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 MARAON
NAME EXTENSION (JR., SR)
FIRST NAME MA.VICTORIA
MIDDLE NAME QUILITANO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/20/2985 ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH BASEY SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS
Widowe Separat House/Block/Lot No. Street
NEW SAN AGUSTIN
d ed
Other/s: Subdivision/Village Barangay
7. HEIGHT (m) 1.253 BASEY SAMAR
City/Municipality Province
8. WEIGHT (kg) 48 ZIP CODE 6720
18. PERMANENT ADDRESS
9. BLOOD TYPE O+
House/Block/Lot No. Street
10. GSIS ID NO. 2004637234 NEW SAN AGUSTIN
Subdivision/Village Barangay
BASEY SAMAR
11. PAG-IBIG ID NO. 9131-4505-1577
City/Municipality Province
12. PHILHEALTH NO. 13-050098115-7 ZIP CODE 6720
13. SSS NO. 06-2742212-6 19. TELEPHONE NO. NONE
14. TIN NO. 946-722-965 20. MOBILE NO. 09771617461 / 09460994765
15. AGENCY EMPLOYEE NO. 08-9631 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MARAON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME MARVIN NOT APPLICABLE HUGO QUILITANO MARAON 08/28/2013
MIDDLE NAME SAMACO
OCCUPATION GOVERNMENT EMPLOYEE
EMPLOYER/BUSINESS NAME DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
BUSINESS ADDRESS MAGSAYSAY BLVD., TACLOBAN CITY
TELEPHONE NO. NONE
24. FATHER'S SURNAME QUILITANO
NAME EXTENSION (JR., SR)
FIRST NAME VICTORINO NOT APPLICABLE
MIDDLE NAME TABUGUCA
25. MOTHER'S MAIDEN NAME
SURNAME CAJARA
FIRST NAME COLUMBA
MIDDLE NAME VIOJAN (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To
ELEMENTARY BASEY II CENTRAL ELEM.SCHOOL ELEMENTARY 1992 1998 1998 NONE
SECONDARY /
VOCATIONAL BASEY NATIONAL HIGH SCHOOL HIGH SCHOOL 1998 2002 2002 NONE
NONE
TRADE
COURSE LEYTE NORMAL UNIVERSITY BACHELOR OF SCIENCE IN SOCIAL WORK 2002 2006 2006 NONE
COLLEGE
LEYTE COLLEGES SUPPLEMENTAL 2017 2018 2018 NONE
GRADUATE STUDIES NONE
(Continue on separate sheet if necessary)
SIGNATURE DATE 11/02/2021
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 applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
RA 1080 (LICENSURE EXAMINATION FOR SOCIAL LEYTE NATIONAL HIGH SCHOOL, TACLOBAN
73.8 8/21-23/2020 0033243 12/20/2022
WORKERS) CITY
RA 1080 (LICENSURE EXAMINATION FOR SAN FERNANDO ELEMENTERY
79.6 3/25/2018 1652652 12/20/2021
TEACHERS) SCHOOL,TACLOBAN 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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)
DEPARMENT OF SOCIAL WELFARE AND
6/2/2014 PRESENT PROJECT DEVELOPMENT OFFICER II P33,575 15 CONTRACTUAL Y
DEVELOPMENT
DEPARMENT OF SOCIAL WELFARE AND CONTRACT OF
6/3/2013 6/1/2014 PROJECT DEVELOPMENT OFFICER II P27,565 15 N
DEVELOPMENT SERVICE
11/29/2009 01/31/2013 REMEDIAL MANAGEMENT ASSISTANT TAYTAY SA KAUSWAGAN INCORPORATED P9,200 N/A REGULAR N
10/01/2007 11/29/2009 PROGRAM ASSISTANT TAYTAY SA KAUSWAGAN INCORPORATED P7,800 N/A REGULAR N
08/01/2007 09/01/2007 ENUMERATOR NATIONAL STATISTICS OFFICE P10,000.00 6 CONTRACTUAL Y
(Continue on separate sheet if necessary)
SIGNATURE DATE 11/02/2021
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
NONE N/A
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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
TRAINING ON KILOS-UNLAD CASE MANAGEMENT TECHNICAL WRITING AND SUCCESS STORY
08/18/2021 8/20/2021 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
DOCUMENTATION
ROLL-OUT TRAINING ON PARENTING MODULE 07/28/2021 07/30/2021 24 TECHNICAL SAVE THE CHILDREN PHILIPPINES
TRAINING ON REPUBLIC ACT 11310 AN ACT INSTITUTIONALIZING THE PANTAWID PAMILYANG
09/16/2020 09/18/2020 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
PILIPINO PROGRAM AND ITS IMPLEMENTING RULES AND REGULATIONS
TRAINING /ORIENTATION ON THE USE OF SOCIAL WELFARE AND DEVELOPMENT INDICATOR TOOL
