Regine Morales Mantilla

CS Form No. 212 PERSONAL DATA SHEET Revised 2017 WARNING: Any misrepresentation 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 ACCOM PLISHING THE PDS FORM . Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. (Do not fill up. For CSC use only) 1. CS ID No. I. PERSONAL INFORMATION MANTILLA 2. SURNAME NAME EXTENSION (JR., SR) FIRST NAME REGINE MIDDLE NAME MORALES 3. DATE OF BIRTH (mm/dd/yyyy) 20/10/1993 FILIPINO 16. CITIZENSHIP MAHARLIKA.BISLIG CITY If holder of dual citizenship, 5. SEX FEMALE please indicate the details. 6 CIVIL STATUS SINGLE 4. PLACE OF BIRTH Pls. indicate country: 03927 17. RESIDENTIAL ADDRESS NARCISO House/Block/Lot No. Street BRGY. WASHINGTON Subdivision/Village 7. HEIGHT (m) 1.48 8. WEIGHT (kg) 45.5 9. BLOOD TYPE B 10. GSIS ID NO. NONE 11. PAG-IBIG ID NO. NONE 12. PHILHEALTH NO. - SURIGAO CITY SURIGAO DEL NORTE City/Municipality Province 8400 ZIP CODE 2 18. PERMANENT ADDRESS House/Block/Lot No. Street SAN ANDRES BRGY. MAHARLIKA BISLIG CITY SURIGAO DEL SUR City/Municipality Province 8311 ZIP CODE 13. SSS NO. - 19. TELEPHONE NO. 14. TIN NO. - 20. MOBILE NO. NONE 15. AGENCY EMPLOYEE NO. Barangay NONE - - 21. E-MAIL ADDRESS (if any) II. FAMILY BACKGROUND 22. SPOUSE'S SURNAME NONE FIRST NAME NONE MIDDLE NAME NONE OCCUPATION NONE EMPLOYER/BUSINESS NAME NONE BUSINESS ADDRESS NONE TELEPHONE NO. NONE 24. FATHER'S SURNAME 23. NAME of CHILDREN (Write full name and list all) NAME EXTENSION (JR., SR) JR. DATE OF BIRTH (mm/dd/yyyy) RAINIER ETHAN M. MONTEROS 04/18/2018 MANTILLA FIRST NAME RAUL MIDDLE NAME ASINO 12/01/1941 NAME EXTENSION (JR., SR) NA 25. MOTHER'S MAIDEN NAME SURNAME MORALES FIRST NAME LUISA MIDDLE NAME CUBONG 03/18/1961 (Continue on separate sheet if necessary) III. EDUCATIONAL BACKGROUND 26. LEVEL NAME OF SCHOOL (Write in full) BASIC EDUCATION/DEGREE/COURSE (Write in full) PERIOD OF ATTENDANCE From ELEMENTARY SECONDARY VOCATIONAL / TRADE COURSE COLLEGE CLEMENTINO V. DIEZ MEMORIAL CENTRAL ELEMENTARY SCHOOL SURIGAO DEL NORTE NATIONAL HIGH SCHOOL SURIGAO DEL NORTE COLLEGE OF AGRICULTURE AND TECHNOLOGY LIVELIHOOD TRAINING AND PRODUCTIVITY CENTER UNIVERSITY OF SOUTHEASTERN PHILIPPINES- BISLIG CAMPUS To HIGHEST LEVEL/ UNITS EARNED (if not graduated) SCHOLARSHIP/ YEAR GRADUAT ACADEMIC HONORS ED RECEIVED Elementary 06/07/1999 04/08/2006 GRADUATED 2006 NONE Secondary 06/07/2006 04/06/2010 GRADUATED 2010 NONE COOKERY NCII 01/11/2017 03/24/2017 GRADUATED 2017 NONE ADVANCE COMPUTER EDUCATION 09/06/2016 12/13/2016 GRADUATED NCII 2016 NONE 2014 NONE BACHELOR IN SECONDARY EDUCATION-ENGLISH 06/08/2010 04/04/2014 GRADUATED GRADUATE STUDIES (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 SPECIAL LAWS/ CES/ CSEE BARANGAY ELIGIBILITY / DRIVER'S LICENSE LICENSURE EXAMINATION FOR TEACHERS LICENSE (if applicable) RATING (If Applicable) DATE OF EXAMINATION / CONFERMENT PLACE OF EXAMINATION / CONFERMENT 78% 08/17/2014 UM-MATINA, DAVAO CITY NUMBER Date of Validity - 20/10/2020 STATUS OF APPOINTMENT GOV'T SERVICE (Y/ N) (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. INCLUSIVE DATES (mm/dd/yyyy) 28. POSITION TITLE (Write in full/Do not abbreviate) DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full/Do not