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 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 ARIZ
NAME EXTENSION (JR., SR) N/A
FIRST NAME ANGELIE
MIDDLE NAME TANGAL
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
05/201980 ✘ by birth by naturalization
4. PLACE OF BIRTH KINGKING PANTUKAN DAVAO DEL NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
17. RESIDENTIAL ADDRESS #3750 Roxas Street
6 CIVIL STATUS Single ✘ Married
Widowed Separated House/Block/Lot No. Street
VIAJE VILLAGE KINGKING
Other/s:
Subdivision/Village Barangay
PANTUKAN DAVAO DE ORO
7. HEIGHT (m) 1.54 METERS
City/Municipality Province
8. WEIGHT (kg) 58 kg. ZIP CODE 8809

9. BLOOD TYPE O 18. PERMANENT ADDRESS

#3750 ROXAS Street
VIAJE VILLAGE KINGKING
10. GSIS ID NO. 2001536277
Subdivision/Village Barangay
PANTUKAN DAVAO DE ORO
11. PAG-IBIG ID NO. 195000278633
City/Municipality Province
12. PHILHEALTH NO. 160000616734 ZIP CODE 8809

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

14. TIN NO. 940-395-763 20. MOBILE NO. 09464620818

15. AGENCY EMPLOYEE NO. 8408990 21. E-MAIL ADDRESS (if any) [email protected]
FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME ARIZ 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME RHIO ARIZ GELRHI TANGAL 03/21/2011

MIDDLE NAME CAIS

OCCUPATION SEAFARER
EMPLOYER/BUSINESS NAME C.F. SHARP
BUSINESS ADDRESS CASA ROCHA,GENERAL LUNA STREET,INTRAMUROS, MANILA

TELEPHONE NO. (632) 527.6031

24. FATHER'S SURNAME TANGAL
NAME EXTENSION (JR., SR) N/A
FIRST NAME ERNESTO
MIDDLE NAME ALMERO
25. MOTHER'S MAIDEN NAME
SURNAME MAKINANO
FIRST NAME ALEJANDRA
MIDDLE NAME APIT (Continue on separate sheet if necessary)

DUCATIONAL BACKGROUND YE
HIGHEST AR
BASIC EDUCATION/DEGREE/COURSE SCHOLARSHIP/
LEVEL/ GR
26. NAME OF SCHOOL PERIOD OF ATTENDANCE ACADEMIC
LEVEL (Write UNITS AD
HONORS
(Write in full) EARNED UA
in full) RECEIVED
From To (if not graduated) TE
D
03/2 THIRD
ELEMENTARY KINGKING CENTRAL ELEMENTARY SCHOOL ELEMENTARY EDUCATION 1987 1993 6/19 HONORABLE
93 MENTION
04/0
VOCATIONAL / FIRST HONORABLE
SECONDARY PANTUKAN NATIONAL HIGH SCHOOL HIGH SCHOOL EDUCATION 1993 1997 2/19 MENTION
97

N/A

TRADE BACHELOR OF SECONDARY EDUCATION

COLLEGE
COURSE
ST.MARYS COLLEGE TAGUM CITY MAJOR IN PHYSICAL EDUCATION HEALTH 1997 2001 N/A
AND MUSIC

MASTER OF ARTS IN EDUCATION

GRADUATE STUDIES ST.MARYS COLLEGE TAGUM CITY
MAJOR IN ENGLISH
2001 2005 N/A
MASTER OF ARTS IN EDUCATION IN
GRADUATE STUDIES ST.MARYS COLLEGE TAGUM CITY
PHYSICAL EDUCATION
6/27/2005 05/20,2007 27 UNITS N/A

GRADUATE STUDIES UNIVERSITY OF SOUTHEASTERN PHILIPPINES EDUCATIONAL MANAGEMENT 8/10/2017 present 36 UNITS N/A
ntinue on separate sheet if necessary)
SIGNATURE DATE 08/05/19
CS FORM 212 (Revised 2017), Page 1 of 4
 Married
Widow/er
Separated

by naturalization
Solo Parent
Others
Angola
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas, The
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei 
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombia
Comoros
Congo, Democratic Republic of the
Congo, Republic of the

