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CS Form No.

212
Revised 2017

PERSONAL DATA SHEET


WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/crimina
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.

I. PERSONAL INFORMATION
2. SURNAME DIONSON
FIRST NAME LLOYD
MIDDLE NAME REYES
3. DATE OF BIRTH
(mm/dd/yyyy) 9/30/1973 16. CITIZENSHIP Filipino Dual Citiz

4. PLACE OF BIRTH BACOLOD CITY If holder of dual citizenship,

please indicate the details.


5. SEX Male Female

6 CIVIL STATUS
Single Married 17. RESIDENTIAL ADDRESS 98
Widowed Separated House/Block/Lot No.
Other/s:
Subdivision/Village
7. HEIGHT (m) 1.67 BAIS CITY
City/Municipality
8. WEIGHT (kg) 75 ZIP CODE 6206
9. BLOOD TYPE A+ 18. PERMANENT ADDRESS 98
House/Block/Lot No.

10. GSIS ID NO. 2004344644


Subdivision/Village

11. PAG-IBIG ID NO. 0615867311 BAIS CITY


City/Municipality

12. PHILHEALTH NO. 120507198487 ZIP CODE 6206


13. SSS NO. 0720207976 19. TELEPHONE NO. +63 35 402 8
14. TIN NO. 199378973 20. MOBILE NO. 0927 496 20
15. AGENCY EMPLOYEE NO. 04690916 21. E-MAIL ADDRESS (if any) lloyd.dionson@dep
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME DIONSON 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME YEVETTE YUL GABRIEL F. DIONSON
MIDDLE NAME FAUSTO
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME DIONSON
NAME EXTENSION (JR., SR)
FIRST NAME HERNANE
MIDDLE NAME TOBONGBANUA
25. MOTHER'S MAIDEN NAME

SURNAME REYES
FIRST NAME ERNA
MIDDLE NAME GONZALES (Continue on separate shee

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE


BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY BAIS CITY PILOT SCHOOL 1980 1986

SECONDARY /
VOCATIONAL BAIS CITY HIGH SCHOOL 1986 1990

TRADE
COMPUTER COLLEGE OF THE BACHELOR OF SCIENCE IN
COURSE
COLLEGE 1991 1995
VISAYAS COMPUTER SCIENCE
NEGROS ORIENTAL STATE CERTIFICATE IN
2002 2003
UNIVERSITY (GGMC) PROFESSIONAL EDUCATION
NEGROS ORIENTAL STATE MASTERS OF SCIENCE IN
GRADUATE STUDIES 2004 2007
UNIVERSITY (MAIN CAMPUS) INFORMATION TECHNOLOGY
(Continue on separate sheet if necessary)

SIGNATURE DATE
AL DATA SHEET
rk Experience Sheet shall cause the filing of administrative/criminal case/s against the person

PDS) BEFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Filipino Dual Citizenship


by birth by naturalization

Pls. indicate country:

TAVERA STREET
Street
BARANGAY 2
Barangay
NEGROS ORIENTAL
Province

6206
TAVERA STREET
Street
BARANGAY 2
Barangay
NEGROS ORIENTAL
Province

6206

+63 35 402 8001

0927 496 2067

lloyd.dionson@deped.gov.ph

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

YUL GABRIEL F. DIONSON 9/25/2005


(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/


YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

ELEMENTARY VALEDIC-
1986 TORIAN
GRADUATE
H.S. 1ST HON.
1990 MENTION
GRADUATE

ACADEMIC,
GRADUATED 1995 COMPUTER
EXCELLENCE

GRADUATED 2003
COMPLETED
ACADEMIC
REQUIREMENTS
e on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 1 of 4


IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR


81.60% 8/31/2003 CEBU CITY, REGION VII
TEACHERS (LET)
CAREER SERVICE PROFESSIONAL 86.22% 3/8/1999 CSC, NATIONAL CAPITAL REGION
CAREER SERVICE SUB-
86.05% 4/11/1995 ILOILO CITY, REGION VI
PROFESSIONAL

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

01 / 01 / Deparment of Education, Division


PRESENT Teacher I ### 11.2
17 of Bais City
Deparment of Education, Division
06/ 03 /16 12/31/2016 Teacher I ### 11.1
of Bais City
Deparment of Education, Division
01/ 01 /16 6/2/2016 Teacher I ### 11.1
of Bais City
Deparment of Education, Division
06/ 03 /13 12/31/2015 Teacher I ### 11.1
of Bais City
11/5/2007 3/31/2013 ICT Instructor La Consolacion College 9,000.00

3/31/2005 10/15/2007 ICT Instructor Negros Oriental State University


6/4/2001 3/30/2005 ICT Instructor
Negros Oriental State University
Dai-ichi Electronics Manufacturing
2/22/1999 10/22/2000 Analyst/Computer Programmer ###
Corporation
11/24/1997 9/15/1998 Computer Programmer MIS Net, Inc. ###

