CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)
I. PERSONAL INFORMATION
2. SURNAME MAGPIONG
FIRST NAME MYRA
MIDDLE NAME MACASARTE 3. NAME EXTENSION (e.g. Jr., Sr.)
16. RESIDENTIAL ADDRESS
4. DATE OF BIRTH (mm/dd/yyyy) 10 / 31 / 1997 LARENA, SIQUIJOR
5. PLACE OF BIRTH Helen, Larena, Siquijor
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 6226
Married Separated
17. TELEPHONE NO. N/A
Annuled Others, specify
_________ 18. PERMANENT ADDRESS LARENA, SIQUIJOR
8. CITIZENDSHIP Filipino
9. HEIGHT (m) 157
10. WEIGHT (kg) 54 ZIP CODE 6226
11. BLOOD TYPE O+ 19. TELEPHONE NO. N/A
12. GSIS ID NO. N/A 20. EMAIL ADDRESS (if any) myra9267magpiong@[Link]
13. PAGIBIG ID NO. N/A 21. CELLPHONE NO. (if any) 09661868211
14. PHILHEALTH NO. N/A 22. AGENCY EMPLOYEE NO. N/A
15. SSS NO. N/A 23. TIN 076102016-11
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME N/A 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME N/A N/A
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUS. NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME Magpiong
FIRST NAME Alex
MIDDLE NAME Homdos
27. MOTHER'S MAIDEN NAME
MOTHER'S SURNAME Macasarte
FIRST NAME Vilma
MIDDLE NAME Maghanoy
III. EDUCATIONAL BACKGROUND
HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS ATTENDANCE SCHOLARSHIP/ ACADEMIC
GRADUATED
(Write in full) (Write in full) (if graduated) EARNED HONORS RECEIVED
(if not
graduated) From To
Larena Central Elementary
ELEMENTARY 2010 2004 2010 N/A
School
Enrique Villanueva National
SECONDARY 2014 2010 2014 First Honorable Mention
High School
VOCATIONAL/ TRADE
N/A N/A N/A N/A N/A N/A
COURSE
Bachelor of Tulong Dunong PASUC/
COLLEGE Siquijor State College 2018 2014 2018
Secondary Education Magna Cum Laude
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
IV. CIVIL SERVICE ELIGIBILITY
MAGPIONG, MYRA MACASARTE CS FORM 212 (Revised 2005), Page 1 of 3
29.
CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF LICENSE (if applicable)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
LET (LICENSURE EXAMINATION FOR
82% 09 / 30 / 2018 UCLM Mandaue City, Cebu
TEACHER)
V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY INCREMENT APPOINTMENT (Yes / No)
From To
(Format "00-0")
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF POSITION / NATURE OF WORK
(Write in full) HOURS
From To
N/A
VII. TRAINING PROGRAMS (Start from the most recent training.)
32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To
Philippine League of Secretaries
Youth Legislative and Leadership Seminars(YOLLS) 11 / 03 / 2018 11 / 05 / 2018 36hrs
to the Sanggunian, Inc.
The Department of the Interior
Barangay Newly-Elected Officials(BNEO) 2018 Program 08 / 08 / 2018 08 / 10 / 2018 36hrs
and Local Government(DILG)
SK Mandatory Training 05 / 24 / 2018 05 / 24 / 2018 8hrs University of San Jose Recoletos
Seminar-Workshop on Action Research 03 / 23 / 2018 03 / 23 / 2018 4hrs Siquijor State College
Seminar on Child Protection Policy and Criteria for Screening and Ranking
03 / 23 / 2018 03 / 23 / 2018 4hrs Siquijor State College
of Teacher Applicants
Learning Action Cell Seminar 03 / 22 / 2018 03 / 22 / 2018 4 hrs Siquijor State College
Guidelines in the Deployment of Pre Service Teachers to Elementary and
Secondary Laboratory School Principals, Head Teachers and Teachers-In- 01 / 18 / 2018 01 / 18 / 2018 4hrs DepEd Siquijor Division
Charge, Cooperating Teachers and Head of Teacher Education Institutions
Civic Welfare Training Service 2014 2015 90hrs Siquijor State College
VIII. OTHER INFORMATION
33. 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: 35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION
SPECIAL SKILLS / HOBBIES:
(Write in full) (Write in full)
Dancing N/A Siquijor State College Alumni Association Inc.
MAGPIONG, MYRA MACASARTE CS FORM 212 (Revised 2005), Page 2 of 3
36. Are you related by consanguinity or affinity to any of the following :
a. Within the third degree (for National Government Employees):
YES NO
appointing authority, recommending authority, chief of office/bureau/department or person who
has immediate supervision over you in the Office, Bureau or Department where you will be If YES, give details:
appointed? N/A
b. Within the fourth degree (for Local Government Employees): YES NO
appointing authority or recommending authority where you will be appointed?
If YES, give details:
I have an uncle who is teaching in the province.
37. a. Have you ever been formally charged? YES NO
If YES, give details:
N/A
b. Have you ever been guilty of any administrative offense? YES NO
If YES, give details:
N/A
38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
N/A
39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
N/A
40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
N/A
41. 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:N/A
b. Are you differently abled? YES NO
If YES, please specify:N/A
c. Are you a solo parent? YES NO
If YES, please specify:N/A
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME ADDRESS TEL. NO.
Ms. Alje Marie B. Mirasol Cabulihan, Larena, Siquijor N/A
Mrs. Rhea Glenn Solitana Luyang, Siquijor, Siquijor N/A
Mrs. Gene T. Gica Lambojon, Siquijor, Siquijor
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines.
N/A
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust
that this information shall remain confidential. PHOTO
17092956
COMMUNITY TAX CERTIFICATE NO.
Larena, Siquijor
ISSUED AT SIGNATURE (Sign inside the box)
2019-01-25 01 / 25 / 2019
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
MAGPIONG, MYRA MACASARTE CS FORM 212 (Revised 2005), Page 3 of 3