Costa Rica

Cote d'Ivoire

Croatia

Cuba
C
y
p
r
Czech
u Republic
s
Djibouti
Dominica
 DEPARTMENT OF EDUCATION PANTUKAN
01/03/2017 03/17/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/24/2017 03/16/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/23/2017 01/23/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/10/2017 01/22/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/09/2017 01/09/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/01/2017 01/08/2017 TEACHER III (SHS) 23,257.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
09/15/2016 12/13/2016 TEACHER III (SHS) 22,328.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
09/13/2016 09/14/2016 TEACHER III (SHS) 22,328.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
06/13/2016 09/12/2016 TEACHER III (SHS) 22,328.00 SG 13-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
05/15/2016 06/12/2016 TEACHER I 19,286.00 SG-11-2 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
03/18/2016 05/14/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
03/17/2016 03/17/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
02/17/2016 03/17/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
02/16/2016 02/16/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/23/2016 02/15/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/22/2016 01/22/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
01/01/2016 01/21/2016 TEACHER I 19,077.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
12/19/2015 12/31/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
12/14/2015 12/18/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
10/12/2015 12/13/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
12/09/2015 9/12/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
11/21/2015 8/12/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
11/20/2015 11/20/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
06/02/2015 11/19/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
06/01/2015 06/01/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
08/07/2014 05/31/2015 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
08/04/2014 08/06/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
07/17/2014 08/03/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
07/14/2014 07/16/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
07/12/2014 07/13/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
07/11/2014 07/11/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION PANTUKAN
05/15/2013 07/10/2014 TEACHER I 18,549.00 SG-11-1 PERMANENT YES
NATIONAL HIGH SCHOOL
01/01/2010 05/31/2010 INSTRUCTOR III MSU CSPEAR 12,546.00 SG-0-0 CONT YES
01/01/2009 12/31/2009 INSTRUCTOR III MSU CSPEAR 12,546.00 SG-0-0 CONT YES

01/01/2008 12/13/2008 INSTRUCTOR III MSU CSPEAR 12,546.00 SG-0-0 CONT YES

06/13/2007 12/31/2007 INSTRUCTOR III MSU CSPEAR 12,546.00 SG-0-0 CONT YES
06/01/2006 05/31/2007 INSTRUCTOR I USP MAMPISING 11.167.00 SG-0-0 TEMP YES
10/01/2005 05/31/2006 INSTRUCTOR I USP MAMPISING 11.167.00 SG-0-0 TEMP YES

10/01/2004 09/30/2005 INSTRUCTOR I USP MAMPISING 11.167.00 SG-0-0 TEMP YES

10/01/2003 09/30/2004 INSTRUCTOR I USP MAMPISING 11.167.00 SG-0-0 TEMP YES

SIGNATURE DATE 08/05/19

 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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

REGIONAL TRAINING ON LITERACY INSTRUCTION

deped Learning Managemnet System Hands on Activity

"7-27- 20 7-31-20
Structural Framework of Structural Mangamenet System for course Creator DepED Region XI
7/11/2020
7/11/20 DepED Region XI
TRENDS AND ISSUES IN QUALITATIVE RESEARCH FOR RESEARCH ENTHUSIASTS AND
Educational Management Doctorate Council Universirty
SCHOOL ADMINISTRATORS IN REVIEW OF RELATED LITERATURE WRITING AND ETHICS 4/13/2018 8 HRS. Managerial of Southestern Philippines Obrero Campus Davao City.
IN THE CONDUCT OF RESEARCH.
HARMONIZING THEORIES AND CONCEPTS IN THE EDUCATIONAL PLATFORM: KEY TO Educational Management Doctorate Council Universirty
EFFECTIVE LEADERS AND MANAGERS IN THE 21ST CENTURY 11/30/2018 11/31/2018 16 HRS. TECHNICAL
of Southestern Philippines Obrero Campus Davao City.

