CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15357815

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME FANTONIAL
FIRST NAME JOANA ROSE
MIDDLE NAME GESALAN 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS 202 Spolarium St., Duljo Fatima, CEBU CITY (Capital),
4. DATE OF BIRTH (mm/dd/yyyy) 05 / 29 / 1995
CEBU
5. PLACE OF BIRTH Cebu City
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 6000
Married Separated
17. TELEPHONE NO. N/A
Annuled Others, specify
_________ 18. PERMANENT ADDRESS 202 Spolarium St., Duljo Fatima, CEBU CITY (Capital),
CEBU
8. CITIZENDSHIP Filipino
9. HEIGHT (m) 149
10. WEIGHT (kg) 64 ZIP CODE 6000
11. BLOOD TYPE O+ 19. TELEPHONE NO. N/A
12. GSIS ID NO. N/A 20. EMAIL ADDRESS (if any) joanarosefantonial25@gmail.com
13. PAGIBIG ID NO. 121214419276 21. CELLPHONE NO. (if any) 09121248531
14. PHILHEALTH NO. 1202-5680-4390 22. AGENCY EMPLOYEE NO. 31219
15. SSS NO. 0640749556 23. TIN 343-198-323

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME Fantonial

FIRST NAME Florentino Jr

MIDDLE NAME Villamor

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME Gesalan

FIRST NAME Rosario

MIDDLE NAME Ramos

III. EDUCATIONAL BACKGROUND

HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS SCHOLARSHIP/ ACADEMIC
GRADUATED
(Write in full) (Write in full) EARNED HONORS RECEIVED
(if graduated)
(if not
graduated) From To

Young Ladies Association of

ELEMENTARY 2008 2002-06 2008-03
Charity (YLAC) Free School

Saint Mary's Academy of San

SECONDARY 2012 2008-06 2012-03 5th Honorable Mention
Nicolas

VOCATIONAL/ TRADE Recoletos Industrial and

Cookery NC II 2017 2017-05 2017-06
COURSE Technological Training Center

University of San Jose- Bachelor of

COLLEGE 2017 2012-06 2017-03
Recoletos Secondary Education

Master of Arts in
GRADUATE STUDIES Cebu Technological University 2018-11 Present
Education

IV. CIVIL SERVICE ELIGIBILITY

FANTONIAL, JOANA ROSE GESALAN - T15357815 CS FORM 212 (Revised 2005), Page 1 of 3
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
LET (LICENSURE EXAMINATION FOR
81.80 09 / 24 / 2017 University of Cebu - Banilad Campus 1629513 04/24/2018
TEACHER)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

Senior High School Research

11/25/2017 Present University of San Jose- Recoletos Php 20,000 0-0 Application No
Teacher

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF
POSITION / NATURE OF WORK
(Write in full) HOURS
From To

N/A

VII. TRAINING PROGRAMS (Start from the most recent training.)

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

USJR COE AND JBOGM

The Basics of Research in Education: Pursuit Towards Providing Quality
01 / 27 / 2018 01 / 28 / 2018 20 TUTORIAL REVIEW AND
Education
TRAINING SERVICES
Recoletos Industrial and
National Certificate II in Cookery 05 / 02 / 2017 06 / 25 / 2017 316 Technological Training Center,
USJR and TESDA

TEVSAPHIL Inc - Intel Easy Steps Computer Literacy Program 03 / 15 / 2017 04 / 06 / 2017 100 TEVSAPHIL Inc

Enhancement of Teaching Competence 03 / 04 / 2017 03 / 05 / 2017 16 EduStudio

USJR College of Education and

Southeast Asian Ministers of
Pre- Service Student Teacher Exchange in Southeast Asia 01 / 15 / 2017 02 / 13 / 2017 224
Education Organization
(SEAMEO)
USJR AND INTERNATIONAL
International TESOL Education and Consultancy Corporation 08 / 27 / 2015 08 / 28 / 2015 30
TESOL/ITECC
Royal Institution, Singapore with
International Certification Level I - Assistant Cook Recoletos Industrial and
Technological Training Center

VIII. OTHER INFORMATION

33. 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: 35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION
SPECIAL SKILLS / HOBBIES:
(Write in full) (Write in full)

Best 10 of the International Essay Contest for SEA-Teachers Alumni

Playing Musical Instruments N/A
in Indonesia

Photography

Poster Editing

Painting and Crafting

Cooking and Baking

Singing

Writing Poetry

FANTONIAL, JOANA ROSE GESALAN - T15357815 CS FORM 212 (Revised 2005), Page 2 of 3
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

appointing authority, recommending authority, chief of office/bureau/department or person who
has immediate supervision over you in the Office, Bureau or Department where you will be If YES, give details:
appointed? _____________________________________
_____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed?
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37. a. Have you ever been formally charged? YES NO

If YES, give details:
_____________________________________
_____________________________________

b. Have you ever been guilty of any administrative offense? YES NO

If YES, give details:
_____________________________________
_____________________________________

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________

39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
_____________________________________
_____________________________________

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________
_____________________________________

41. 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 differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

Dr. Jestoni P. Babia Cebu City 417-9500

Englevert P. Reyes, MA.Ed Cebu City 09333113137

Mr. Mark S. Borres Lapu-Lapu City, Cebu 09323070245

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that
this information shall remain confidential. PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

FANTONIAL, JOANA ROSE GESALAN - T15357815 CS FORM 212 (Revised 2005), Page 3 of 3