CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s aga
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 SATUR
NAME EXTENSION (JR., SR
FIRST NAME MARISSA

MIDDLE NAME PANGAN

3. DATE OF BIRTH
(mm/dd/yyyy) 7/20/1973 16. CITIZENSHIP Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH La Paz, Tarlac If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 32 MILAGROSA STREET

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
BAGONG BARRIO
Other/s:
Subdivision/Village Ba
CALOOCAN CITY
7. HEIGHT (m) 1.64
City/Municipality Pr
8. WEIGHT (kg) 62kg. ZIP CODE 1400

18. PERMANENT ADDRESS 32 Milagrosa St.

9. BLOOD TYPE B
House/Block/Lot No. S
BAGONG BARRIO
10. GSIS ID NO. 73072000959
Subdivision/Village Ba
CALOOCAN CITY
11. PAG-IBIG ID NO. 1060-0203-7489
City/Municipality Pr

12. PHILHEALTH NO. 01-000208034-1 ZIP CODE 1400 T

13. SSS NO. 33-2184537-8 19. TELEPHONE NO. 281-99-10

14. TIN NO. 186-590-153 20. MOBILE NO. 09091433610

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
4173664 21. E-MAIL ADDRESS (if any) marissapangansatur@yahoo.co
SATUR 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) DANTE P. SATUR JR.
DANTE SR.

MIDDLE NAME RABILAS DANEMARK P. SATUR

OCCUPATION OFW, DOHA QATAR DANISH P. SATUR

EMPLOYER/BUSINESS NAME ALIJARAH TRANSPORT

BUSINESS ADDRESS DOHA QATAR

TELEPHONE NO.

24. FATHER'S SURNAME PANGAN

SR.
FIRST NAME ALBERTO

MIDDLE NAME MACABANTI

25. MOTHER'S MAIDEN NAME

SURNAME DUPITAS

FIRST NAME AIDA

MIDDLE NAME VEGA (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 COMILLAS ELEMENTARY SCHOOL ELEMENTARY 1980 1986

SECONDARY COMILLAS NATIONAL HIGH SCHOOL SECONDARY 1986 1990

VOCATIONAL /

TRADE
COURSE
COLLEGE CENTRAL LUZON STATE UNIVERSITY BACHELOR OF ELEMENTARY EDUCATION 1991 1995

2010 2014
GRADUATE STUDIES GOVERNOR ANDRES PASCUAL COLLEGE 42 units Summer Summer
(Continue on separate sheet if necessary)

SIGNATURE DATE April

CS FORM
L DATA SHEET
rience 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:

Street
150
Barangay

Province
1400

Street
150
Barangay

Province

Tarlac

281-99-10

09091433610

marissapangansatur@yahoo.com.ph

DATE OF BIRTH (mm/dd/yyyy)

6/20/1996

NOV. 21, 2001

SEPT. 02, 2006

Feb. 15,1949

5/4/1952

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC HONORS
GRADUATED
RECEIVED

1986 Third Honor

1990
 1995

2014
parate sheet if necessary)

April 11, 2017

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 76% 8/22/1997 TARLAC CITY 0268937

(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

Grade 13 Step
1/19/2015 Present Teacher III Bagong Barrio Elementary School 25257.00
1
Permanent
Grade 12 Step
9/11/2013 Novemebr,2015 Teacher II Bagong Barrio Elementary School 21940.00
1
Permanent
Grade 10 Step
1/6/2003 November,2012 Teacher I Bagong Barrio Elementary School 17318.00
3
Permanent

6/14/2002 12/20/2002 Substitute Morning Breeze Elementary School 10495.00 substitute

7/13/2001 12/21/2001 LSB Libis Baesa Elementary School 9500.00 Contractual

7/13/2000 12/21/2000 LSB Camarin D Elementary School 9500.00 Contractual

 (Continue on separate sheet if necessary)

SIGNATURE DATE April 11, 2017

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

7/20/2018

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Yes

Yes

Yes

Yes

Yes

Yes
arate sheet if necessary)

April 11, 2017

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

Cornerstone School Moderator March, 2015 M

Kariton Klasrum Aug. 19, 2015 M

Rotary Club of Grace Park RI District 3800 Oct. 24, 2012 M

(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
Division Caravan of Best Practices in Edukasyon sa Pagpapakatao Demonstration Teaching
Jan. 31, 2017 Bagong Barrio
Participants

Early Enrollment and Registration Jan. 30, 2017 Bagong Barrio

SDO Caloocan Training on the manual Accomplishment of the National School Building (NSBI)
Jan. 24, 2017 Division Confe
forms and School Site Development Plan

In-SERVICE TRAINING FOR TEACHER Oct. 26, 2016 Oct. 30, 2016 40 Training Bagong Barrio

Philippine Government ElectronicProcurement System (PhilGEPS) Training Aug. 9, 2016 Aug. 10, 2016 16 Training AM ZONE Inte

MTAP -DepEd NCR- Seminar Workshop in Mathematics with the Theme: "Making K-12 San Francisco
Sept. 19, 2015 Sept. 20, 2015 16 Training
Succeed" Quezon City
Division Mass Training of Grade III Teachers on the Implementation of the k to 12 Basic
May 13,2014 5/17/2014 50 Training Teacher's Cam
Education Program

Division Enhancement Program for Mathematics Teachers June 23,30,2012 July 7,14,21,2012 40 Training Caloocan Elem

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Teaching, Computer Literate Special Basic Citizen Military Training Class 01-2016 A
 (Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

Moderator

Member

Member

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

Bagong Barrio Elementary School

Bagong Barrio Elementary School

Division Conference Hall, Caloocan City

Bagong Barrio Elementary School

AM ZONE Internet Caf, Pasig City

San Francisco High School, Misamis St.Bantay,

Quezon City

Teacher's Camp, Baguio City

Caloocan Elementary School-Central, Caloocan City

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

Army Reserve Command

eparate sheet if necessary)

April 11, 2017

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
Salome D. Salasac, Ed.D. Bagong Barrio E/S-Principal 9213821024 3.5 cm. X 4.5 cm
(passport size)

Elaine B. Del Rosario Bagong Barrio E/S- Teacher 9985582886 With full and handwritten
name tag and signature over
printed name
Ranie O. Nidoy Bagong Barrio E/S- Teacher 9774444947
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
MARISSA P. SATUR
ID/License/Passport No.: 0268937
Signature (Sign inside the box)
APRIL 11,2017
Date/Place of Issuance: 1/10/1998/Manila
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this April 11,2017 , 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