abbreviate) MONTHLY SALARY SALARY/ JOB/ PAY GRADE (if applicable)& STEP (Format "00-0")/ INCREMENT From To 08/29/2019 04/03/2020 SUBSTITUTE TEACHER DAY-ASAN NATIONAL HIGH SCHOOL - CONTRACTUAL YES 07/05/2017 10/03/2017 SUBSTITUTE TEACHER TAFT NATIONAL HIGH SCHOOL - CONTRACTUAL YES 08/04/2015 05/19/2016 CUSTOMER SERVICE REPRESENTATIVE TELEPERFORMANCE - CONTRACTUAL NO (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 29. INCLUSIVE DATES (mm/dd/yyyy) NAME & ADDRESS OF ORGANIZATION (Write in full) From NONE N/A POSITION / NATURE OF WORK NUMBER OF HOURS To 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) 30. INCLUSIVE DATES OF ATTENDANCE (mm/dd/yyyy) TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (Write in full) NUMBER OF HOURS CONDUCTED/ SPONSORED BY (Write in full) From To CERTIFICATE OF COMMENDATION AS A RESOURCE SPEAKER IN EDITORIAL WRITING DURING THE CONDUCT OF THE DISTRICT-BASED TRAINING ON CAMPUS JOURNALISM AND DESKTOP PUBLISHING 09/07/2017 09/07/2017 8 R.C OUANO MES. ELEMENTARY SCHOOL, BGRY. CAGNIOG,SURIGAO CITY CERTIFICATE OF COMMENDATION FOR BEING A FACILITATOR DURING CAREER GUIDANCE WEEK CELEBRATION 08/14/2017 08/23/2017 24 TAFT NATIONAL HIGH SCHOOL CERTIFICATE OF COMMENDATION FOR BEING THE TOURNAMENT MANAGER IN SOFTBALL DURING THE JOINT TAFT NHS INTRAMURALS AND DISTRICT IX MEET 2017 08/10/2017 08/12/2017 24 PROVINCIAL SPORTS COMPLEX,SURIGAO CITY CERTIFICATE OF COMMENDATION FOR BEING A FACILITATOR DURING THE JOINT TAFT NHS INTRAMURALS AND DISTRICT IX MEET 2017 08/10/2017 08/12/2017 24 PROVINCIAL SPORTS COMPLEX,SURIGAO CITY CERTICATE OF COMMENDATION FOR BEING THE JUDGE IN NUTRI-JINGLE DURING THE NUTRITION MONTH CELEBRATION 07/28/2017 07/28/2017 4 TAFT NATIONAL HIGH SCHOOL NATIONAL CERTIFICATE II IN COOKERY 22/02/2017 12/05/2017 316 CERTIFICATE OF TRAINING FOR COOKERY NCII 11/01/2017 03/24/2017 316 03/06/2017 03/14/2017 80 02/22/2017 03/06/2017 72 SURIGAO DEL NORTE COLLEGE OF AGRICULTURE AND TECHNOLOGY SURIGAO DEL NORTE COLLEGE OF AGRICULTURE AND TECHNOLOGY SURIGAO DEL NORTE COLLEGE OF AGRICULTURE AND TECHNOLOGY SURIGAO DEL NORTE COLLEGE OF AGRICULTURE AND TECHNOLOGY CERTIFICATE OF COMPLETION FOR ADVANCE COMPUTER EDUCATION NCII 05/09/2016 12/13/2016 360 LIVELIHOOD TRAINING AND PRODUCTIVITY CENTER CERTIFICATE OF APPRECIATION DURING THE3RD BRIGADA ESKWELA OF SAINT VINCENT DE PAUL DIOCESAN COLLEGE 5/29/2015 5/29/2015 8 SAINT VINCENT DE PAUL DIOCESAN COLLEGE CERTIFICATE OF PARTICIPATION DURING THE IN-SERVICE TRAINING OF SVPDC TEACHERS WITH THE THEME : UTILIZATION OF TSNA TOOL FOR TEACHERS' COMPETENCIES AND K-12 CURRICULUM STANDARDS 5/18/2015 5/23/2015 48 SAINT VINCENT DE PAUL DIOCESAN COLLEGE AGENT OF CHANGE CERTIFICATE OF RECOGNITION AS A MEMBER OF CAMPUS MINISTRY 07/05/2013 07/06/2014 360 UNIVERSITY OF SOUTHEASTERN PHILIPPINES- BISLIG CAMPUS STUDENT TEACHING 11/25/2013 3/28/2014 640 UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS CERTIFICATE OF PARTICIPATION ON GAINING A BETTER APPRECIATION OF THE ART OF TEACHING 9/26/2013 9/27/2013 16 UNIVERSITY OF IMMACULATE CONCEPTION, BONIFACIO, DAVAO CITY MALUGOD NA PARANGAL SA AKTIBONG PAGLAHOK SA KULMINASYON SA BUWAN NG WIKA NA MAY TEMANG: WIKA NATIN ANG DAANG MATUWID 08/30/2013 08/30/2013 