CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s aga
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 n

I. PERSONAL INFORMATION
2. SURNAME TANDAS
NAME EXTENSION (JR., SR)
FIRST NAME GRACE

MIDDLE NAME CAÑONES

3. DATE OF BIRTH
(mm/dd/yyyy) JAN.16,1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by

4. PLACE OF BIRTH STA. CRUZ MANILA If holder of dual citizenship, Pls. indicate coun
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS #5385 PAPA

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Str

Other/s: SAN VICENTE FERRER AREA D

Subdivision/Village Bara
CALOOCANCITY
7. HEIGHT (m) 1.524
City/Municipality Prov

8. WEIGHT (kg) 53 ZIP CODE

18. PERMANENT ADDRESS #5385 PAPA

9. BLOOD TYPE +B
House/Block/Lot No. Str
SAN VICENTE FERRER AREA D
10. GSIS ID NO. 2005332959
Subdivision/Village Bara
CALOOCANCITY
11. PAG-IBIG ID NO. 914237709469
City/Municipality Prov

12. PHILHEALTH NO. 03-026157951-7 ZIP CODE 1400

13. SSS NO. 34-3277033-2 19. TELEPHONE NO. N/A

14. TIN NO. 703-991-125 20. MOBILE NO. 09124018221

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) gracecanones@yahoo.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TANDAS 23. NAME of CHILDREN (Write full name and list all)

FIRST NAME DIONEL JR. KYLER JOHN C. TANDAS

MIDDLE NAME CRISPINO

ADVERTISING
OCCUPATION
FINISHER
EMPLOYER/BUSINESS NAME GRAPHIC VISION INC.
#57 SGT. RIVERA
BUSINESS ADDRESS
QUEZON CITY
TELEPHONE NO. 410-4131

24. FATHER'S SURNAME CAÑONES

NAME EXTENSION (JR., SR)
FIRST NAME ALFREDO

MIDDLE NAME REPOL

25. MOTHER'S MAIDEN NAME

SURNAME MONTESCLAROS

FIRST NAME ESTHER

MIDDLE NAME BAER (Continue on separate sheet if nece

III. EDUCATIONAL BACKGROUND

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

JUNE 3, MARCH
ELEMENTARY CAMARIN D. ELEMENTARY SCHOOL ELEMENTARY
1998 30, 2004 GRADUATED
 JUNE 3, MARCH
SECONDARY
VOCATIONAL / CAMARIN HIGH SCHOOL HIGH SCHOOL GRADUATED
2004 30, 2008

TRADE
BACHELOR OF ELEMENTARY JUNE 3, MARCH
COURSE
COLLEGE ST.CLARE COLLEGE OF CALOOCAN INC.
EDUCATION GRADUATED
2008 30, 2012

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 2
L DATA SHEET
perience Sheet shall cause the filing of administrative/criminal case/s against the person

BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship
by naturalization

Pls. indicate country:

PAPAYA ST.
Street
SAN VICENTE FERRER AREA D CAMARIN
Barangay

Province

PAPAYA ST.
Street
CAMARIN
Barangay

Province

1400

N/A

09124018221

gracecanones@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

10-31-2017

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

2003-2004 ___
 2007-2008 ___

2011-2012 ___

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

POLYTECHNIC UNIVERSITY OF THE

BOARD OF PROFESSIONAL TEACHERS 75 03/29/2015
PHILIPPINES

(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
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

DEPED/ MALIGAYA ELEMENTARY

7/12/2017 PRESENT TEACHER 1 19620.00 10
SCHOOL
6/16/2014 4/10/2016 ELEMENTARY TEACHER ABIERTAS RADIANCE SCHOOL INC. 9000.00 0
AGUSTINIAN SCHOOL OF CALOOCAN
6/18/2012 4/7/2014 ELEMENTARY TEACHER 5000.00 0
INC.
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

1362527 01/16/2022

ue on separate sheet if necessary)

n of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
PERMANENT YES

FULLTIME NO

FULLTIME NO
ue on separate 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 / NATURE
From To

(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/ SPON
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

TEACHERS INDUCTION PROGRAM 10/2/2018 2/24/2018 27 hrs DIVISION

LEARNING EFFECTIVELY THROUGH ENHANCED AND EVIDENCE BASED

12/16/2017 12/16/2017 8 hrs MALIGAYA EL
PEDAGOGIES

BREAD AND PASTRY NCII 1/9/2017 1/30/2017 120 hrs SLDM NOVAL

AN UPDATE K TO12 CURRICULUM, PERSONALITY DEVELOPMENT THROUGH

COMMUNICATION; LEVEL ASSESMENT, THE NEW GRADING SYSTEM AND CHILD 5/29/2013 5 hrs
PROTECTION POLICY

K TO 12 UPDATE OF TEACHING STRATEGIES 5/2/2013 7 hrs

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

M
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ASSOCIATION/O
(Write in full)
dancing, singing and surfing to the internet

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 2
 N / NATURE OF WORK

CTED/ SPONSORED BY
(Write in full)

DIVISION OF QUEZON CITY

LIGAYA ELEMENTARY SCHOOL

DM NOVALICHES QUEZON CITY

ST. AGUSTIN PUBLICATION

ST. AGUSTIN PUBLICATION

MEMBERSHIP IN
OCIATION/ORGANIZATION
(Write in full)
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 by YES ✘ NO
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 out If YES, give details:
(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
FORMER PRINCIPAL IN CAMP
MRS. FLORENCE B. MATIAS AGUINALDO HIGH SCHOOL
9274991420 3.5 cm. X 4.5 cm
(passport size)

BOARD MEMBER IN ABIERTAS With full and handwritten

MRS. AGAPITA E. PANTANILA RADIANCE SCHOOL
9153289605 name tag and signature
over
TEACHER IN ABIERTAS RADIANCE printed name
MS. LAURICE DE GUZMAN SCHOOL
9476258212
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
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.: 1362527

Signature (Sign inside the box)

Date/Place of Issuance: 06/5/2015 MANILA 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