FINANCIAL MANAGEMENT OPERATIONS MANUAL 11/13/2017 11/15/2017 24 HRS. MANAGEMENT

DEPARTMENT OF EDUCATION

SPORTS CLINIC FOR TECHNICAL OFFICIALS AND COACHES 9/10/2017 10/10/2017 16 HOURS TECHNICAL
DEPARTMENT OF EDUCATION

2017 PSYSC NATIONAL SCIENCE CLUBS SUMMIT 9/9/2017 10/9/2017 16 HOURS TECHNICAL PSYSC NATIONAL SCIENCE CLUB

3 DAY TRAINING OF KINDERGARTEN AND SECONDARY SCHOOL TEACHERS ON EARLY IDENTIFICATION AND
ASSESSMENT OF CHILDREN WITH SPECIAL NEEDS IN THE REGULAR SCHOOL SYSTEM 07/05/2016 07/07/2017 18 HOURS TECHNICAL
DEPARTMENT OF EDUCATION
2016 GRADE 11 REGIONAL MASS TRAINING FOR TEACHERS ON K TO 12 ENHANCE BASIC
06/18/2016 07/31/2016 21 HOURS TECHNICAL
EDUCATION FOR COMMON TOPICS DIVISION LEVEL DEPARTMENT OF EDUCATION

(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)
GOLDEN VOICE CHAMPION,SAYAWITAN CHAMPION SOUTHERN MINDANAO REGIONAL ATHLETIC
SINGING ASSOCIATION '94 AND 96
BARANGAY KINGKING ZUMBA ASSOCIATION
DAVAO ASSOCIATION OF PHYSICAL
DANCESPORT CHAMPION ST. MARYS COLLEGE Year 2000/Barangay Kingking Zumba Performer 1ST
DANCING Runner Up 2019 Municipality Nutrition Month Culmination July 29,2019 EDUCATION TEACHERS
SPEECHFEST SECONDARY LEVEL FIRST PLACER IN TALUMPATI DEKLAMASYON TANGLAW THETRE DANCESPORT COUNCIL OF THE PHILIPPINES
ACTING GUILD BEST ACTRESS AWARDEE DAVAO CHAPTER
TRAINOR ARAW NG PANTUKAN CHAMPION INDAK INDAKAN SA DAAN '02,NEO ETHNIC
UNIVERSITY OF SOUTHEASTERN PHILIPPINES
TRAINING DIFFERENT DANCE GENRE CHOREOGRAPHER GRAND CHAMPION UNIVERSITY OF SOUTHEASTERN PHILIPPINES 2005-2006-
MABINI CAMPUS ALUMNI ASSCOCIATION
2006
WINNING COACH AND CHOREOGRAPER,ZUMBA GRAND CHAMPION INTRAMURALS 2013 and 2018

(Continue on separate sheet if necessary)

SIGNATURE DATE 08/05/2019

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
a. within the third degree?
YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
YES ✘ ________________________________
NO

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
YES ✘ NO
________________________________
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
YES ________________________________
✘ NO 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:
________________________________
YES ________________________________
✘ NO
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:
YES ✘ NO
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
election to promote/actively campaign for a national or local candidate? If YES, give details:
YES ✘ NO
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO give details (country):
If YES,
YES ✘ NO
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
EMMALINDA B. RANALAN KINGKING PANTUKAN, COMPOSTELA VALLEY 9069143706 3.5 cm. X 4.5 cm
MANKILAM, TAGUM CITY, DAVAO DEL (passport size)
VLADIMIR I. SANTOS Ed. D. NORTE
9177076891
With full and handwritten
ROXAS STREET KINGKING,PANTUKAN name tag and signature over
REV. JIMMY O. MONTAOS COMPOSTELA VALLEY
09171336744 printed name

42. Computer generated

I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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.: 0719538

Signature (Sign inside the box)
07/30/20
Date/Place of Issuance: DAVAO CITY
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