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 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

I. PERSONAL INFORMATION
2. SURNAME LAGARTO
NAME EXTENSION (JR., SR
FIRST NAME MYRA SHIMEATH

MIDDLE NAME DEL ROSARIO

3. DATE OF BIRTH
(mm/dd/yyyy)
01/25/1988 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by
POBLACION, ALICIA,
4. PLACE OF BIRTH
ZAMBOANGA DEL SUR
If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

17. RESIDENTIAL ADDRESS

6 CIVIL STATUS Single ✘ Married
House/Block/Lot No. S
Widowed Separated
POBL
✘ Other/s: Subdivision/Village Ba
ALICIA ZAMBOAN
7. HEIGHT (m) 1.41
City/Municipality Pr
8. WEIGHT (kg) 60 ZIP CODE 7040
18. PERMANENT ADDRESS
9. BLOOD TYPE 0+
House/Block/Lot No. S
POBL
10. GSIS ID NO. 2004 250261
Subdivision/Village Ba
ALICIA ZAMBOAN
11. PAG-IBIG ID NO. 0922 3581904
City/Municipality Pr
12. PHILHEALTH NO. 120507469545 ZIP CODE 7040
13. SSS NO. 1007765981 19. TELEPHONE NO. N/A
14. TIN NO. 263229699 20. MOBILE NO. 0998 2851398/ 09353866227
15. AGENCY EMPLOYEE NO. 5010119 21. E-MAIL ADDRESS (if any) myrashimeath.delrosario@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME LAGARTO 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME DENEL LAGARTO, JAN DENIEL DEL ROSARIO

MIDDLE NAME DIOCARIES

OCCUPATION SOLDIER
EMPLOYER/BUSINESS NAME AFP- PHILIPPINE MARINES
BUSINESS ADDRESS FORT BONIFACIO, TAGUIG
TELEPHONE NO.

24. FATHER'S SURNAME DEL ROSARIO

NAME EXTENSION (JR., SR)
FIRST NAME RANJOR
MIDDLE NAME CACCAM
25. MOTHER'S MAIDEN NAME

SURNAME DRAGON
FIRST NAME GENEVIEVE
 MIDDLE NAME DUGHO (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
ALICIA CENTRAL ELEMENTARY ELEMENTARY EDUCATION
ELEMENTARY 1994 2000 N/A
SCHOOL (GRADE 1-6)
VOCATIONAL SECONDARY EDUCATION
SECONDARY / ALICIA NATIONAL HIGH SCHOOL 2000 2004 N/A
(YEAR I-IV)

N/A N/A N/A

TRADE ATENEO DE ZAMBOANGA BS COMMERCE-FINANCIAL

COURSE 2004 2008 N/A
UNIVERSITY MANAGEMENT
COLLEGE
WESTERN MINDANAO STATE PROFESSIONAL EDUCATION
2010 2011 N/A
UNIVERSITY-EXT.STUDIES UNIT CERTIFICATE
MASTER IN EDUCATION-
SOUTHERN MINDANAO COLLEGES 2015 2017 N/A
EDUCATIONAL MANAGEMENT
GRADUATE STUDIES
UNIVERSIDAD DE ZAMBOANGA DOCTOR IN EDUCATION 2018 2018 9 UNITS

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience 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
POBLACION
Barangay
ZAMBOANGA SIBUGAY
Province
7040

Street
POBLACION
Barangay
ZAMBOANGA SIBUGAY
Province
7040
N/A
0998 2851398/ 09353866227
myrashimeath.delrosario@deped.gov.ph

DATE OF BIRTH (mm/dd/yyyy)

