CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes q with "P" and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)
I. PERSONAL INFORMATION
M |O |R |A |L |L |O | | | | | | | | | | | | | | | | | |
2. SURNAME
| |
FIRST NAME
J | E |N |N |Y | | | | | | | | | | | | | | | | | | | | |
|
MIDDLE NAME A | R |A | Z |A |S | | | | | | | | | | 3. |NAME| EXTENSION
| | (e.g.| Jr., Sr.)
| | | | | |
4. DATE OF BIRTH (mm/dd/yyyy) APRIL 1O, 1981 16. RESIDENTIAL ADDRESS
5. PLACE OF BIRTH PILI CAM. SUR ZONE 1, SAGRADA PILI CAMARINES SUR
6. SEX Male ✘ Female
7. CIVIL STATUS Single Widowed ZIP CODE 4418
✘ Married Separated 17. TELEPHONE NO. NONE
Annulled Other, Specify 18. PERMANENT ADDRESS
8. CITIZENSHIP FEILIPINO ZONE 1, SAGRADA PILI CAMARINES SUR
9. HEIGHT (m) 5'
10. WEIGHT (kg) 55 kg. ZIP CODE 4418
11. BLOOD TYPE B 19. TELEPHONE NO. NONE
12. GSIS ID NO. 02003520423 20. E-MAIL ADDRESS (if any) jenny.morallo001@[Link]
13. PAG-IBIG ID NO. 1210-2200-3355 21. CELLPHONE NO. (if any) 09298202414
14. PHILHEALTH NO. 10-000088551-1 22. AGENCY EMPLOYEE NO. 4365084
15. SSS NO. NONE 23. TIN
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME MORALLO 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME SAMSON JR. SOFIA JANE A. MORALLO 4/21/2003
MIDDLE NAME CURATIVO SAMUEL JAMES A. MORALLO 7/7/2005
OCCUPATION NONE ASHLY JANE A. MORALLO 5/9/2008
EMPLOYER/BUS. NAME NONE SABINA JANE A. MORALLO 2/15/2011
BUSINESS ADDRESS NONE SYMON JAMES A. MORALLO 12/19/2016
TELEPHONE NO. NONE
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME ARAZAS
FIRST NAME NESTOR SR.
MIDDLE NAME MARCAIDA
27. MOTHER'S MAIDEN NAME
SURNAME IBARRETA
FIRST NAME DOLORES
MIDDLE NAME MORA (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND YEAR
GRADUATED
HIGHEST GRADE/ INCLUSIVE DATES OF
28. SCHOLARSHIP/
NAME OF SCHOOL DEGREE COURSE LEVEL/ ATTENDANCE ACADEMIC
LEVEL (Write (Write in full) UNITS EARNED
HONORS
in full) (if not From To RECEIVED
graduated)
(if graduated)
ELEMENTARY CAROYROYAN ELEM. SCHOOL 1994 1988 1994
SECONDARY USI PILI CAMPUS (FORMERLY SCLS) 1994 1998
VOCATIONAL /
TRADE
COLLEGE
COURSE
CBSUA (FORMERLY CSSAC) BSEAGED 2002 1998 2002
GRADUATE STUDIES CENTRAL BICOL STATE UNIVERSITY OF
MSAGED 2013 2009 2013
AGRICULTURE
(Continue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29. DATE OF LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE NUMBER DATE OF
CONFERMENT
RELEASE
LICENSURE EXAM FOR TEACHERS 81.40% AUG. 2002 LEGAZPI CITY 0779488 11/15/02
(Continue on separate sheet if necessary)
GOV'T
SERVICE
30. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
(mm/dd/yyyy) MONTHLY & STEP STATUS OF
SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To
(Yes / No)
JUNE DEPED-PILI-ANAYAN SAGRADA ELEM. REGULAR
PRESENT MASTER TEACHER I P35,693.00 SG 18 -1 YES
13,2016 SCHOOL PERMANENT
DEPED-PILI-ANAYAN SAGRADA ELEM. REGULAR
6/4/2008 6/12/2016 TEACHER I P19496 SG 11-3 YES
SCHOOL PERMANENT
6/27/2007 8/6/2007 TEACHER I DEPED-PILI-PILI CENTRAL SCHOOL P9,939 SG 11-1 SUBSTITUTE YES
2/13/2007 3/30/2007 TEACHER I DEPED-PILI-PILI CENTRAL SCHOOL P9,939 SG 11-1 SUBSTITUTE YES
DEPED-OCAMPO-OCAMPO CENTRAL
7/17/2006 11/6/2006 TEACHER I P9,939 SG 11-1 SUBSTITUTE YES
SCHOOL
DEPED-OCAMPO-OCAMPO CENTRAL
1/18/2006 3/31/2006 TEACHER I P9,939 SG 11-1 SUBSTITUTE YES
SCHOOL
DEPED-PILI-ANAYAN SAGRADA ELEM.
