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 a
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. (D

I. PERSONAL INFORMATION
2. SURNAME MONTOYA

FIRST NAME CHERRY NAME EXTENSION

MIDDLE NAME PERIDO

3. DATE OF BIRTH
(mm/dd/yyyy) 05/27/1980 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth

4. PLACE OF BIRTH AMADEO, CAVITE If holder of dual citizenship, Pls. indicate co

Male ✘ Female please indicate the details.
5. SEX

Single ✘ Married
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 039
Widowed Separated House/Block/Lot No.
Other/s: L
Subdivision/Village B
7. HEIGHT (m) 5'2 AMADEO C
City/Municipality P
8. WEIGHT (kg) 55 kgs. ZIP CODE 4119
9. BLOOD TYPE B
18. PERMANENT ADDRESS 039
House/Block/Lot No.

10. GSIS ID NO. N/A L

Subdivision/Village B

11. PAG-IBIG ID NO. 1210-6630-1270 AMADEO

City/Municipality P
12. PHILHEALTH NO. 08-050875073-4 ZIP CODE 4119

13. SSS NO. 33-4993132-9 19. TELEPHONE NO. 046- 8400-922

14. TIN NO. 909-390-473 20. MOBILE NO. 0977-322-6729

15. AGENCY EMPLOYEE NO. 092695 21. E-MAIL ADDRESS (if any) cherrypmontoya@gmail.co
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MONTOYA 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR., SR) N/A MIKHAIL VINCE P. MONTOYA

FIRST NAME MARLON

MIDDLE NAME AMBUNAN MARCIN SIMON P. MONTOYA

OCCUPATION MARKET INSPECTOR II N/A

EMPLOYER/BUSINESS NAME LGU AMADEO, CAVITE N/A

BUSINESS ADDRESS AMADEO, CAVITE N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME PERIDO N/A

FIRST NAME
NAME EXTENSION (JR., SR) N/A
N/A
ROBERTO
MIDDLE NAME PERIDO N/A

25. MOTHER'S MAIDEN NAME MERIAM MALIMBAN ANACAY N/A

SURNAME ANACAY N/A

FIRST NAME MERIAM N/A

MIDDLE NAME MALIMBAN (Continue on separate sheet if necessa

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SALABAN ELEMENTARY SCHOOL ELEMENTARY 1987 1993 N/A

SECONDARY AMADEO NATIONAL HIGH SCHOOL HIGH SCHOOL 1993 1997 N/A
VOCATIONAL /

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

TRADE
COURSE
BACHELOR OF SECONDARY EDUCATION
COLLEGE CAVITE STATE UNIVERSITY MAJOR IN MAPEH
1999 2003 N/A

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

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY

CS FOR
L DATA SHEET
perience Sheet shall cause the filing of administrative/criminal case/s against the person

BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship
by birth by naturalization

Pls. indicate country:

Street
LOMA
Barangay
CAVITE
Province
4119

Street
LOMA
Barangay
CAVITE
Province
4119

046- 8400-922

0977-322-6729

cherrypmontoya@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

8/10/2006

5/1/2016

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

1993 N/A
 1997 N/A

N/A N/A

2003 N/A

N/A N/A

eparate sheet if necessary)

MAY 31, 2019

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

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

LICENSURE EXAMINATION FOR TEACHERS

76.4 09/24/2017 MANILA 1596138
(LET)
N/A N/A N/A N/A
N/A
N/A N/A N/A N/A N/A

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

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

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

(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. POSITION TITLE
INCLUSIVE DATES (mm/dd/yyyy)
DEPARTMENT / AGENCY / OFFICE / COMPANY STATUS OF
(Write in full/Do not (Write in full/Do not abbreviate) APPOINTMENT
From To abbreviate)

1/6/2009 03/31/2019 TEACHER BLESSINGS IN THE WORD FELLOWSHIP SCHOOL INC. CONTRACTUAL

1/5/2003 10/30/2003 QUALITY CONTROLLER UNIVERSAL ROBINA CORPORATION CONTRACTUAL

1/6/1998 11/30/1998 ADMINISTRATIVE CREW JOLLIBEE FOOD CORPORATION CONTRACTUAL

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

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

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

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

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

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

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

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 31,2019

CS FORM 212 (Revised 201

 LICENSE (if applicable)

Date of
Validity

05/27/2020

N/A

N/A

N/A
N/A

N/A

N/A

N/A

N/A

N/A

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

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N/A

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 N/A

N/A

N/A

arate sheet if necessary)

