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

MIDDLE NAME Raganas

3. DATE OF BIRTH
09/23/1992 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH Mangagoy, Bislig City, Surigao del Sur If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS P-7 Lomao
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separat Palasao
Other/s: ed Subdivision/Village Barangay
Cantilan Surigao del Sur
7. HEIGHT (m) 152
City/Municipality Province
8. WEIGHT (kg) 52 ZIP CODE 8317

18. PERMANENT ADDRESS P-7 Lomao

9. BLOOD TYPE B+
House/Block/Lot No. Street

10. GSIS ID NO. N/A Palasao

Subdivision/Village Barangay
Cantilan Surigao del Sur
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 182509619892 ZIP CODE 8317

13. SSS NO. 0940-846-968 19. TELEPHONE NO.

14. TIN NO. 330-363-777-000 20. MOBILE NO. 09657446174

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME Brent Christian Lafuente 09/23/2009

MIDDLE NAME Abigail Lafuente 12/3/2011

OCCUPATION Kyrie L. Caballes 07/18/21

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Lafuente

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

MIDDLE NAME Arjona

25. MOTHER'S MAIDEN NAME Elsie Langguing Raganas

SURNAME Raganas

FIRST NAME Elsie

MIDDLE NAME Langguing (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Cantilan Pilot School Elementary 1998 2004 Graduated 2004 N/A

SECONDARY /
VOCATIONAL Madrid National High School Secondary 2004 2008 Graduated 2008 N/A

N/A N/A N/A N/A N/A N/A N/A

TRADE
Bachelor of Science in Business
COURSE
COLLEGE Saint Michael College
Administration 2012 2016 Graduated 2016 N/A

GRADUATE STUDIES Saint Michael College Bachelor of Secondary Education 2017 2018 Graduated 2018 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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

License Professional Teacher 81 September 30, 2018 Cagayan de Oro City 1740777 9/23/2025

(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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

1/9/2022 1/4/2023 Teacher Cantilan National High School 25,549 N/A Substitute Y

2/8/2021 4/21/2022 Teacher Palasao Integrated School N/A N/A Volunteer Y

3/6/2019 9/3/2020 Teacher Hotchkiss Learning Center 6,500 N/A Contractual N

(Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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

School Based Mid Year Performance Review and Assessment 6/2/2023 6/2/2023 8 Managerial Cantilan National High School

Launching of the National Bible Month Celebration 6/1/2023 6/1/2023 8 Managerial Cantilan National High School

Competency Assured Relevant and Employable Skills

Shielded Metal Arc Welding (SMAW) NC I 12/16/2021 4/2/2022 268 Technical
(Cares) Training Center, Inc.
In-Service Training on Designing Higher Order Thinking Skills (HOTS) Questions and
2/2/2022 4/2/2022 24 Managerial Palasao Integrated School
Assessment Tools (Designing Integrative Authentic Assessment)

Construction of Table of Specifications (TOS) and Item Analysis 12/17/2021 12/17/2021 8 Managerial Palasao Integrated School

Advocacy Campaign on Violence Against Women and Children (VAWC) and RA 11313 or Safe
10/12/2021 10/12/2021 8 Managerial Palasao Integrated School
Spaces Act of 2019

Republic Act 11313 Safe Spaces Act of 2019 11/29/2019 11/29/2019 8 Managerial Palasao Integrated School

Providing Formative Assessment and Timely Formative Feedback in Distance Learning 11/25/2021 11/25/2021 8 Managerial Palasao Integrated School

Positive Use of ICT in the Teaching-Learning Process 8/15/2021 8/15/2021 8 Managerial Palasao Integrated School

Planting, Care and Maintenance of Bamboo, Falcata and Fruit Trees 2/23/2021 2/24/2021 16 Agricultural Department of Agriculture

Visual Graphics Design 3/12/2019 1/27/2020 80 Technical SDSSU (Cantilan Campus)

International Training Series on New Trends in Education 9/20/2019 9/22/2020 24 Technical Southeast Asian Institute Educational Training, Inc.

(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)
BASIC COMPUTER IN MICROSOFT
WORD,POWERPOINT AND EXCEL
PLAYING BADMINTON

READING

WATCHING DOCUMENTARIES

(Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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? ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? ✘ NO
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘ NO
If YES, give details:
________________________________
________________________________
✘ NO
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
✘ NO
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:
________________________________
NO
________________________________
✘

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? ________________________________
✘ NO
________________________________
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:
✘ NO
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:
✘ NO
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: NO
a. Are you a member of any indigenous group? ✘ NO
If YES, please specify:
b. Are you a person with disability? ✘ NO
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
Alan S. Millan Tandag City, Surigao del Sur 9100871106 4.5 cm. X 3.5 cm
(passport size)

Mercinda O. Puerto Cantilan, Surigao del Sur 9507633494

Computer generated
or photocopied picture
Agnes C. Villarta Cantilan, Surigao del Sur 9104934331 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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 FOR TEACHER

ID/License/Passport No.: 1740777

Signature (Sign inside the box)
05/19/2023
Date/Place of Issuance: Butuan City, JANUARY 4, 2018
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