8 BISLIG CITY NATIONAL HIGH SCHOOL ON BECOMING A TEACHER 08/07/2013 10/28/2013 40 ASSESSMENT FOR STUDENT LEARNING 08/07/2013 10/28/2013 40 EXPLORING THE CURRICULUM AND TEAM TEACHING 11/11/2012 3/15/2013 40 MICROTEACHING AND THE USE OF TECHNOLOGY 10/07/2012 10/10/2012 40 UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS OBSERVATION OF CLASSROOM MANAGEMENT SKILLS 11/14/2011 3/15/2012 40 UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS CERTIFICATE OF COMPLETION FOR FIELD STUDY 1: OSERVATION OF LEARNERS' DEVELOPMENT AND SCHOOL ENVIRONMENT 7/14/2011 12/10/2011 40 UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS CERTIFICATE OF RECOGNITION AS A MEMBER OF THE EDUCATION STUDENT'S ORGANIZATION OF UNIVERSITY OF SOUTHEASTERN PHILIPPINES 07/14/2010 06/27/2011 360 UNIVERSITY OF SOUTHEASTERN PHILIPPINESBISLIG CAMPUS CERTIFICATE OF ACHIEVEMENT IN PREPARING SWEETS LEADING TO COOKERY NCII CERTIFICATE OF ACHIEVEMENT IN PREPARING COLD MEALS LEADING TO COOKERY NCII UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS UNIVERSITY OF SOUTHEASTERN PHILIPPINES-BISLIG CAMPUS (Continue on separate sheet if necessary) VIII. OTHER INFORMATION 31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full) COOKING (COOKERY NCII HOLDER) NONE NONE COMPUTER LITERATE N/A N/A SINGING N/A N/A DANCING N/A N/A DRAWING N/A N/A (Continue on separate sheet if necessary) SIGNATURE DATE 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, YES NO √ NO √ 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? YES If YES, give details: ________________________________ YES NO If YES, give details: ________________________________ Date Filed: b. Have you been criminally charged before any court? √ 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? 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 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)? 39. YES NO √ If YES, give details: ________________________________ YES If YES, give details: NO √ YES If YES, give details: NO √ 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? YES If YES, give details: NO √ Have you acquired the status of an immigrant or permanent resident of another country? YES NO √ 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? b. Are you a person with disability? c. Are you a solo parent? YES If YES, please specify: If YES, please specify ID No: If YES, please specify ID No: 41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) 42. NAME ADDRESS TEL. NO. LOUISE JUSSETH D. LORCHANO SURIGAO CITY - BARBARA P. BALGOMA SURIGAO CITY VERINA B. OLOJAN SURIGAO CITY -/- 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. ID picture taken within the last 6 months 3.5 cm. X 4.5 cm (passport size) With full and handwritten name tag and signature over printed name Computer generated or photocopied picture 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 PRC ID Government Issued ID: ID/License/Passport No.: - Date/Place of Issuance: 7/15/2015,Davao City SUBSCRIBED AND SWORN to before me this Signature (Sign inside the box) Date Accomplished Right Thumbmark , affiant exhibiting his/her validly issued government ID as indicated above. Person Administering Oath CS FORM 212 (Revised 2017), Page 4 of 4