDANCE ASSOCIATION

CHED, CEBU NORMAL UNIVERSITY

Bulacan State University, Malolo, Bulacan

BISU-Bilar, Campus

Roxas, Boulevard, Pasay City

sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

None

Phil.Folk Dance Society

Phil. Ass. Of Teacher Educ Faculty Ass.

Dimiao Music and Arts Foundation

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
ALMA VILMA S. PAELMAO BISU-BILAR, BOHOL 09199959282 3.5 cm. X 4.5 cm
(passport size)

DR. LUZVIMINDA F. GANAS BISU-BILAR, BOHOL 09183668352 With full and handwritten
name tag and signature over
printed name
DR. LICINIA S. SANIEL BISU-BILAR, BOHOL 09982316526
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: HES 2009-001

ID/License/Passport No.: 0501961

Signature (Sign inside the box)
September 6, 2019
Date/Place of Issuance: 11/20/1998, Cebu 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

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