CS FORM 212 (Revised 2005)
Unique Applicant Number
PERSONAL DATA SHEET T15186386
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 ACOPIADO
FIRST NAME RUTH
MIDDLE NAME MANLANGIT 3. NAME EXTENSION (e.g. Jr., Sr.)
16. RESIDENTIAL ADDRESS 278 Poblacion, MANUKAN, ZAMBOANGA DEL NORTE
4. DATE OF BIRTH (mm/dd/yyyy) 04 / 16 / 1993
5. PLACE OF BIRTH Iligan City, Lanao del Norte
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 7110
Married Separated
17. TELEPHONE NO. N/A
Annuled Others, specify
_________ 18. PERMANENT ADDRESS 278 Poblacion, MANUKAN, ZAMBOANGA DEL NORTE
8. CITIZENDSHIP Filipino
9. HEIGHT (m) 5"2
10. WEIGHT (kg) 50 ZIP CODE 7110
11. BLOOD TYPE O+ 19. TELEPHONE NO. N/A
12. GSIS ID NO. 20. EMAIL ADDRESS (if any) ruthacopiado@[Link]
13. PAGIBIG ID NO. 121229998669 21. CELLPHONE NO. (if any) 09207277837
14. PHILHEALTH NO. 400060003707 22. AGENCY EMPLOYEE NO. TCH1-573321-2018
15. SSS NO. 1012501224 23. TIN 722985462
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME Acopiado 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME Roland Landy Love Manlangit Acopiado 03 / 24 / 2013
MIDDLE NAME Suico Andy Lance Manlangit Acopiado 04 / 26 / 2014
OCCUPATION Electrician Lovely Bliss Manlangit Acopiado 11 / 07 / 2019
EMPLOYER/BUS. NAME ZANECO
BUSINESS ADDRESS Dipolog City, Zamboanga del Norte
TELEPHONE NO.
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME Manlangit
FIRST NAME Arturo
MIDDLE NAME Recososa
27. MOTHER'S MAIDEN NAME
MOTHER'S SURNAME Jumangpang
FIRST NAME Cresencia
MIDDLE NAME Culanculan
III. EDUCATIONAL BACKGROUND
HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE SCHOLARSHIP/
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS
GRADUATED ACADEMIC HONORS
(Write in full) (Write in full) EARNED
(if graduated) RECEIVED
(if not
graduated) From To
Manukan West Central 1999-06- 2005-04-
ELEMENTARY 2005 4th Honors
School 07 22
Saint Estanislao Kostka 2005-06- 2009-03-
SECONDARY 2009 4th Honor
College 06 22
VOCATIONAL/ TRADE
COURSE
Bachelor of Science in
Saint Estanislao Kostka
COLLEGE Business 2014 2009-06 2014-03
College
Administration
Saint Estanislao Kostka Bachelor of 2015-06- 2016-03-
2016
College Elementary Education 15 26
ACOPIADO, RUTH MANLANGIT - T15186386 CS FORM 212 (Revised 2005), Page 1 of 3
III. EDUCATIONAL BACKGROUND
HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE SCHOLARSHIP/
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS
GRADUATED ACADEMIC HONORS
(Write in full) (Write in full) EARNED
(if graduated) RECEIVED
(if not
graduated) From To
GRADUATE STUDIES Saint Vincent's College MAED 9
IV. CIVIL SERVICE ELIGIBILITY
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
TEACHERS EXAM 81.20 09 / 25 / 2016 Pagadian City, Zamboanga del Sur 1483850 12/09/2016
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 APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")
Saint Estanislao Kostka College,
06/05/2017 03/31/2018 Senior High School Teacher 8,234 0-1 Contractual No
Inc.
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
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
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To
National Seminar- Workshop on Promoting Substantive Pedagogy through
01 / 23 / 2019 01 / 24 / 2019 16
Action Research
Two- Day Values Formation and Spiritual Enrichment Seminar 08 / 06 / 2018 08 / 07 / 2018 16
DIWA LEARNING SYSTEMS
DIWA Innovators Congress 11 / 25 / 2017 11 / 25 / 2017 8
INC.
1-Day Seminar-Workshop on the Supervision of the School and Industry-
09 / 14 / 2017 09 / 14 / 2017 8 DepEd
Based Immersion
National Certificate II in Cookery 03 / 25 / 2017 07 / 17 / 2017 Saint Vincent's College
Responding To The 21st Century Educational Trends 10 / 03 / 2015 10 / 04 / 2015 16 Ateneo de Zamboanga University
Experiential Learning Courses (Field Study and Practice Teaching) 06 / 22 / 2015 03 / 03 / 2016 Saint Estanislao Kostka College
Leadership Training Seminar 10 / 09 / 2012 10 / 09 / 2012 8 College Student Council
VIII. OTHER INFORMATION
33. 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: 35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION
SPECIAL SKILLS / HOBBIES:
(Write in full) (Write in full)
Educational Technology Skill Outstanding Demonstrator in the Final Demonstration Teaching
People Skill Emcee in the Buwan ng Wika 2017
Problem Solving Skill Senior High School Sports Coordinator
ACOPIADO, RUTH MANLANGIT - T15186386 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? _____________________________________
_____________________________________
_____________________________________
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:
_____________________________________
_____________________________________
_____________________________________
37. a. Have you ever been formally charged? YES NO
If YES, give details:
_____________________________________
_____________________________________
b. Have you ever been guilty of any administrative offense? YES NO
If YES, give details:
_____________________________________
_____________________________________
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:
_____________________________________
_____________________________________
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:
_____________________________________
_____________________________________
40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________
_____________________________________
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:KALIBUGAN
b. Are you differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME ADDRESS TEL. NO.
Joviner Yabres Lactam Poblacion, Manukan, Zamboanga del 09171473531
Norte
Linda Byrd Gomez Segundo Sindangan, Zamboanga del Norte 09998821775
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. 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
03778484
COMMUNITY TAX CERTIFICATE NO.
Poblacion, Manukan, Zamboanga del Norte
ISSUED AT SIGNATURE (Sign inside the box)
2018-01-15 01 / 17 / 2018
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
ACOPIADO, RUTH MANLANGIT - T15186386 CS FORM 212 (Revised 2005), Page 3 of 3