01/25/2014
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

3RD
2000
HONORS
VALEDIC-
2004
TORIAN

ACAD.
2008
SCHOLAR

2011 N/A

2017 N/A

N/A N/A

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

CIVIL SERVICE-PROFESSIONAL 82.97 7/22/2007 DPLMHS, ZAMBOANGA CITY 176595

LICENSURE EXAMINATION FOR

77.40 9/25/2011 DPLMHS, ZAMBOANGA CITY 1114895
TEACHERS

(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

12/2/2017 PRESENT TEACHER II DEPED-ALICIA NATIONAL HIGH SCHOOL 22149.00 12-1 REG.-PERMANENT

11/10/2015 12/2/2017 TEACHER I DEPED-ALICIA NATIONAL HIGH SCHOOL 18735.00 11-2 REG.-PERMANENT

11/10/2012 10/10/2015 TEACHER I DEPED-ALICIA NATIONAL HIGH SCHOOL 18549.00 11-1 REG.-PERMANENT

7/27/2009 9/30/2012 TELLER ALICIA NEIGHBORHOOD MULTIPURPOSE COOPERATIVE 6615.00 N/A REG.-PERMANENT

9/22/2008 6/26/2009 CUSTOMER SERVICE REPRESENTATIVE TELETECH HOLDINGS INCORPORATED 9000.00 N/A REG.-PERMANENT
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

01/25/
2021

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

N
arate 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 /
From To

IMMACULATE CONCEPTION LECTORS ASSOCIATION 7/4/1905 PRESENT LECTOR/ MEMBER

(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
NATIONAL SEMINAR ON MEDIA LITERACY INTEGRATION IN THE NATIONAL C
07/08/2018 09/08/2018 24.00 TECHNICAL TELEVISION
K12 CURRICULUM

REGIONAL TRAINING OF TEACHERS- SHS- HUMSS 10/08/2017 10/28/2017 160.00 TECHNICAL DEPED REGI

INTERNATIONAL SEMINAR ON INSTRUCTIONAL LEADERSHIP JAG CENTER

03/10/2017 03/12/2017 24.00 TECHNICAL DEVELOPME
AND MANAGEMENT

DIVISION IPCRF/OPCRF REVIEW AND EVALUATION 03/07/2017 03/08/2017 16.00 TECHNICAL DEPED- ZAM

DIVISION ORIENTATION ON NATIONAL BUILDING INVENTORY 02/01/2017 02/01/2017 8.00 TECHNICAL DEPED- ZAM

DEPED COMPUTERIZATION PROGRAM 26,27 BATCHES

4/22/2016 4/26/2016 16.00 TECHNICAL DEPED- ZAM
CLUSTER TRAINING FOR RECIPIENTS
INTERNATIONAL TRAINING ON IM'S DEVELOPMENT AND SOUTHEAST
2/19/2016 2/21/2016 24.00 TECHNICAL EDUCATIONA
ACTION RESEARCH

DIVISION TRAINING ON LRMDS 09/10/2015 09/10/2015 16.00 TECHNICAL DEPED-ZAM

REGIONAL TRAINING OF TEACHERS- MATH GRADE10 05/03/2015 05/08/2015 48.00 TECHNICAL DEPED- REG

YEARLY SCHOOL-BASED IN-SERVICE TRAINING FOR TEACHERS

2012 2018 240.00 TECHNICAL DEPED-AL
(EVERY SEMBREAK)

LAC SESSIONS 2012 2018 TECHNICAL DEPED-AL

 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

LECTOR/ MEMBER

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

NATIONAL COUNCIL FOR CHILDREN'S

TELEVISION & DEPED-ZSIBUGAY

DEPED REGION IX OFFICE

JAG CENTER FOR PROFESSIONAL

DEVELOPMENT

DEPED- ZAMBOANGA SIBUGAY

DEPED- ZAMBOANGA SIBUGAY

DEPED- ZAMBOANGA SIBUGAY

SOUTHEAST ASIAN INSTITUTE OF

EDUCATIONAL TRAINING INC.

DEPED-ZAMBOANGA SIBUGAY

DEPED- REGION IX OFFICE

DEPED-ALICIA NHS

DEPED-ALICIA NHS
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

eparate 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 ✘

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
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? APPROVED RESIGNATION
________________________________
________________________________
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
Deped-Zsibugay Division Office, Ipil, 3.5 cm. X 4.5 cm
ROSEMARIE E. DIOCARES, Ed. D. Zamboanga Sibugay
0947 9282848 (passport size)

With full and handwritten

LHORELLE L. CABALIDA, Ed. D. Alicia NHS, Poblacion, Alicia, ZSP 0915 2607209
name tag and signature over
printed name
CONSOLACION E. DIAZ, Ed. D. Alicia NHS, Poblacion, Alicia, ZSP 0906 8950093
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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.: 1114895

Signature (Sign inside the box)

Date/Place of Issuance: 1/30/2012

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 o

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