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 against the person
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 not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME UBERA
NAME EXTENSION (JR., SR) N/A
FIRST NAME DAVID JOHN

MIDDLE NAME DESCALZO

3. DATE OF BIRTH
(mm/dd/yyyy) 09/17/1991
16. CITIZENSHIP ✘ Filipino Dualby Citizenship
by
birt
naturalization
4. PLACE OF BIRTH ARITAO, NUEVA VIZCAYA If holder of dual citizenship, Pls.hindicate country:
please indicate the details.
5. SEX ✘ Male Female
✘ Married 17. RESIDENTIAL ADDRESS #258
6 CIVIL STATUS Single
Wido Separat House/Block/Lot No. Street

wed ed PUROK LINGLINGAY BARANGAY COMON

Other Subdivision/Village Barangay
/s: ARITAO NUEVA VIZCAYA
7. HEIGHT (m) 1.66
City/Municipality Province
8. WEIGHT (kg) 61 kgs ZIP CODE 3704

9. BLOOD TYPE AB
18. PERMANENT ADDRESS #258
House/Block/Lot No. Street

10. GSIS ID NO. 02004792405 PUROK LINGLINGAY BARANGAY COMON

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 9912256182997 ARITAO NUEVA VIZCAYA

City/Municipality Province

12. PHILHEALTH NO. 06000629912 ZIP CODE 3704

13. SSS NO. 0121131065 19. TELEPHONE NO. N/A

14. TIN NO. 422-266-492 20. MOBILE NO. 0935-1917-986 / 0949-169-7430

15. AGENCY EMPLOYEE NO. 109 21. E-MAIL ADDRESS (if any) davidjohn.ubera@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME UBERA

NAME EXTENSION (JR., SR)
FIRST NAME ALFREDO

MIDDLE NAME BRIONES

25. MOTHER'S MAIDEN NAME

SURNAME DESCALZO

FIRST NAME TERESITA

MIDDLE NAME SIENDA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY COMON ELEMENTARY SCHOOL PRIMARY EDUCATION 1997 2003 2003 Third Honors

SECONDARY /
VOCATIONAL SAINT TERESITA'S ACADEMY HIGH SCHOOL 2003 2007 2007 Eight Honors

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

TRADE
BACHELOR IN SECONDARY
COURSE
COLLEGE NUEVA VIZCAYA STATE UNIVERSITY 2007 2011 2011 Cum Laude
EDUCATION (Major in English)
MASTER OF ARTS IN EDUCATION
GRADUATE STUDIES IFUGAO STATE UNIVERSITY 2012 2019 2012 N/A
(Major in Educational Management)
(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 04, 2022

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 applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

LICENSURE EXAMINATION FOR TEACHERS 76.20% 09/25/2011 UNIVERSITY OF BAGUIO, BAGUIO CITY 1114363 01/21/2012

PD 907 - HONOR GRADUATE ELIGIBILITY N/A 05/17/2013 CIVIL SERVICE COMMISSION - REGION 2 100102130030 04/11/2011

(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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY 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)

01/01/2022 PRESENT HEAD TEACHER I / SCHOOL HEAD DEPED-CAROLOTAN HIGH SCHOOL 30,799.00 14-1 REG. PERM Y

06/22/2021 12/31/2021 HEAD TEACHER I / SCHOOL HEAD DEPED-CAROLOTAN HIGH SCHOOL 30,799.00 14-1 REG. PERM Y

01/01/2021 06/21/2021 SECONDARY SCHOOL TEACHER III DEPED-ARITAO NATIONAL HIGH SCHOOL 26,754.00 13-1 REG. PERM Y

01/01/2020 12/31/2020 SECONDARY SCHOOL TEACHER III DEPED-ARITAO NATIONAL HIGH SCHOOL 26,754.01 13-1 REG. PERM Y

01/01/2019 12/31/2019 SECONDARY SCHOOL TEACHER III DEPED-ARITAO NATIONAL HIGH SCHOOL 25,232.00 13-1 REG. PERM Y

07/17/2018 12/31/2018 SECONDARY SCHOOL TEACHER III DEPED-ARITAO NATIONAL HIGH SCHOOL 24,224.00 13-1 REG. PERM Y

01/01/2018 07/16/2018 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 20,179.00 11-1 REG. PERM Y

01/01/2017 12/31/2017 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 19,620.00 11-1 REG. PERM Y

01/01/2016 12/31/2016 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 19,077.00 11-1 REG. PERM Y

09/28/2015 12/31/2015 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 18,549.00 11-1 REG. PERM Y

08/10/2015 09/27/2015 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 18,549.00 11-1 SUBSTITUTE Y

06/25/2015 07/31/2015 SECONDARY SCHOOL TEACHER I DEPED-ARITAO NATIONAL HIGH SCHOOL 18,549.01 11-1 SUBSTITUTE Y

04/06/2012 03/31/2015 HEAD, LANGUAGE DEPARTMENT NUEVA VIZCAYA INSTITUTE 8,000.00 N/A PERMANENT N

06/03/2011 03/31/2012 CLASSROOM TEACHER NUEVA VIZCAYA INSTITUTE 6500.00 N/A PROBATIONARY N

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 04, 2022

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 / NATURE OF WORK
From To

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

INTERNATIONAL SEMINAR ON INTERDISCIPLINARY APPROACH IN KTO12 04/21/2021 04/23/2021 24 TECHNICAL SCHOOLS DIVISION OF NUEVA VIZCAYA