6/23/2005 9/16/2005 TEACHER I P9,939 SG 11-1 SUBSTITUTE YES
SCHOOL
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
31. NAME & ADDRESS OF ORGANIZATION NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To
NONE
(Continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start from the most recent training.)
INCLUSIVE DATES OF ATTENDANCE
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To
THREE-DAY DIVISION LIVE-OUT TRAINING-WORKSHOP ON
INTERDISCIPLINARY CONTEXTUALIZATION (Icon) AND INQUIRY-BASED NOV 6 ,2019 NOV 8,2019 24 DIVISION OF CAMARINES SUR
SCIENCE TEACHING APPROACHES
DISTRICT TRAINING WORKSHOP ON ACTION RESEARCH AND INNOVATION SEPT 27,2019 SEPT 29,2019 24 PILI DISTRICT
BASIC ROBOTICS TRAINING SEPT 25,2019 SEPT 27,2019 24 DIVISION OF CAMARINES SUR
3 ARAW NA PAGSASANAY NG PRIMALS (FILIPINO) AUG 30,2019 AUG 31,2019 16 DPILI DISTRICT
DIVISION TRAINING WORKSHOP ON ACTION RESEARCH AND INNOVATIONS JUL 18,2019 JUL 18,2019 8 DIVISION OF CAMARINES SUR
3 ARAW NA PAGSASANAY NG PRIMALS (FILIPINO) PARA SA IKATLONG
MAR 15,2019 MAR 17,2019 24 CONGRESSIONAL
DISTRITO
5-DAY SCHOOL BASED INSET ON DEVELOPING AND APPLYING ICT IN
OCT 22,2018 OCT 26,2018 40 ANAYAN-SAGRADA ELEMENTARY SCHOOL
TEACHING-LEARNING PROCESS IN THE IMPLEMENTATION OF RPMS & PPST
PHILIPPINE PROFESSIONAL STANDARD FOR TEACHERS (PPST) AND
AUG 28,2018 AUG 31,2018 32 DIVISION OF CAMARINES SUR
RESULTS-BASED PERFORMANCE MANAGEMENT SYSTEM (RPMS)
ACTION RESEARCH WRITING IN ENGLISH NOV 24,2016 NOV 26,2016 24 DEPED PILI DISTRICT
FIVE-DAY SCHOOL BASED SEMINAR WORKSHOP ON LATEST TRENDS IN DEPED ANAYAN-SAGRADA ELEMENTARY
OCT 24,2016 OCT 28,2016 40
TEACHING K TO 12 SUBJECTS,ICT AND CAMPUS JOURNALISM SCHOOL
3RD DISTRICT LIVE OUT TRAINING ON LATEST TRENDS ON CAMPUS
SEPT 30 2016 OCT 1,2016 16 DEPED CAMARINES SUR
JOURNALISM
3-DAY DISTRICT WIDE LIVE OUT TRAINING WORKSHOP ON SCHOOL PAPER
MAY 13,2016 MAY 16,2016 24 DEPED CAMARINES SUR
PRODUCTION
2-DAY TRAINING WORKSHOP ON RESULT BASED PERFORMANCE
AUG 20 2014 AUG 22,2014 16 DEPED PILI DISTRICT
MANAGEMENT SYSTEM
DISTRICT SEMINAR WORKSHOP ON CAMPUS JOURNALISM FOR TEACHER
SEPT 22,2012 0CT 6,2012 24 DEPED PILI DISTRICT
COACHES
3 DAY DISTRICT SEMINAR/TRAINING ON PROFESSIONAL DEVELOPMENT
JULY 23,2011 JULY 9,2011 24 DEPED PILI DISTRICT
PROGRAM FOR SCIENCE TEACHERS
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION: ASSOCIATION/ORGANIZATION
33. SPECIAL SKILLS / HOBBIES: 34. 35.
(Write in full)
(Write in full)
COMPUTER LITERATE NONE NONE
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
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 If YES, give details:
has immediate supervision over you in the Office, Bureau or Department where you will be _____________________________________
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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL YES ✘ NO
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.
AURORA F. ESTRADA ANAYAN, PILI, CAMARINES SUR 91999132149
DENNIS P. CEDRON SAN JOSE, PILI, CAMARINES SUR 9083892808
PEDRO T. BUSTARGA SAN AGUSTIN, PILI, CAMARINES SUR 9285952635
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.
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)
JUNE 4,2020
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
CS FORM 212 (Revised 2005), Page 4 of 4
