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 OLEA
NAME EXTENSION (JR., SR)
FIRST NAME MARY ANN
MIDDLE NAME GUIBAO
3. DATE OF BIRTH
(mm/dd/yyyy) 1/22/1993 16. CITIZENSHIP

4. PLACE OF BIRTH LAWAAN E. SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLOCK 9 LOT 7 PHASE 2
House/Block/Lot No. Street
HORNO HOAI SAN ROQUE
Subdivision/Village Barangay
7. HEIGHT (m) 1.52 ANTIPOLO CITY RIZAL
City/Municipality Province
8. WEIGHT (kg) 60 kg ZIP CODE 1870
9. BLOOD TYPE O
18. PERMANENT ADDRESS BLOCK 9 LOT 7 PHASE 2
House/Block/Lot No. Street

10. GSIS ID NO. 2004491469 HORNO HOAI SAN ROQUE

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211 4935 5884 ANTIPOLO CITY RIZAL

City/Municipality Province

12. PHILHEALTH NO. 0300-0270-1959 ZIP CODE 1870

13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 455-771-965 20. MOBILE NO. 09566680342
15. AGENCY EMPLOYEE NO. 4732908 21. E-MAIL ADDRESS (if any) maryann.olea001@deped,gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME OLEA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) RHYZO MAVERICK G. OLEA
FIRST NAME RYGEL 04/14/2016

MIDDLE NAME PAGADORA

OCCUPATION MECHANIC

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME GUIBAO

NAME EXTENSION (JR., SR)
FIRST NAME OSCAR
MIDDLE NAME CLAMANA
25. MOTHER'S MAIDEN NAME

SURNAME SAMSON
FIRST NAME JOVITA
MIDDLE NAME ALBUTRA (Continue on separate sheet if necessary)

NAME OF SCHOOL HIGHEST LEVEL/

26. PERIOD OF ATTENDANCE YEAR SCHOLARSHIP/
BASIC EDUCATION/DEGREE/COURSE UNITS
LEVEL (Write in EARNED
GRADUATED ACADEMIC HONORS
(Write in full) RECEIVED
full) (if not graduated)
From To

ELEMENTARY GIPORLOS CENTRAL SCHOOL ELEMENTARY 1999 2005 PRIMARY 2005 N/A

SALCEDO VOCATIONAL HIGH

SECONDARY
VOCATIONAL / SECONDARY 2005 2009 SECONDARY 2009 N/A
SCHOOL

N/A
TRADE
COURSE
COLLEGE LEYTE NORMAL UNIVERSITY COLLEGE 2009 2013 GRADUATED 2013 N/A

MASTER IN
GRADUATE STUDIES UNIVERSIDAD DE DAGUPAN EDUCATION/EDUCATIONAL 2021 2022 42 N/A N/A
LEADERSHIPP
(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 13, 2023

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

LICENSURE EXAMINATION FOR TEACHER 75 9/29/2013 MANILA 1256323

(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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
DEPARTMENT OF EDUCATION ANTIPOLO REGULAR/
2/6/2014 PRESENT TEACHER I 25,852.14 11-2 PERMANENT
Y
NATIONAL HIGH SCHOOL

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 13, 2023

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

(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

ANHS MID-YEAR INSERVICE TRAINING FOR TEACHERS 6/2/2023 10/2/2023 40 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL

MENTAL HEALTH AND PSYCHOSOCIAL SUPPORT CAPACITY BUILDING TRAINING 08/18/2022 08/18/2022 2 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL

E-RAISE UP 09/19/2021 9/22/2021 32 TECHNICAL DEPED CALABARZON REGION IV-A

GAD CAPACITY BUILDING TRAINING 5/11/2021 5/11/2021 2 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL

INSERVICE TRAING FOR TEACHER (GABAY TIWALA AT PAGKAKAISA) 3/15/2021 3/15/2021 2 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL

DIVISION ONLINE REFRESHER COURSE ON COACHING AND ACCREDITATION OF

3/15/2021 3/17/2021 12 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL
SELECTED EVENTS DURING COVID 19 PANDEMIC
RECLAIMING THE ZEST AND JOY IN TEACHING: TEACHER FOR HOPE TEACHER FOR
12/14/2020 12/17/2020 13 TECHNICAL ANTIPOLO NATIONAL HIGH SCHOOL
CHANGE
CAPABILITY FOR TEACHERS AND SCHOOL LEADERS FOCUSED ON THE DEVELOPMENT
7/7/2020 9/7/2020 12 TECHNICAL DEPED CALABARZON REGION IV-A
AND UTILIZATION OF IDEA EXAMPLAR

(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)

DANCE

MUSIC

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 13, 2023

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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
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
Barangay election)?
If YES, give details:
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:
39. Have you acquired the status of an immigrant or permanent resident of another country?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
RUFINA DULFO ANTIPOLO CITY 9322630173 3.5 cm. X 4.5 cm
(passport size)
ANTIPOLO CITY
MARICAR BUCAYU 9972287004 With full and handwritten
name tag and signature over
printed name
ANAJANE ABREO TERESA, RIZAL 9358366839
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.: 1256323 Signature (Sign inside the box)
MARCH 13, 2023
Date/Place of Issuance: AUGUST 2023/QUEZON 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