MAY 31,2019

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 / N
From To

SEVENTH- DAY ADVENTIST SALABAN AMADEO, CAVITE 1/1/2000 PRESENT N/A SABBATH SCHOO

BLESSINGS IN THE WORD FELLOWSHIP SCHOOL INC. 1/6/2009 03/31/2014 N/A TRACK AND

BLESSINGS IN THE WORD FELLOWSHIP SCHOOL INC. 1/6/2014 03/31/2019 N/A BASKETBALL

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

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

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

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

(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
CAPACITY OF BUILDING OF GRADE 7 PRIVATE SCHOOL TEACHERS ON K TO 12 BASIC BASIC ED
05/30/ 2012 1/6/2012 24 HOURS TECHNICAL
EDUCATION CURRICULUM ( BEC) REG
DIVISION OF CAPABILITY BUILDING ON THE IMPLEMENTATION OF K TO 12 BASIC EDUCATION Division of Ca
CURRICULUM FOR PRE- SCHOOL, GRADE 3 AND GRADE 9 TEACHERS FOR PRIVATE SCHOOLS 05/25/2014 05/28/2014 24 HOURS TECHNICAL
School Princip
INLET DIVISION CAPABILITY BUILDING ON THE IMPLEMENTATION OF K TO 12 BASIC EDUCATION Division of Ca
CURRICULUM FOR PRE- SCHOOL, GRADE 4 AND GRADE 10 TEACHERS FOR PRIVATE SCHOOLS
05/25/2015 05/29/2015 40 HOURS TECHNICAL
School Princip
Division of Ca
MTAP TRAINING FOR TEACHERS 07/22/2017 07/29/2017 16 HOURS TECHNICAL
School Princip

HOPE FOR KIDS EVANGELISM EXPLOSION TRAINING 05/ 29/2017 05/31/2017 24 HOURS TECHNICAL
EVANGEL
DEPED- PEAC 2018 SUMMER- IN- SERVICE TRAINING (INSET) FOR JUNIOR HIGH
05/21/2018 05/23/2018 24 HOURS TECHNICAL
SCHOOLTEACHERS IN PRIVATE SCHOOLS PRIVATE EDUC
PEAC-CEAP IN- SERVICE TRAINING FOR PRIVATE ELEMENTARY SCHOOL TEACHERS,
REVITALIZING TRACHING AND LEARNING FOR HIGHLY EFFECTIVE K TO 6 CLASSROOMS 5/5/2018 7/5/2018 24 HOURS TECHNICAL
(RETEACH) PRIVATE EDUC

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

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

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

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

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE TRACK AND FIELD COACH ( 2009-2014)

ORAL AND WRITTEN ENGLISH SKILLS BASKETBALL GIRLS COACH ( 2014-2019)

CERTIFICTE OF APPRECIATION FOR BEING EGULAR AND PNCTUAL IN ATTENDANCE, IN THE

INTERPERSONAL SOCIABILTY SKILLS SUBMISSION OF LESSON PLAN AND TEST DRAFTS AND IN OTHER DUTY ASSIGNMENT (2012)
 CERTICATE OF APPRECIATION FOR BEING A GUEST SPEAKER DURING THE RECOGNITION DAY ON
ADAPTABILITY APRIL 3, 2017 AT SALABAN ELEMENTARY SCHOOL

FAST LEARNING SKILLS SEVENTH DAY ADVENTIST ( SABBATH SCHOOL Superintendent ) (2000- Present)

N/A N/A

N/A N/A

N/A N/A

N/A N/A

N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS F
T / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

SABBATH SCHOOL SUPERINTENDENT

TRACK AND FIELD COACH

BASKETBALL GIRLS COACH

N/A

N/A

N/A

N/A
eparate sheet if necessary)
PROGRAMS ATTENDED
ast five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

BASIC EDUCATION CURRICULUM DEPED

REGION IV-A (CALABARZON)
Division of Cavite Province Association of Private
School Principals and Administrators (DCPAPSPA)
Division of Cavite Province Association of Private
School Principals and Administrators (DCPAPSPA)
Division of Cavite Province Association of Private
School Principals and Administrators (DCPAPSPA)

EVANGELISM EXPLOSION PHILIPPINES

PRIVATE EDUCATION ASSISTANCE COMMITTEE (PEAC)

PRIVATE EDUCATION ASSISTANCE COMMITTEE (PEAC)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

N/A

N/A

N/A
 N/A

N/A

N/A

N/A

N/A

N/A

N/A
eparate sheet if necessary)

MAY 31, 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:

________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO

If YES, give details:

________________________________
N/A
________________________________
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:
________________________________
N/A
________________________________
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: N/A
YES ✘ 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? If YES, give details: N/A

39. Have you acquired the status of an immigrant or permanent resident of another country? YES ✘ NO

If YES, give details (country):

N/A

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 wi

the last 6 month
3.5 cm. X 4.5 cm
MR. ARVIN B. BELARDO POBLACION 1 AMADEO, CAVITE 0917-868-2212 (passport size)

With full and handw

HON. DONN CLARENCE BAYOT POBLACION 4 AMADEO, CAVITE 0917-523-0718 name tag and signatu
printed name
HON. SUSAN A. COSING SALABAN AMADEO, CAVITE 0917-550-6555 Computer genera
or photocopied pic
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not acceptabl
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.: 1596138

Signature (Sign inside the box)
05-31-2019
Date/Place of Issuance: 2017/ MANILA
Date Accomplished Right Thumbma

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated a
Person Administering Oath

CS FORM 212 (Revised 2

 If YES, give details:
________________________________
N/A

If YES, give details:

________________________________
N/A
________________________________

If YES, give details:

________________________________
N/A
________________________________
N/A

If YES, give details:

________________________________
N/A
________________________________

If YES, give details:

________________________________
FINISH CONTRACT
________________________________
✘ NO

N/A
✘ NO

N/A

✘ NO

If YES, give details (country):

N/A

✘ NO
N/A
✘ NO

N/A
✘ NO
N/A

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