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 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 DONATO
NAME EXTENSION (JR., SR)
FIRST NAME VIOLA

MIDDLE NAME BACDAYAN

3. DATE OF BIRTH
(mm/dd/yyyy) 10/2/1967 16. CITIZENSHIP
Filipino Dualby
Citizenship
birth by naturalization
4. PLACE OF BIRTH Salcedo, Ilocos Sur If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS 113 Doce

6 CIVIL STATUS
Widow Separate House/Block/Lot No. Street
ed
Other/ d East Bag. Barrio Brgy. 156
Subdivision/Village Barangay
s: Caloocan NCR
7. HEIGHT (m) 3.937
City/Municipality Province
8. WEIGHT (kg) 78 ZIP CODE

18. PERMANENT ADDRESS 113 Doce

9. BLOOD TYPE O
House/Block/Lot No. Street
East Bag. Barrio Brgy. 156
10. GSIS ID NO. 2002486916
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1060-0203-8087 Caloocan NCR

City/Municipality Province
12. PHILHEALTH NO. 1900-0842-1815 ZIP CODE 1400
13. SSS NO. 3301-497-746 19. TELEPHONE NO. 09665915461
14. TIN NO. 223117573 20. MOBILE NO. 09665915461
15. AGENCY EMPLOYEE NO. 4175148 21. E-MAIL ADDRESS (i violadonato@yahoo.ca
II. FAMILY BACKGROUND
23. NAME of CHILDREN (Write full name DATE OF BIRTH
22. SPOUSE'S SURNAME DONATO
and list all) (mm/dd/yyyy)
FIRST NAME Rene NAME EXTENSION
(JR., SR)
MIDDLE NAME Toliong Harmony Joy Donato 12/17/1994
OCCUPATION Messenger Rene Albien Donato 9/13/1996
EMPLOYER/BUSINESS NAME Self Employed Renz Vryle B. Donato 3/30/2000
BUSINESS ADDRESS 113 Doce St. East bagong Barrio Cal. City
TELEPHONE NO. 9771822670
24. FATHER'S SURNAME Bacdayan
FIRST NAME Bienvenido NAME EXTENSION
(JR., SR)
MIDDLE NAME Cagdan
25. MOTHER'S MAIDEN NAME

SURNAME Haluber
FIRST NAME Genoveva
MIDDLE NAME Gamueta (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 Imelda SDA Elem. School 6/16/1974 3/30/1979 1979 Salutatorian

NCEE
SECONDARY /
VOCATIONAL Baesa Adventist Academy 6/18/1979 3/25/1984 1984
Awardee

TRADE
Adventist University of the Philippines
COURSE
COLLEGE Bachelor of Science in Biology 6/18/1984 30/22/1988 1988
(Formerly PUC)
GRADUATE STUDIES MLQU, Manila Master of Arts in Teaching Science 7/6/2000 10/25/2002 2002
(Continue on separate sheet if necessary)

SIGNATURE DATE
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

PBET 76.8 Quezon City 0352283 10/2/2019

(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)

July 8,1989 April 15,1995 Permanent Science Teacher Central Luzon Conference 3600.00 Permanent

6/18/1995 4/5/1997 Science and Math Teacher Joseph and Mary Academy 4500.00 Permanent

4/10/1997 7/10/2000 Sales Representative Colonial Mutual Group 10000.00

7/18/2000 1/9/2003 Science and Math Teacher Dep ED Caloocan , Bagumbong High School 85000.00 LSB Yes

1/10/2003 Present Science and Research Teacher Dep ED Caloocan , Caloocan High School 45000.00 Tchr III Yes

(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 / NATURE OF WORK
From To

Philippine Public Safety Order Support Group 11/4/2012 Present Administrator

Seventh-Day Adventist Church 1/2/1997 Present Communication Leader and Youth Sabbath School Teacher

Master Guide 6/10/1984 Present Pathfinder Deputy Director

Nat Sci Club Adviser Association 6/10/2012 4/10/2015 Bonafide Member

Adventist Community Service 1/10/1997 Present Asisstant Leader

Family Life Ministry 01/ 01//2015 Present Director

(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

orientation on Partnership Framework and Training on Project Proposal Nov. 27, 2018 Nov. 29, 2018 24.0 SDO- Caloocan

Workshop on Research Writing and Appraisal for Secondary School Research Committee
Oct. 11, 12018 Oct. 14, 2018 30.0
Members and Master Teachers SDO- Caloocan
How To Package and present your research Oct. 1, 12017 Oct. 4, 2017
DOST - NCR

Facing Today's Challenges Through Research and Innovation 3/5/2017 3/7/2017

DOST - NCR

Anti- Drug Forum for Health Workers Sept. 22, 2016 9/22/2016
OFFICE of the PRESIDENT

INVENT A SCHOOL _PROGRAM 7/13/2017 Jul. 14, 2017

SDO- CALOOCAN

Environment Training for Teachers Nov. 16, 2016 Nov. 29, 2018
DENR- NCR

Second Science congress at Caloocan 4/5/2016 4/5/2016

SDO- CALOOCAN

Division Training Workshop in Research Jan. 20, 2016 1/22/2016 SDO- CALOOCAN

Annual Assessment of the Implementation of the Special Curricular program in Science and
Feb. 2, 2015 Feb. 5, 2016 DEP-ED Central Office
Technology

Capacitating Teachers in research and Development and Innovation Dec. 10, 2016 DOST, NCR

Ideation Tools and Technique Sept. 28 Sept. 30, 2015

DOST - NCR

First Science Congress of caloocan Oct. 23, 2014

SDO- CALOOCAN

Mass Training of Grade ( Teachers : Science 5/19/2014 5/23/2014

DEP ED -NCR

Capacitating Teachers in Research

DOST - NCR

(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)

READING AND RESEARCHING PPSOSG Administrator

WRITING MASTER GUIDE INSTRUCTOR/ DEPUTY

COOKING FAMILY LIFE MINISTRY LEADER

DIRECTING DRAMA/ PLAY COMMUNICATION LEADER

SEWING KID COORDINATOR

PROGRAM COORDINATOR SABBATH SCHOOL YOUTH TEACHER

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 3 of 4
 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? YE ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? S
YE ✘

S give details:
If YES,
________________________________

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 any court or tribunal? YES NO
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, YE ✘
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, NO
S 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 ✘ 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 YE ✘ NO
election to promote/actively campaign for a national or local candidate? If S
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
FERAZIM DANNUG 10th Ave. GracePark Cal City 3.5 cm. X 4.5 cm
(passport size)

ARLENE MANIQUIZ 10th Ave. GracePark Cal City With full and handwritten
name tag and signature over
printed name
EDGARDO LOPEZ 10th Ave. GracePark Cal City
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.: 0352283

Signature (Sign inside the box)

Date/Place of Issuance: 4/16/1998 , 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 4