12/06/2019 12/07/2019 16 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
FOR CITY/MUNICIPAL LINKS
ROLL-OUT TRAINING ON CAMP COORDINATION AND CAMP MANAGEMENT 10/28/2019 10/31/2019 32 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
TRAINING ON HOME-BASED MENTORING ON EARLY LITERACY AND NUMERACY 06/25/2018 06/27/2018 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
ROLL-OUT TRAINING ON CASELOAD MANAGEMENT AND ELECTRONIC-CASE MANAGEMENT AND
02/12/2018 02/15/2018 32 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
PRIORITY INTEGRATION OF CONVERGENCE APPROACH AND COMMUNITY ORGANIZING
ROLL-OUT TRAINING ON FOOD AND NUTRITION MODULE (HUNGER MITIGATION) 05/25/2017 05/27/2017 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
ROLL-OUT TRAINING FOR PANTAWID PAMILYA IMPLEMENTERS ON THE USE OF EARLY CHILDHOOD
04/17/2017 04/21/2017 40 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
CARE AND DEVELOPMENT MODULE
SKILLS TRAINING ON DOCUMENTATION OF SUCCESS STORIES AND GOOD PRACTICES 01/23/2017 01/25/2017 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
YOUTH DEVELOPMENT SESSION, LIFE SKILLS TRAINING 08/24/2016 08/26/2016 24 TECHNICAL WORLD VISION PHILIPPINES
ROLL-OUT TRAINING ON YOUTH DEVELOPMENT SESSION TO CITY/MUNICIPAL LINKS 04/06/2016 04/08/2016 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
SKILLS ENHANCEMENT TRAINING ON SOCIAL CASE MANAGEMENT AND INTERVENTION PLANNING 03/07/2017 03/09/2016 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
TRAINING ON DISASTER RISK REDUCTION AND MANAGEMENT 08/10/2015 08/12/2015 24 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
WORKSHOP ON FORMULATION OF INTERVENTION PLAN FOR PANTAWID PAMILYA HOUSEHOLDS 02/24/2015 02/25/2015 16 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
ROLL-OUT TRAINING ON THE USE OF THE SOCIAL WELFARE DEVELOPMENT INDICATOR TOOL 11/19/2014 11/20/2014 16 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
GENDER SENSITIVITY TRAINING 09/17/2014 09/17/2014 8 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
TRAINING -ORIENTATION FOR PANTAWID PAMILYA CITY/MUNICIPAL LINKS 06/16/2014 06/22/2014 56 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
PSYCHOSOCIAL AND FIRST AID TRAINING 06/02/2014 06/06/2014 40 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
TRAINING ON CASE MANAGEMENT AND THE USE OF SOCIAL WELFARE INDICATOR TOOL ON SET 6
06/24/2013 06/28/2013 40 TECHNICAL DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT
AREAS
(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)
BEST PROGRAM ASSISSTANT-(TAYTAY SA KAUSWAGAN INCORPORATED,GUIUAN SOCIAL WELFARE EMPLOYEES
COMPUTER LITERATE
BRANCH-2008) ASSOCIATION OF THE PHILIPPINES
(Continue on separate sheet if necessary)
SIGNATURE DATE 11/02/2021
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
by any court or tribunal?
YES ✘ NO
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? ________________________________
Resignation, to seek for a better opportunity
________________________________
where i can contribute my skills
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
BRGY. ROXAS, BASEY, WESTERN the last 6 months
RASSENDYL E. LLENADO SAMAR
09123827475 4.5 cm. X 3.5 cm
(passport size)
BRGY.BUSCADA, BASEY WESTERN
RIZA V. TAGANNA SAMAR
09551101032
Computer generated
or photocopied picture
MA CHRISTINE J. MALATE BRGY. TIGBAO, TACLOBAN CITY 09165429623 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.: 0033243 Signature (Sign inside the box)
11/02/2021
Date/Place of Issuance: 12/20/2022/ TACLOBAN CITY
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.
CLARITO T. LOGRONIO
SAO/ OIC DC, HRMDD
Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of 4