2/26/1996 11/14/1997 Computer Programmer V.Y. Domingo Jewellers, Inc. 8,000.00

8/7/1995 1/6/1996 Passage Clerk Negros Navigation Company, Inc. 5,000.00


Computer Operator, Data City Environment & Natural
7/3/1995 8/3/1995
Encoder Resources Office, Iloilo City
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 2
LICENSE (if applicable)

NUMBER Date of
Validity
10-15-
02878108
03

on separate sheet if necessary)

of duties should be indicated in the attached Work Experience sheet. GOV'T


SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
Permanent Yes

Permanent Yes

Permanent Yes

Permanent Yes

Fulltime No
Fulltime Yes

Fulltime Yes

Regular No

Regular No

Regular No

Contractual No
Contractual Yes
on separate sheet if necessary)

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 POS
From To

(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/ CONDU
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
PI
PINOY TENNIS TRAINERS PROGRAM 4/25/2017 4/27/2017 24 Technical
REFRESHER COURSE FOR COACHES AND OFFICIATING OFFICIALS 2/10/2017 2/12/2017 24 Technical
SPORTS CLINIC FOR COACHES ### ### 24 Technical BA
CAREER ENTRY COURSE FOR SOFTWARE DEVELOPERS (CECSD) JAVA MET
NC IV
8/1/2015 9/30/2015 240 Technical
NATIONAL SEMINAR-WORKSHOP ON THE PREPARATION OF CE
1/23/2015 1/25/2015 24 Technical
INSTRUCTIONAL MATERIALS FOR K12 CLASSROOM ADV
PRODUCTION-BASED TRAINING ON WEB DESIGN AND DEVELOPMENT
PHASE 1
11/24/2014 ### 24 Technical
4-DAY SCHOOL-BASED INSTRUCTIONAL PLAN ORIENTATION AND
ORIENTATION ON BASIC CONTINUOUS IMPROVEMENT (C.I.)
11/20/2014 ### 32 Technical BA
3-DAY ORIENTATION FOR DEPED COMPUTERIZATION PROGRAM (DCP)
RECEPIENTS, ICT SKILLS ENHANCEMENT TRAINING FOR SCHOOL 6/26/2014 6/28/2014 24 Technical BA
HEADS, ICT COORDINATORS
JAVA EDUCATIONAND DEVELOPMENT INITIATIVE TEACHER TRAINING ON
SOLARIS OPERATION SYSTEM
3/27/2008 3/29/2008 25 Technical IN
JAVA EDUCATIONAND DEVELOPMENT INITIATIVE TEACHER TRAINING ON
MOBILE PROGRAMMING
3/24/2008 3/26/2008 26 Technical IN
M
MICROSOFT SQL SERVER 6.5 SYSTEM ADMINISTRATION 3/3/2000 3/3/2000 8 Technical
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

COMPUTER PROGRAMMING Service Award 2013 - La Consolacion College Philip

KEYBOARDING Most Outstanding Teacher 2011 - La Consolacion College Philip


Natio
INTERNET SEARCH Outstanding Service Award 2010 - La Consolacion College
Profe
PC TROUBLESHOOTING Service to the University Award 2005 - Negros Oriental State University Philip

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

separate sheet if necessary)


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

CONDUCTED/ SPONSORED BY
(Write in full)

PINOY TENNIS TRAINERS BY


STEPHAN LHUILLIER
DEPED REGION VII

BAIS CITY SCHOOLS DIVISION


METRO DUMAGUETE COLLEGE /
TESDA
CENTER FOR PROFESSIONAL
ADVANCEMENT OF EDUCATORS
DEPED REGION VII

BAIS CITY SCHOOLS DIVISION

BAIS CITY SCHOOLS DIVISION


PHILIPPINE SOCIETY OF
INFORMATION TECHNOLOGY
PHILIPPINE SOCIETY OF
EDUCATORS
INFORMATION TECHNOLOGY
EDUCATORS
MANNASOFT TECHNOLOGY
CORPORATION
separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

Philippine E-Learning Society

Philippine Society of IT Educators


National Organization for
Professional Teachers
Philippine Jaycess, Inc.

separate 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? 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
the last 6 mo
DR. CORTEZ, BELLADONNA A. NORSU Bais Campus 2 3.5 cm. X 4.5
(passport si

JALUAG, DAISY D. Juan Luna St. Bais City With full and han
name tag and sign
printed nam
SANTOS, YVONNE N. Juan Luna St. Bais City Computer gene
42. or photocopied
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not accept
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: 0818601 - PRC
ID/License/Passport No.: G0801011969 - DRIVER'S LIC. Signature (Sign inside the box)

Date/Place of Issuance: 11/21/2003 CEBU CITY - PRC Date Accomplished Right Thumbm

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicate

Person Administering Oath

CS FORM 212 (Rev


If YES, give details:
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________
NO

NO

NO
If YES, give details (country):

NO

NO

NO

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
Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4