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 ag
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

I. PERSONAL INFORMATION
2. SURNAME MARABI
NAME EXTENSION (JR., SR
FIRST NAME MARIA JESSICA

MIDDLE NAME VILLAS

3. DATE OF BIRTH
(mm/dd/yyyy) 10/2/1971 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH MARIBOJOC,BOHOL If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS JUGO

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
POB
Other/s:
Subdivision/Village Ba
MARIBOJOC BO
7. HEIGHT (m) 1.52 m.
City/Municipality Pr
8. WEIGHT (kg) 68kg ZIP CODE 6336

18. PERMANENT ADDRESS JUGO

9. BLOOD TYPE B+
House/Block/Lot No. S
POB
10. GSIS ID NO. 711002014474
Subdivision/Village Ba
MARIBOJOC
11. PAG-IBIG ID NO. 0701-3006-4411
City/Municipality Pr

12. PHILHEALTH NO. 12-0555446647 ZIP CODE 6336

13. SSS NO. 06-14454262 19. TELEPHONE NO. (038)5049232

14. TIN NO. 918-086-538 20. MOBILE NO. 09079963304

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
4356755 21. E-MAIL ADDRESS (if any) mariajessicamarabi@gmail.com
MARABI 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) MOIRA EDEN V. MARABI
EDGAR
MAIRA JEWANA V. MARABI
CARABALLE

OCCUPATION SEAMAN

EMPLOYER/BUSINESS NAME ISLAND SHIPPING CORPORATTION

BUSINESS ADDRESS CEBU, CITY

TELEPHONE NO. 9327859144

24. FATHER'S SURNAME VILLAS

NAME EXTENSION (JR., SR)
FIRST NAME SERGIO

MIDDLE NAME ANQUILERO

25. MOTHER'S MAIDEN NAME ANGHAG

SURNAME VILLAS

FIRST NAME URSALINA

MIDDLE NAME REGAÑON (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
LEVEL (Write in EARNED
(Write in full)
full) (if not graduated)
From To

ELEMENTARY SANTA CRUZ ELEMENTARY SCHOOL PRIMARY EDUCATION 1977 1984 GRADUATED

SECONDARY SAINT VINCENT INSTITUTE HIGH SCHOOL 1984 1988 GRADUATED

VOCATIONAL /

TECHNICAL EDUCATION AND SKILLS

DEVELOPMENT AUTHORITY
COMPUTER EDUCATION PASS
TRADE
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE UNIVERSITY OF SAN CARLOS
MAJOR IN PHYSICAL EDUCATION
1989 1995 GRADUATED

MASTER OF ARTS IN EDUCATION MAJOR IN

GRADUATE STUDIES UNIVERSITY OF BOHOL
SUPERVISION AND ADMINISTRATION
2001 2003 27 UNITS
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

JUGO STREET
Street
POBLACION
Barangay
BOHOL
Province
6336

JUGO STREET
Street
POBLACION
Barangay
BOHOL
Province

(038)5049232

09079963304

mariajessicamarabi@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

2/5/2010

6/18/2013

9/19/1937

4/7/1945

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1984 N/A

1988 N/A
 1995 N/A

N/A N/A
parate 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 LICENSE (if ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHERS 75.0 8/1/2001 CEBU CITY 733095

(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 STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

1/1/2019 PRESENT TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 23,198.00 11-3 PERMANENT

1/1/2018 12/31/2018 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 22,698.00 11-3 PERMANENT

1/1/2017 12/31/2017 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 22,088.00 11-3 PERMANENT

1/1/2016 12/31/2016 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 19,496.00 11-3 PERMANENT

1/1/2015 12/31/2015 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 18,922.00 11-3 PERMANENT

1/1/2014 12/31/2014 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 18,922.00 11-3 PERMANENT

11/22/2013 12/31/2013 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 18,735.00 11-2 PERMANENT

6/1/2012 11/21/2013 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 17,318.00 11-2 PERMANENT

6/1/2011 5/31/2012 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 15,900.00 11-2 PERMANENT

11/22/2010 5/31/2011 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 15,698.00 11-1 PERMANENT

6/24/2009 11/21/2010 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 14,198.00 11-1 PERMANENT

7/1/2008 6/23/2009 TEACHER 1 PAGNITOAN NATIONAL HIGH SCHOOL P 12,026.00 11-1 PERMANENT

11/21/2007 6/30/2008 TEACHER 1 INABANGA HIGH SCHOOL P 10,933.00 11-1 PERMANENT

7/1/2003 11/152007 COLLEGE INSTRUCTOR CVSCAFT-CALAPE CAMPUS P 8,500.00 N/A PERMANENT

6/1/1996 6/31/2003 SECONDARY SCHOOL TEACHER UNIVERSITY OF BOHOL-LOON INSTITUTE P 5,000.00 N/A PERMANENT
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

