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 CATIMBANG
FIRST NAME MYFE NAME EXTENSION (JR., SR) N/A
MIDDLE NAME FERNANDEZ
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 08/22/1975 ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS N/A PUROK 2

Widowed House/Block/Lot No. Street
Separated N/A CAMBANOGOY
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.52 m ASUNCION DAVAO DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 70 kg ZIP CODE 8102

9. BLOOD TYPE O+
18. PERMANENT ADDRESS N/A PUROK 2
House/Block/Lot No. Street
10. GSIS ID NO. 2005761026 N/A CAMBANOGOY
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121024523300 ASUNCION DAVAO DEL NORTE

City/Municipality Province

12. PHILHEALTH NO. 020257200 ZIP CODE 8102

13. SSS NO. 3328680219 19. TELEPHONE NO. N/A

14. TIN NO. 188189962 20. MOBILE NO. 09216172760

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) myfecatimbang@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CATIMBANG 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) JOSHUA ANDRIAN FERNANDEZ CATIMBANG

FIRST NAME JOSE N/A 02/21/2005

MIDDLE NAME MARCELLANA JEFFREY FERNANDEZ CATIMBANG 02/16/2007

OCCUPATION GOVERNMENT EMPLOYEE NOTHING FOLLOWS

EMPLOYER/BUSINESS NAME ASUNCION WATER DISTRICT

BUSINESS ADDRESS P-4 CAMBANOGOY ASUNCION

TELEPHONE NO. 09055252335

24. FATHER'S SURNAME FERNANDEZ

NAME EXTENSION (JR., SR) N/A
FIRST NAME MIGUEL

MIDDLE NAME ASCANO

25. MOTHER'S MAIDEN NAME LICERA
SURNAME FERNANDEZ

FIRST NAME FIDELA

MIDDLE NAME JADRAQUE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

CAMBANOGOY CENTRAL ELEMENTARY

ELEMENTARY PRIMARY 1982 1988 1988 WITH HONOR
ELEMENTARY SCHOOL GRADUATE

MARYKNOLL HIGH SCHOOL OF HIGH SCHOOL

SECONDARY SECONDARY 1988 1992 1992 WITH HONOR
ASUNCION GRADUATE
VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE
COLLEGE
COLLEGE FABIE SCHOOL OF MIDWIFERY MIDWIFERY 1992 1994 1994 N/A
GRADUATE
ARRIESGADO COLLEGE FOUNDATION BACHELOR OF SCIENCE IN COLLEGE
COLLEGE 2006 2008 2009 N/A
INCORPORATION NURSING GRADUATE
ARRIESGADO COLLEGE FOUNDATION BACHELOR OF SCIENCE IN COLLEGE
GRADUATE STUDIES 2017 2019 2019 N/A
INCORPORATION MIDWIFERY GRADUATE
(Continue on separate sheet if necessary)

SIGNATURE DATE December 18 ,2023

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

NURSING LICENSURE EXAMINATION(RA 1080) 75.00% 07/04/2020 ATENEO DE DAVAO, DAVAO CITY 0930672 08/22/2027

UNIVERSITY OF MINDANAO, BOLTON, DAVAO

MIDWIFERY LICENSURE EXAM 84.35% 11/30/1994 0110085 08/22/2026
CITY

NOTHING FOLLOWS

(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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
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 HEALTH
PS
04/17/2023 Present NURSE II DAVAO CENTER FOR 39,672.00 16/1 PS Y
CONTRACTUAL
HEALTH DEVELOPMENT
DEPARTMENT OF HEALTH
PS
01/01/2023 04/16/2023 MIDWIFE II DAVAO CENTER FOR 27,000.00 11/1 PS Y
CONTRACTUAL
HEALTH DEVELOPMENT
DEPARTMENT OF HEALTH
PS
01/01/2022 12/31/2022 MIDWIFE II DAVAO CENTER FOR 25,439.00 11/1 PS Y
CONTRACTUAL
HEALTH DEVELOPMENT
DEPARTMENT OF HEALTH
PS
01/01/2021 12/31/2021 MIDWIFE II DAVAO CENTER FOR 23,877.00 11/1 PS Y
CONTRACTUAL
HEALTH DEVELOPMENT
DEPARTMENT OF HEALTH
PS
02/15/2020 12/31/2020 MIDWIFE II DAVAO CENTER FOR HEALTH 20,754.00 11/1 PS Y
CONTRACTUAL
DEVELOPMENT
DEPARTMENT OF HEALTH
CONTRACT OF
08/19/2019 12/31/2019 PUBLIC HEALTH ASSOCIATE DAVAO CENTER FOR HEALTH 32,057.55 15/1 PS N
SERVICE
DEVELOPMENT

NOTHING FOLLOWS

SIGNATURE DATE December 18 ,2023

CS FORM 212 (Revised 2017), Page 2 of 3
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 N/A N/A N/A 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

DEPARTMENT OF INFORMATION
VACCINE INFORMATION MANAGEMENT SYSTEM 09/01/2022 09/01/2022 2 HRS TECHNICAL
TECHNOLOGY

ORIENTATION OF THE UNIVERSAL HEALTH CARE LAW 02/16/2022 02/16/2022 2 HRS TECHNICAL DEPARTMENT OF HEALTH REGION XI

UHC STAKE HOLDERS ANALYSIS AND FACILITY MAPPING 09/24/2019 09/27/2019 18 UNITS TECHNICAL DEPARTMENT OF HEALTH REGION XI

SYSTEMS REFORMS THROUGH MATERNAL DEATH SURVEILLANCE AND

RESPONSE BUILDING THE REGIONAL, PROVINCIAL AND CITY REVIEW TEAM 10/29/2018 10/31/2018 18 UNITS TECHNICAL DEPARTMENT OF HEALTH REGION XI
CAPACITY

MATERNAL NEONATAL INFANT DEATH REPORTING SYSTEM 05/12/2018 05/11/2019 6UNITS TECHNICAL DEPARTMENT OF HEALTH REGION XI

NOTHING FOLLOWS

(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 full)
(Write in full)

COMPUTER LITERATE N/A N/A

READING

DRIVING

NOTHING FOLLOWS

(Continue on separate sheet if necessary)

SIGNATURE DATE December 18 ,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? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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
LGU SAN ISIDRO-MUNICIPAL HEALTH the last 6 months
MERCY ASUNCION U. MACASERO, MD, FPSMS OFFICE
0920-973-0942 3.5 cm. X 4.5 cm
(passport size)
PROVINCIAL DOH OFFICE,CAPITOL
JENNIFER D. HINGGO,MPA COMPOUND,TAGUM CITY
0945-471-4251 With full and handwritten
name tag and signature over
printed name
STO. NIÑO, SAN ISIDRO, DAVAO DEL
JAY RYAN G. VALIAO, RN NORTE
0932-944-6816
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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

ID/License/Passport No.: 0110085 Signature (Sign inside the box)
08/26/1995
Date/Place of Issuance:
DAVAO 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