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 Beriña
NAME EXTENSION (JR., SR
FIRST NAME Hannie

MIDDLE NAME Discaya

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 3/22/1993

4. PLACE OF BIRTH Las Pinas City If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS Block 6 Lot 16B Santol St.

6 CIVIL STATUS
House/Block/Lot No. S
Camella Springville Mo
Subdivision/Village Ba
Bacoor C
7. HEIGHT (m) 1.45
City/Municipality Pr
8. WEIGHT (kg) 45 ZIP CODE 4102

18. PERMANENT ADDRESS Same as above

9. BLOOD TYPE AB+
House/Block/Lot No. S

10. GSIS ID NO. 2003282040

Subdivision/Village Ba

11. PAG-IBIG ID NO. 1211 4889 7187

City/Municipality Pr

12. PHILHEALTH NO. 22 - 000125642 - 4 ZIP CODE

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

14. TIN NO. 438 - 593 - 963 20. MOBILE NO. +639357029062

15. AGENCY EMPLOYEE NO. 5901362 21. E-MAIL ADDRESS (if any) hannieberina@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Berina

NAME EXTENSION (JR., SR)
FIRST NAME Henry
 MIDDLE NAME Dimabayao

25. MOTHER'S MAIDEN NAME

SURNAME Discaya

FIRST NAME Margie

MIDDLE NAME Tamayo (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 Umabay Exterior Elementary School Elementary 06/01/05 03/30/05

Masbate National Comprehensive

SECONDARY /
VOCATIONAL Secondary 06/01/05 03/30/09
High School

TRADE
COURSE
COLLEGE Philipine Normal University BSE major in Music 06/01/09 04/30/13

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Re

 nal case/s against the person

(Do not fill up. For CSC use only)

XTENSION (JR., SR)

dicate country:

Santol St. Phase 1 West

Street
Molino III
Barangay
Cavite
Province

Street

Barangay

Province

9062

@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

heet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2005

2009

PNU -
2013
Rondalla

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 78.6 9/29/2013 Arellano University 1247542 3/22/2020

(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
SERVICE
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 (Y/
N)
Music, Arts, Physical Education and Health Grade 11
7/24/2015 Present
Teacher
Golden Acres National HS 22437.00
Step 2
Permanent Y

5/1/2013 3/30/2015 Music Teacher Bloomfield Academy 15000.00

(Continue on separate sheet if necessary)

SIGNATURE DATE 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

(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

Seminar Workshop on Gender and Development 12/14/2019 1214/1019 8 Technical Gold

DIVISION SEMINAR WORKSHOP ON THE CRITICAL CONTENT AND PEDAGOGIES

10/23/2019 10/26/2019 24 Technical
IN TEACHING MUSIC AND ARTS FOR GRADE 9 TEACHERS

07/19/2019 07/21/2019 36 Technical BSP

Basic Training Course for Outfit Advisor

01/15/19 01/19/19 40 Technical

Mass Training of Rondalla for Teachers

IN – SERVICE TRAINING 05/29/2019 06/02/2019 40 Technical Gold

Seminar Workshop on Gender and Development 12/16/2018 12/17/2018 16 Technical Gold

IN – SERVICE TRAINING 10/22/2018 10/26/2018 24 Technical Gold

DIVISION SEMINAR WORKSHOP ON THE CRITICAL CONTENT AND PEDAGOGIES

8/4/2018 8/18/2018 24 Technical
IN TEACHING MUSIC AND ARTS FOR GRADE 7 AND 8

Seminar Workshop on Gender and Development 11/12/2018 11/13/2018 16 Technical Gold

Division Training of Untrained Junior High School Teachers for the K to 12 Basic
9/14/2017 9/15/2017 8 Technical
Education Program

Faculty Development Training and Seminar 6/2/2017 6/2/2017 16 Technical University

Faculty In-Service Training 5/29/2017 6/1/2017 24 Technical Gold

 Seminar Workshop on Gender and Development 12/17/2016 12/18/2017 16 Technical Gold

Divisionwide Encampment in a Troop Camp Setting 12/2/2016 12/4/2016 40 Technical

Global Filipino Schools Lead Teacher Training Workshop 10/24/2016 10/26/2016 24 Technical Gold

Semestral Break INSET 10/24/2016 1-/28/2016 40 Technical Gold

Outdoor Leadership Course 8/5/2016 8/7/2016 40 Technical

Faculty In-Service Training 6/10/2016 6/10/2016 8 Technical Gold

Semestral Break INSET 10/27/2015 10/27/2015 8 Technical Gold

Regional Seminar Workshop in Quality Teaching of Physical Education and Sports 09/26-27/2015 10/4/2015 24 Technical

Basic Training Course with Age Level Specialization 10/23/2015 10/25/2015 40 Technical

Division Teacher Induction Program 8/1/2015 8/2/2015 16 Technical

Faculty Development Training and Seminar 5/28/2015 5/28/2015 8 Technical University

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
Read Books, Sing, Dance and Play Musical
Most Innovative Teacher 2019
Instruments
Most Deligent Teacher 2018

(Continue on separate sheet if necessary)

SIGNATURE DATE
 PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

parate sheet if necessary)

OGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Golden Acres National High School

DepEd Las Pinas

BSP - Metro Manila South Council

DepEd NCR

Golden Acres National High School

Golden Acres National High School

Golden Acres National High School

Deped Las Pinas

Golden Acres National High School

Deped Las Pinas

University of Perpetual Help System - DALTA

Golden Acres National High School

 Golden Acres National High School

GSP - Rizal Council

Golden Acres National High School

Golden Acres National High School

GSP - Rizal Council

Golden Acres National High School

Golden Acres National High School

DepEd NCR

GSP - Rizal Council

Deped Las Pinas

University of Perpetual Help System - DALTA

parate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

parate 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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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 any court or tribunal?
If YES, give details:
________________________________
________________________________
37. 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 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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
Lynn R. Sunglao Bacoor, Cavite 9168780128 3.5 cm. X 4.5 cm
(passport size)

Josie A. Criste Bacoor, Cavite 9276303031 With full and handwritten

name tag and signature over
printed name
Elsie T. Torreno Las Pinas 9238988355
Computer generated
or photocopied picture
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 administrative/criminal case/s against me.

42.
is not acceptable

PHOTO
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.: 1247542

Signature (Sign inside the box)

Date/Place of Issuance: 12/12/2013 - Manila

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

above.

17), Page 4 of 4