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 SUAN
NAME EXTENSION (JR., SR) NA
FIRST NAME RODEMAY

MIDDLE NAME REGAÑON

3. DATE OF BIRTH
(mm/dd/yyyy) JULY 17, 1987 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH PALO, LEYTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS 1112 SAN ISIDRO ST.

6 CIVIL STATUS
House/Block/Lot No. Street
Widowed Separate
N/A STA. CRUZ
Other/s: d
Subdivision/Village Barangay
PALO LEYTE
7. HEIGHT (m) 1.50 m
City/Municipality Province
8. WEIGHT (kg) 54 KG ZIP CODE 6500

18. PERMANENT ADDRESS 1112 SAN ISIDRO ST.

9. BLOOD TYPE O+
House/Block/Lot No. Street
N/A STA. CRUZ
10. GSIS ID NO. 2004981322
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 080150098908 PALO LEYTE

City/Municipality Province

12. PHILHEALTH NO. 130250848499 ZIP CODE 6501

13. SSS NO. NA 19. TELEPHONE NO. NA

14. TIN NO. 424-606-320 20. MOBILE NO. 09495725133/09606648626

15. AGENCY EMPLOYEE NO. 6291831 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SUAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME MICHAEL ROBERT

NAME EXTENSION (JR., SR)
N/A
DASHELLE R. SUAN 7/5/2008

MIDDLE NAME ADARLO

DAMIEN R. SUAN 5/16/2014

OCCUPATION N/A
DANDREI R. SUAN 8/5/2020

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME REGAÑON

NAME EXTENSION (JR., SR)
FIRST NAME RODRIGO NA

MIDDLE NAME TAMPIL

25. MOTHER'S MAIDEN NAME

SURNAME PLIMACO

FIRST NAME THELMA

MIDDLE NAME VILLACORTE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PALO CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 7/6/1994 3/31/2000 2000 W/ HONORS

SECONDARY ST. MARY'S ACADEMY OF PALO HIGHSCHOOL 6/6/2000 3/31/2004 2004

VOCATIONAL /

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

TRADE
COURSE BACHELOR OF ELEMENTARY
COLLEGE LEYTE NORMAL UNIVERSITY
EDUCATION
1/6/2004 10/30/2009 2010 N/A

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 10, 2022

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

LICENSURE EXAMINATION FOR TEACHERS (LET) 77.6 09/29/2013 TACLOBAN CITY 1432162 7/17/2023

(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
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if 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)

1/1/2021 PRESENT TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 24,161 11-2 REGULAR Y

ELEMENTARY SCHOOL
1/1/2020 12/31/2020 TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 22, 316 11-1 REGULAR Y
ELEMENTARY SCHOOL
1/1/2019 12/31/2019 TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 20, 754 11-1 REGULAR Y
ELEMENTARY SCHOOL
1/1/2018 12/31/2018 TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 20,179 11-1 REGULAR Y
ELEMENTARY SCHOOL
1/1/2017 12/31/2017 TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 19, 620 11-1 REGULAR Y
ELEMENTARY SCHOOL
06/13/2016 12/31/2016 TEACHER 1 DEPARTMENT OF EDUCATION / PAWING 19,077 11-1 REGULAR Y
ELEMENTARY SCHOOL
1/6/2010 4/30/2016 HOME ECONOMICS AND LIVELIHOOD TACLOBAN ANGELICUM LEARNING 11000.00 N/A PERMANENT NO
EDUCATION TEACHER CENTER

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 10, 2022

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 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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

VIRTUAL IN SERVICE-TRAINING FOR TEACHERS 8/30/2021 3/9/2021 24 TECHNICAL NATIONAL

3 DAY VIRTUAL TRAINING-WORKSHOP ON CONTEXTUALIZATION OF EDUCATIONAL 12/14/2020 12/16/2020 24 TECHNICAL PALO III DISTRICT
RESOURCES IN KEY LEARNING AREAS

DISTRICT ROLL-OUT OF RPMS-PPST FOR TEACHERS AND SCHOOL HEADS 09/27/2018 09/29/2018 24.0 TECHNICAL PALO II DISTRICT

THREE-DAY DISTRICT-BASED ORIENTATION ON R.A. 9710 (MAGNA CARTA FOR WOMEN) 05/21/2018 05/23/2018 24.0 TECHNICAL PALO II DISTRICT

SEVEN-DAY DISTRICT BASE TRAINING-WORKSHOP ON THE DEVELOPMENTALLY APPROPRIATE

PRACTICES IN EARLY LANGUAGE LITERACY AND NUMERACY (LEARNING STATION CONTEST) 10/23/2017 10/29/2017 56.0 TECHNICAL PALO II DISTRICT

3-DAY CLUSTER-BASED LIVE-OUT TRAINING WORKSHOP ON CONTEXTUALIZED READING

MATERIALS FOR K TO 6. 11/17/2016 11/19/2016 24.0 TECHNICAL PALO II DISTRICT

TEACHER ORIENTATION AND PERSONNEL INDUCTION TO THE CAREER SERVICE VERSION 3.0
(TOPICS 3.0) 08/19/2016 08/21/2016 24.0 TECHNICAL DIVISION OF LEYTE

DISTRICT-BASED ECHO-SEMINAR ACTION RESEARCH WRITING WORKSHOP FOR TEACHERS 08/16/2016 08/18/2016 24.0 TECHNICAL PALO II DISTRICT

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write in
full)

COMPUTER LITERATE NONE NONE

READING

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 10, 2022

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
by any court or tribunal? YES ✘ NO
If YES, give details:
________________________________
________________________________
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 YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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
JOSEPHINE N. DAZA BARAS, PALO LEYTE O9295572977 3.5 cm. X 4.5 cm
(passport size)
MICHELLE R. AZURA TACLOBAN CITY 9351398963 With full and handwritten
name tag and signature over
325-5658/325- printed name
PROFESSOR REGINA G. CINCO KALIPAYAN TACLOBAN CITY
2156 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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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
administrative/criminal case/s against me. PHOTO

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/License/Passport No.: 0708547

Signature (Sign inside the box)
JANUARY 10, 2022
Date/Place of Issuance: TACLOBAN 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