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/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 BAJA
NAME EXTENSION (JR., SR)
FIRST NAME CINDY

MIDDLE NAME TABLANDO

3. DATE OF BIRTH
11/7/1974 16. CITIZENSHIP
by
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
bir naturalization
4. PLACE OF BIRTH CAGAYAN DE ORO CITY If holder of dual citizenship, th indicate country:
Pls.

5. SEX ✘ Female please indicate the details.

Male
Singl ✘ Married 17. RESIDENTIAL ADDRESS 143 MAGSAYSAY
6 CIVIL STATUS Wid
e Separat House/Block/Lot No. Street
owe
Othe ed 18
d Subdivision/Village Barangay
r/s: CAGAYAN DE ORO CITY MISAMIS ORIENTAL
7. HEIGHT (m) 1.6
City/Municipality Province
8. WEIGHT (kg) 66 ZIP CODE 9000

18. PERMANENT ADDRESS 143 MAGSAYSAY

9. BLOOD TYPE "B"
House/Block/Lot No. Street
18
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CAGAYAN DE ORO CITY MISAMIS ORIENTAL
11. PAG-IBIG ID NO. 1210-1668-4297
City/Municipality Province

12. PHILHEALTH NO. 15-050075046-6 ZIP CODE 9000

13. SSS NO. 08-1209365-8 19. TELEPHONE NO. N/A

14. TIN NO. 921-258-693 20. MOBILE NO. 09352874220

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) cindyt.baja@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME BAJA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME CHELITO MAXFEL T. BAJA II 2/14/2001
MIDDLE NAME GEBE MICAEL T. BAJA 7/6/2009
OCCUPATION MAINTENANCE ENGINEER N/A N/A

EMPLOYER/BUSINESS NAME CITY ECONOMIC ENTERPRISES DEPARTMENT N/A N/A

BUSINESS ADDRESS COGON MARKET N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME TABLANDO N/A N/A

NAME EXTENSION (JR., SR) N/A
FIRST NAME CAYETANO N/A

MIDDLE NAME PAALAM N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME TABLANDO N/A N/A

FIRST NAME CONCEPCION N/A N/A

MIDDLE NAME (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

JUNE, MARCH,
ELEMENTARY CITY CENTRAL SCHOOL ELEMENTARY ELEMENTARY 1987 N/A
1981 1987
MISAMIS ORIENTAL GENERAL COMPRHENSIVE JUNE, MARCH,
SECONDARY /
VOCATIONAL HIGH SCHOOL
SECONDARY HIGH SCHOOL 1991 N/A
1987 1991

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

TRADE
Bachelor of Elementary Education with Area of JUNE, MARCH,
COURSE
COLLEGE XAVIER UNIVERSITY
Concentration -Filipino COLLEGE 1995 N/A
1991 1995

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE July 23, 2018

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 TEACHERS 75.0 8/24/1996 CAGAYAN DE ORO CITY

(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

MA 4,2018 July 19,2018

June PUERTO ELEMENTARY SCHOOL
Y Substitute Teacher1
6,1 Full Time High School Teacher 12000.00 N/A
996 May 31,2018 Kong Hua School
MAY 6,1996 MAY 10,2011 Full Time Preschool/Elementary Teacher ST. IGNATIUS LEARNING CENTER 9000.00 N/A
 (Continue on separate sheet if necessary)

SIGNATURE DATE July 23,20

CS
 LICENSE (if applicable)

NUMBER Date of
Validity

0020153 11/7/2021

e on separate sheet if necessary)

duties should be indicated in the attached Work Experience sheet.

GOV'T SERVICE
STATUS OF
APPOINTMENT
(Y/ N)

FULL-TIME N/A

FULL-TIME N/A
e on separate sheet if necessary)

July 23,2018

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

(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

Genyo e-Learning Training For Education ( eLITE ) 5/29/2015 5/29/2015 4.0 N/A DIWA
" Enhancement for Teaching, Effectiveness, Preparation of Instructional Objectives,
5/18/2009 5/29/2009 8.0 N/A Saint Ignatius Learning Center
Strategies, Techniques and Instructional Materials "
Skills and Techniques ffor the use of Pre-school Series ( 2002 Textbook
1/12/2002 1/12/2002 8.0 N/A SALESIANA Publishers, INC.
Seminar/Workshop )
The Emerging Learning Environments of the 21st Century for Filipino 11/11/2000 11/11/2000 8.0 N/A SIBS, Publishing House, INC

" Academic Exellence Across The Curriculum " 11/25/2000 11/25/2000 8.0 N/A BOOKMARK

Effective Learning In The Preschool 9/23/2000 9/23/2000 8.0 N/A ABIVA

" Seminar-Workshops on Teaching Strategies and Classroom Management " 10/25/1997 10/25/1997 8.0 N/A VIBAL

Skills and Knowledge Enrichment in Teaching Preschool 10/11/1997 10/11/1997 8.0 N/A PHOENIX

(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
(Write in full)
in full)

Reading books N/A N/A

Surfing the internet N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE July 23, 2018

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

35. a. Have you ever been found guilty of any administrative offense? YE ✘ N
S give details: O
If YES,
________________________________
________________________________
b. Have you been criminally charged before any court? YE ✘ N
S give details: O
If YES,
________________________________
Date Filed:
________________________________
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
YE ✘ N
by any court or tribunal?
S give details: O
If YES,
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘ YE N
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES,
S give details: O
out (abolition) in the public or private sector? Resign-
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
YE ✘ NO
Barangay election)?
S give details:
If YES,
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? S give details:
If YES,
39. Have you acquired the status of an immigrant or permanent resident of another country?
YE ✘ NO
S give details (country):
If YES,

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? YE ✘ NO
If YES,S please specify:
b. Are you a person with disability? YE ✘ NO
If YES,S please specify ID No:
c. Are you a solo parent? YE ✘ NO
If YES,S 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
Mrs. Leonora Alinsub Principal, Puerto Elementary School 9063582504 3.5 cm. X 4.5 cm
(passport size)
CITY ECONOMIC ENTERPRISES
Roy Dablio 9169787683 With full and handwritten
DEPARTMENT
name tag and signature over
printed name
SAINT IGNATIUS LEARNING CENTER, XAVIER
Imee S. Perez 858-8666 Computer generated
HEIGHTS, CAGAYAN DE ORO CITY
or photocopied picture
is not acceptable
42. 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 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

ID/License/Passport No.: 0020153

Signature (Sign inside the box)
July 23, 2018
Date/Place of Issuance: January 8, 1997 / Cagayan de Oro 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