CAPACITY BUILDING ON THE USE AND CURATION OF DEPED - OER 03/06/2021 03/27/2021 32 TECHNICAL DEPED- ICTS EDUC TECHNOLOGY UNIT

DIVISION TECHNICAL AND PEDAGOGICAL TRAINING 03/15/2021 03/19/2021 40 TECHNICAL SCHOOLS DIVISION OF NUEVA VIZCAYA

NATIONAL VIRTUAL IN-SERVICE TRAINING FOR PUBLIC SCHOOL TEACHERS 03/15/2021 03/19/2021 40 TECHNICAL DEPED- ICTS EDUC TECHNOLOGY UNIT

ORIENTATION ON RPMS AND IPCRF FOR SCHOOL YEAR 2020-2021 02/19/2021 02/19/2021 8 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

TRAINING FOR SCHOOL PAPER ADVISERS 02/17/2021 02/19/2021 24 TECHNICAL SCHOOLS DIVISION OF NUEVA VIZCAYA

RENEWING COMMITMENT: A QUEST FOR QUALITY EDUCATION (INSET 2020) 12/14/2020 12/18/2020 40 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

GUIDELINES FOR ASSESSMENT AND GRADING IN LIGHT OF BE-LCP 11/04/2020 11/04/2020 8 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

REORIENTATION ON RPMS-PHIL. PROF STANDARDS FOR TEACHERS (INSET 2019) 05/29/2019 05/30/2019 16 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

MAKING ANHS A GENDER SENSITIVE WORKPLACE 04/24/2019 04/26/2019 24 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

CAPACITY BUILDING ON COMPETENCY-BASED LEARNING & PEDAGOGICAL THEORIES 10/22/2018 10/26/2018 40 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

INTERNATIONAL MIND EDUCATION SPECIALIST TRAINING 11/17/2017 11/19/2017 24 MANAGERIAL INTERNATIONAL MIND EDUCATION INSTITUTE

INSERVICE-TRAINING FOR TEACHERS 2017 10/23/2017 10/27/2017 40 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

INSERVICE-TRAINING FOR TEACHERS 2016 10/25/2016 10/30/2016 40 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

DIVISION TRAINING-WORKSHOP ON PRE-LESSON STRATEGIES IN ENGLISH 8 11/26/2017 11/27/2016 16 TECHNICAL SCHOOLS DIVISION OF NUEVA VIZCAYA

SEMINAR-WORKSHOP ON BUSINESS CORRESPONDENCE 11/11/2015 11/13/2015 24 TECHNICAL SCHOOLS DIVISION OF NUEVA VIZCAYA

CLUSTER INSERVICE-TRAINING FOR TEACHERS 2015 10/25/2015 10/30/2015 40 TECHNICAL DEPED-ARITAO NATIONAL HIGH SCHOOL

INFORMATION AND COMMUNICATION TECHNOLOGY (ICT) 04/04/2014 05/12/2015 120 TECHNICAL ADVOCATES ACADEMIC COLLEGES

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

PUBLIC SPEAKING OUTSTANDING TEACHER OF THE YEAR

ARITAO NATIONAL HIGH SCHOOL
SECOND NATIONAL AWARDS FOR TEACHERS 2020
FACULTY AND EMPLOYEES
INSTABRIGHT INTERNATIONAL GUILD OF RESEARCHERS
JOURNALISTIC WRITING ASSOCIATION
AND EDUCATORS
MICROSOFT OFFICE APPLICATION OUTSTANDING RESEARCHER OF THE YEAR
SECOND NATIONAL AWARDS FOR TEACHERS 2020 NUEVA VIZCAYA SCHOOL PAPER
INSTABRIGHT INTERNATIONAL GUILD OF RESEARCHERS ADVISER'S ASSOCIATION
AND EDUCATORS
FIFTH HONORABLE MENTION
NATIONAL POETRY WRITING CONTEST 2011 NUEVA VIZCAYA PUBLIC AND PRIVATE
SPONSORED BY THE UNIVERSITY OF THE PHILIPPINES AND THE SCHOOL TEACHERS' ASSOCIATION
REPUBLIC OF CHILE

MOST OUTSTANDING TEACHER (SCHOOL-BASED) 2017-2018 / 2018-2019

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 04. 2022

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? ✘ NO
YES
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? ✘ NO
YES
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
by any court or tribunal? YES
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES give details:
If YES,
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 ✘ NO
Barangay election)? YES
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last ✘ NO
election to promote/actively campaign for a national or local candidate? YES
If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? ✘ NO
YES
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? ✘ NO
If YES,YES
please specify:
b. Are you a person with disability? ✘ NO
If YES,YES
please specify ID No:
c. Are you a solo parent? ✘ NO
If YES,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
YOLANDA D. FRONDA, EdD NAGCUARTELAN, ARITAO NV 0915-259-1883 4.5 cm. X 3.5 cm
(passport size)

RODRIGO C. ROSETE, SSP IV STA. CLARA, ARITAO NV 0945-382-1593

Computer generated
or photocopied picture
LINA D. PAL-EC, PSDS DUPAX DEL SUR, NV 0956-203-5963 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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.: 1114363 Signature (Sign inside the box)
MAY 04, 2022
Date/Place of Issuance: 01/24/2012 BAGUIO 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 4 of 4