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 BAYONA
NAME EXTENSION (JR., SR
FIRST NAME NOLINA

MIDDLE NAME BAYLON

3. DATE OF BIRTH
(mm/dd/yyyy) 02/05/1983 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH BATAD, ILOILO If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS N/A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
N/A ROO
Other/s:
Subdivision/Village Ba
TAPAZ C
7. HEIGHT (m) 1.48 m
City/Municipality Pr
8. WEIGHT (kg) 46 kg ZIP CODE 5814

18. PERMANENT ADDRESS N/A

9. BLOOD TYPE B
House/Block/Lot No. S
N/A ROO
10. GSIS ID NO. 02004210945
Subdivision/Village Ba
TAPAZ
11. PAG-IBIG ID NO. 9132-9705-9820
City/Municipality Pr

12. PHILHEALTH NO. 110502493175 ZIP CODE 5814

13. SSS NO. 07-2195967-6 19. TELEPHONE NO. N/A

14. TIN NO. 413-760-677 20. MOBILE NO. 09076244358

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
6308654 21. E-MAIL ADDRESS (if any) bayona@yahoo.com
BAYONA 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) N/A
TEDDY MA. PAULYN MAE B. BAYONA

MIDDLE NAME GALAEZ NYSSA TEAH B. BAYONA

OCCUPATION FARMING NICHOLE B. BAYONA

EMPLOYER/BUSINESS NAME N/A TOM TJ B. BAYONA

BUSINESS ADDRESS N/A TAN IVAN B. BAYONA

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME BAYLON N/A

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

MIDDLE NAME TAMON N/A

25. MOTHER'S MAIDEN NAME RIVERA N/A

SURNAME BAYLON N/A

FIRST NAME HAIDE N/A

MIDDLE NAME DE LA CRUZ (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 EMBARCADERO ELEMENTARY SCHOOL PRIMARY EDUCATION 1990 1996 GRADUATED

SECONDARY BATAD POLYTECHNIC COLLEGE HIGH SCHOOL 1996 2000 GRADUATED

VOCATIONAL /

COMPLETED
KRYZ CULINARY ARTS AND TRAINING
SERVICES BINGAWAN, ILOILO
COOKERY NCII 2016 2016 SHORT TERM
COURSE
TRADE
COURSE BACHELOR OF SCIENCE IN INDUSTRIAL
COLLEGE BATAD POLYTECHNIC COLLEGE
EDUCATION
2000 2004 GRADUATED

GRADUATE STUDIES ACC SAN JOSE, ANTIQUE TRAINING METHODOLOGIES I 2012 2016 36 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE Januar

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) N/A

Dual Citizenship

by naturalization

Pls. indicate country:

N/A
Street
ROOSEVELT
Barangay
CAPIZ
Province
5814

N/A
Street
ROOSEVELT
Barangay
CAPIZ
Province

N/A

09076244358

bayona@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

09/14/2008

9/18/2010

7/16/2012

11/24/2015

5/25/2018

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

IST
1996 HONORABLE
MENTION

2000 PASSED
 2016 PASSED

OUTSTANDING
2004 STUDENT TEACHER

2016 PASSED
parate sheet if necessary)

January 11, 2019

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

GENERAL EDUCATION 76 08/14/2005 ILOILO CITY 03482545

PROFESSIONAL EDUCATION 77

MAJOR IN HOME ECONOMICS 81

GENERAL WIEGHTED AVERAGE RATING 78.46

(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

SENIOR HIGH SCHOOL SECONDARY

03/28/2018 Present TAPAZ NATIONAL HIGH SCHOOL P 24,224.00 N/A PERMANENT
TEACHER 3-1
SENIOR HIGH SCHOOL SECONDARY
01/01/2018 3/27/2018 TAPAZ NATIONAL HIGH SCHOOL P 19,620.00 N/A PERMANENT
TEACHER 1-1
SENIOR HIGH SCHOOL SECONDARY
01/01/2017 12/31/2017 TAPAZ NATIONAL HIGH SCHOOL P 19,620.00 N/A PERMANENT
TEACHER 1-1
SENIOR HIGH SCHOOL SECONDARY
01/01/2016 12/31/2016 TAPAZ NATIONAL HIGH SCHOOL P 19,620.00 N/A PERMANENT
TEACHER 1-1
01/01/2016 11/2/2016 SECONDARY SCHOOL TEACHER 1-2 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

1/1/2015 12/31/2015 SECONDARY SCHOOL TEACHER 1-2 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

01/01/2014 10/30/2014 SECONDARY SCHOOL TEACHER 1-2 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

02/15/2013 12/31/2013 SECONDARY SCHOOL TEACHER 1-2 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

1/1/2013 2/14/2013 SECONDARY SCHOOL TEACHER 1-1 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

6/1/2012 12/31/2012 SECONDARY SCHOOL TEACHER 1-1 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

2/15/2011 5/31/2012 SECONDARY SCHOOL TEACHER 1-1 TAPAZ NATIONAL HIGH SCHOOL P 19,853.00 N/A PERMANENT

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

 (Continue on separate sheet if necessary)

SIGNATURE DATE January 11, 2019

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

10/07/2005

eet if necessary)

GOV'T
SERVICE

(Y/
N)
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

N/A
eet if necessary)

January 11, 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

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

(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
TESDA-DU
TESDA-FOOD PROCESSING 03/10/2010 4/27/2010 3 hours/1mo. N/A

COMPUTER BASIC LITERACY 10/26/2008 3/22/2009 8 hours/4 mos. N/A FONTSMAR

COOKERY NC II 4/8/2016 7/8/2016 8 hours/4 mos. N/A KCARS

TESDA-DU
DRESSMAKING NC II 11/30/2013 8/30/2013 8 hours/4 mos. N/A

TESDA-DU
TAILORING NCII 9/1/2013 12/15/2014 8 hours/4 mos. N/A

TRAINING METHODOLOGY I 6/2/2016 1/2/2017 8 hours/4 mos. N/A 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)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A TAPAZ WE

 COOKING N/A PARENT

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

TESDA-DUMALAG VOCATIONAL TECHNICAL

SCHOOL

FONTSMART COMPUTER ARTS TAPAZ, CAPIZ

KCARSI BINGAWAN CALINOG, ILOILO

TESDA-DUMALAG VOCATIONAL TECHNICAL

SCHOOL
TESDA-DUMALAG VOCATIONAL TECHNICAL
SCHOOL

ACC SAN JOSE, ANTIQUE

N/A

N/A

N/A

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

TAPAZ WEST TEACHERS ASSOCIATION

 PARENT- TEACHERS ASSOCIATION

eparate sheet if necessary)

January 11, 2019

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
SYLVIA F. GUYOD POBLACION, TAPAZ, CAPIZ 3.5 cm. X 4.5 cm
(passport size)
LEONARDO F. FARILLON,Ph. D. SAN NICOLAS, TAPAZ, CAPIZ 9399055142 With full and handwritten
name tag and signature over
printed name
MA. ROWENA S. GLORIA POBLACION TAPAZ, CAPIZ
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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable

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: UMID ID

ID/License/Passport No.: 2004210945

Signature (Sign inside the box)
JANUARY 11, 2019
Date/Place of Issuance: 01/5/2016 ROXAS CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

MA. SHARON A. BARRIENTOS

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