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

I. PERSONAL INFORMATION
2. SURNAME LIMBUTUNGAN
N/A
FIRST NAME MONHANNAH RAMADEAH

MIDDLE NAME CALIMBOL

3. DATE OF BIRTH
(mm/dd/yyyy) 1/11/1997 16. CITIZENSHIP Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH BULUAN, MAGUINDANAO If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS N/A PU

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
N/A POB
Other/s:
Subdivision/Village Ba
COLUMBIO SULTAN
7. HEIGHT (m) 1.56
City/Municipality Pr
8. WEIGHT (kg) 49 ZIP CODE 9801

18. PERMANENT ADDRESS N/A PU

9. BLOOD TYPE O
House/Block/Lot No. S
N/A POB
10. GSIS ID NO. N/A
Subdivision/Village Ba
COLUMBIO
11. PAG-IBIG ID NO. N/A
City/Municipality Pr

12. PHILHEALTH NO. N/A ZIP CODE 9801

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

14. TIN NO. 702-854-441 20. MOBILE NO. 09774850223

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME LIMBUTUNGAN

N/A
FIRST NAME BADRUDIN

MIDDLE NAME DALATEN

25. MOTHER'S MAIDEN NAME

SURNAME CALIMBOL

FIRST NAME MOCHLIZA

MIDDLE NAME SUMAPAL (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 TACURONG PILOT ELEMENTARY SCHOOL PRIMARY SCHOOL N/A

NOTRE DAME SIENA COLLEGE OF GENERAL

SECONDARY HIGH SCHOOL N/A
SANTOS CITY
VOCATIONAL /

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

TRADE
MINDANAO STATE UNIVERSITY GENERAL BACHELOR IN SECONDARY EDUCATION
COURSE
COLLEGE
SANTOS CITY MAJOR IN MATHEMATICS N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
rience 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)

N/A

Dual Citizenship

by naturalization

Pls. indicate country:

PUROK 1
Street
POBLACION
Barangay
SULTAN KUDARAT
Province
9801

PUROK 1
Street
POBLACION
Barangay
SULTAN KUDARAT
Province

N/A

09774850223

mlimutungan@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2008 N/A

2012 N/A
 N/A N/A

2016 N/A

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

LICENSURE EXAMINATION FOR TEACHERS 83.0 9/25/2016 GENERAL SANTOS CITY 1503714

(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

EASTERN KUTAWATO ISLAMIC INSTITUTE

6/13/2016 3/30/2017 TEACHER 3000.00 N/A CONTRACTUAL
INCORPORATED
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

12/19/2016

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N
arate 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 /
From To

N/A 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
ASSOCIATI
14TH NATIONAL SCIENCE QUEST 2/10/2017 2/12/2017 24.0 TECHNICAL

MINDANA
ICT TOOLS FOR CENTURY LEARNING 9/17/2014 9/17/2014 8.0 TECHNICAL C

TRILOGY OF STUDENTS, TEACHER AND LEARNING ENVIRONMENT AND PERSONALITY 8/6/2014 8/6/2014 8.0 MINDANAO S
TECHNICAL
DEVELOPMENT FOR STUDENT EDUCATORS
MINDANAO S
K TO 12 AND EARLY CHILDHOOD EDUCATIONS 2/26/2014 2/26/2014 8.0 TECHNICAL

PEACE EDUCATION 1/25/2014 1/25/2014 8.0 TECHNICAL YO

EDUCATION FOR CONVERGENCE 1/25/2014 1/25/2014 8.0 TECHNICAL YO

LEADERSHIP TO EDUCATION 1/25/2014 1/25/2014 8.0 TECHNICAL YO

CONVERGENCE THROUGH DIALOGUE 1/25/2014 1/25/2014 8.0 TECHNICAL YO

 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COOKING NATIONAL CERTIFICATE II IN COOKERY

READING

PLAYING BADMINTON

WATCHING KDRAMA

(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)

ASSOCIATION OF SCIENCE EDUCATORS IN THE

PHILIPPINES
MINDANAO STATE UNIVERSITY GENSAN-
COLLEGE OF EDUCATION

MINDANAO STATE UNIVERSITY GENSAN- COLLEGE

OF EDUCATION
MINDANAO STATE UNIVERSITY GENSAN- COLLEGE
OF EDUCATION

YOUNG EDUCATOR'S SUMMIT

YOUNG EDUCATOR'S SUMMIT

YOUNG EDUCATOR'S SUMMIT

YOUNG EDUCATOR'S SUMMIT

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

eparate sheet if necessary)

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
TELAFAS, COLUMBIO SULTAN the last 6 months
JANETTE L. BELGIRA KUDARAT 9988588956 3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

NORLY BALIN COLUMBIO, SULTAN KUDARAT 9284940599 name tag and signature over
printed name
ZURNITA AWAL QUIRINO, SULTAN KUDARAT 9363521431 Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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

ID/License/Passport No.: 1503714

Signature (Sign inside the box)

Date/Place of Issuance: 12/19/2016

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 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