11/1/2011

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

NO
arate 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 POSITION /
From To

MARIBOJOC ECHO TOURISM CULTTURAL HERITAGE 6/12/2010 PRESENT N/A M

MARIBOJOC FEDERATED WOMEN LEADERS 4/20/2006 PRESENT N/A M

BOHOL ARTS AND CULTURAL HERITAGE, TAGBILARAN,CITY 8/4/2005 PRESENT N/A M

HOLY CROSS PARISH TRIANGULAR MEET 2/2/2019 2/3/2019 16 HOURS C

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

CONFERENCE WORKSHOP ON STRENGTHENING THE OPERATION OF SCHOOL

2/27/2017 8.0 DEPARTMENT OF EDUC
LIBRARIES & LEARNING RESOURCE CENTERS
DIVISION CAPABILITY- BUILDING PROGRAM FOR CULTURE BASED EDUCATION
10/7/2016 10/8/2016 16.0 DEPARTMEN
AND SPORTS OFFICIATING OFFICIALS

WELLNESS CAMPUS TRAINING- WORKSHOP 10/6/2016 8.0 DEPARTMEN

CONTINOUOS IMPROVEMENT (C I) PROGRAM 9/1/2016 9/3/2016 24.0 DEPARTMEN

DIVISION TRAINING- WORKSHOP ON ENHANCING COMPETENCIES IN TEACHING

8/4/2016 8/6/2016 24.0 DEPARTMEN
MAPEH

BASIC TRAINING COURSE FOR OUTFOT ADVISERS (BTC) 7/1/2016 7/3/2016 24.0 BOY SCOUT

MID-YEAR IN SERVICE TRAINING (INSET) 10/24/2016 10/28/2016 40.0 DEPARTMEN

DIVISION TRAINING-WORKSHOP ON THE CONDUCT OF PHYSICAL FITNESS TEST 10/15/2015 10/17/2015 24.0 DEPARTMEN

DEPARTMEN
DISTRICT RE-ECHO ON THE CONDUCT OF THE PHYSICAL FITNESS TEST 8/28/2015 8 .0
BOHOL

MASS TRAINING FOR GRADE10 MAPEH TEACHERS 5/9/2015 5/13/2015 54.0 DEPARTMEN

TWO-DAY DISTRICT TRAINING ON CHILD

11/28/2014 11/29/2014 16.0 DEPART
PROTECTION POLICY
DIVISION SEMINAR-WORKSHOP ON
UNPUBLISHED VISAYAN FOLKDANCES
9/7/2014 9/9/2014 24.0 DEPART
AND PUBLISHED PHILIPPINES
FOLKDANCES
AND PUBLISHED PHILIPPINES
FOLKDANCES
REGIONAL MASS TRAINING FOR GRADE 7 MAPEH TEACHERS ON THE
5/30/2012 40.0
5/26./2012 DEPAR
IMPLEMENTATION OF K-12 BASIC
EDUCATION CURRICULUM
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

CHOREOGRAPHY CERTIFICATE-BOARD OF JUDGES ASSOCIAT

COOKING COACH-MARIBOJOC ARTS MONTH CELEBRATION SV

DANCING SAYAW PINOY DANCE COMPETITION CAROLIN

SINGING COACH-MARIBOJOC TRIANGULAR MEET ALLIANCE

PLP WRITER IN MAPEH

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

MEMBER

MEMBER

MEMBER

COACH

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION - BOHOL

BOY SCOUT OF THE PHILIPPINES-BOHOL

DEPARTMENT OF EDUCATION-BOHOL

DEPARTMENT OF EDUCATION-BOHOL

DEPARTMENT OF EDUCATION - MARIBOJOC

BOHOL

DEPARTMENT OF EDUCATION-REGION 7

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION - BOHOL

DEPARTMENT OF EDUCATION -REGION 7

REGION 7
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

ASSOCIATION OF CONCERN TEACHERS

SVI ALUMNI ASSOCIATION

CAROLINIANS ALLUMNI ASSOCIATION

ALLIANCE OF VOLUNTERS EDUCATORS

eparate sheet if necessary)

APRIL 25,2019
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,
a. within the third degree? YES ✘

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

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 within
the last 6 months
GERARDO F. SACO JR. MARIBOJOC,BOHOL 9189511466 3.5 cm. X 4.5 cm
(passport size)

ELVIRA I. JABONILLO PUNSOD, MARIBOJOC, BOHOL 9286348160 With full and handwritten
name tag and signature over
printed name
LORNA E. RANCES POBLACION , MARIBOJOC, BOHOL
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.: 733095

Signature (Sign inside the box)
APRIL 26,2019
Date/Place of Issuance: 11/14/2001
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 o

 If YES, give details (country):

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

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