CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any mispresentation 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 DATOMANONG
NAME EXTENSION (JR., SR)
FIRST NAME NADJIRAH
MIDDLE NAME MACAAYONG
3. DATE OF BIRTH
(mm/dd/yyyy) 11/13/1972 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH RAGONDINGAN BUADIPOSO BUNTONG If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed House/Block/Lot No. Street
Separated WEST RAGONDINGAN
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1M BUADIPOSO BUNTONG LANAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 65KG ZIP CODE 9714
18. PERMANENT ADDRESS
9. BLOOD TYPE O
House/Block/Lot No. Street

10. GSIS ID NO. 3171635 WEST RAGONDINGAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1950-0037-2441 BUADIPOSO BUNTONG LANAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 19-000424280-0 ZIP CODE 9714

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

14. TIN NO. 948-141-488 20. MOBILE NO. 09488936999

15. AGENCY EMPLOYEE NO. 4258817 21. E-MAIL ADDRESS (if any) N/A
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME DATOMANONG 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME SAKKAF MOH'D MONER M. DATOMANONG 9/20/1997
MIDDLE NAME USMAN HEDAYA M. DATOMANONG 12/29/1999
OCCUPATION N/A HAFSAH M. DATOMANONG 6/19/2001
EMPLOYER/BUSINESS NAME N/A HAFIS M. DATOMANONG 11/27/2003
BUSINESS ADDRESS N/A MOH'D RYAN M. DATOMANONG 5/28/2005
TELEPHONE NO. N/A

24. FATHER'S SURNAME MACAAYONG

NAME EXTENSION (JR., SR)
FIRST NAME LACSASA
MIDDLE NAME LEMON
25. MOTHER'S MAIDEN NAME

SURNAME MACAAYONG
FIRST NAME MONAWIRA
MIDDLE NAME SULTAN (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
MARAWI CENTRAL
ELEMENTARY PRIMARY EDUCATION 1979 1985 GRADUATED 1985 N/A
ELEMENTARY PILOT SCHOOL
PANGARUNGAN ISLAM
SECONDARY /
VOCATIONAL HIGH SCHOOL 1985 1989 GRADUATED 1989 N/A
COLLEGE
N/A N/A N/A N/A N/A N/A N/A
TRADE
BACHELOR OF ARTS IN
COURSE
COLLEGE MAPANDI MEMORIAL COLLEGE 1989 1993 GRADUATED 1993 N/A
EDUCATION
MASTER OF ARTS IN
GRADUATE STUDIES BUKIDNON STATE COLLEGE EDUCATIONAL ADMINISTRATION 1998 2000 21 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE September 10,2017

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

(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/
DEPARTMENT OF EDUCATION-AUTONOMOUS N)
1/1/2017 PRESENT TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P20,811 11-6 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
1/1/2016 12/31/2016 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P19,925 11-6 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
7/1/2014 12/31/2015 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P19,495 11-6 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
6/1/2012 6/30/2014 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P19,111 11-4 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
6/1/2011 5/31/2012 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P17,765 11-4 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
6/24/2010 5/31/2011 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P16,419 11-4 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
7/1/2009 6/23/2010 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P15,072 11-4 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
7/1/2008 6/30/2009 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P12,026 10-1 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
7/1/2007 6/30/2008 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P10,933 10-1 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
5/31/2007 6/30/2007 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P9,939 10-1 PERMANENT yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
7/1/2001 5/30/2007 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P9,939 10-1 PROVISIONAL yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
1/1/2001 6/30/2001 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P9,466 10-1 PROVISIONAL yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
11/1/1997 12/31/1999 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P8,605 10-1 PROVISIONAL yes
I
DEPARTMENT OF EDUCATION-AUTONOMOUS
2/26/1997 10/31/1997 TEACHER-I REGION IN MUSLIM MINDANAO-LANAO DEL SUR- P7,309 10-1 PROVISIONAL yes
I

(Continue on separate sheet if necessary)

SIGNATURE DATE September 10,2017

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

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

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

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

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

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

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

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

DIVISION GENDER and DEVELOPMENT TRAINING 11/9/2016 11/9/2016 8HOURS MANAGERIAL DIVISION OF LANAO DEL SUR I

2-DAY MASS TRAINING OF GRADE-I TEACHERS ON EGRA-ARATA 9/16/2013 9/17/2013 16HOURS SUPERVISORY DIVISION OF LANAO DEL SUR I
3-DAY SEMINAR WORKSHOP ON THE GUIDELINES ON THE ASSESSMENT and
RATING ON LEARNING OUTCOMES UNDER THE K to 12 BASIC EDUCATION 11/11/2012 11/13/2012 24HOURS SUPERVISORY DIVISION OF LANAO DEL SUR I
CURRICULUM
REGIONAL MASS TRANING OF GRADE-I TEACHER ON Kto12 and MBTS-MLE 6/14/2012 6/18/2012 40HOURS MANAGERIAL DIVISION OF LANAO DEL SUR I

2 DAY ECHO SEMINAR ON THE IMPLEMENTAL OF THE COMPLEMENTARY BASED

PERFORMANCE CB-PAST 2//1/2012 2/3/2012 24HOURS SUPERVISORY DIVISION OF LANAO DEL SUR I

3-DAY TROOP LEADERSHIP COURSE FOR 24HOURS 10/14/2012 10/15/2012 24HOURS TECHNICAL DIVISION OF LANAO DEL SUR I

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32.
(Write in full)
(Write in full)
PHILIPPINES PUBLIC SCHOOL
TEACHING N/A TEACHERS ASSOCIATION

READING QUR-AN N/A

N/A

N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE September 10,2017

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
the last 6 months
SANAORAY I. BAUTE TUCA, MARAWI CITY N/A 3.5 cm. X 4.5 cm
(passport size)

HAYANISAH G. DADAYAN BUADIPOSO BUNTONG N/A With full and handwritten

name tag and signature over
printed name
JAMERAH M. PANGCATAN BUADIPOSO BUNTONG N/A
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: GSIS

ID/License/Passport No.: 006009045332

Signature (Sign inside the box)

Date/Place of Issuance: ILIGAN CITY

September 10,2017
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