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 VILLAFLORES
NAME EXTENSION (JR., SR)
FIRST NAME EHMEE

MIDDLE NAME RACELIS

3. DATE OF BIRTH
(mm/dd/yyyy) 03/26/1996 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH GUINACUTAN VINZONS If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS PUROK 2

6 CIVIL STATUS Married
House/Block/Lot No. Street
GUINACUTAN
Subdivision/Village Barangay
VINZONS CAMARINES NORTE
7. HEIGHT (m) 152
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 4603

18. PERMANENT ADDRESS PUROK 2

9. BLOOD TYPE N/A
House/Block/Lot No. Street
GUINACUTAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
VINZONS CAMARINES NORTE
11. PAG-IBIG ID NO. 121286519846
City/Municipality Province

12. PHILHEALTH NO. 102530551854 ZIP CODE 4603

13. SSS NO. 35-0901159-7 19. TELEPHONE NO. N/A

14. TIN NO. 503-801-486-000 20. MOBILE NO. 09153563604

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME VILLAFLORES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) MARJHANA EMMANUELLE R. VILLAFLORES
FIRST NAME MARK JAYSON 02/25/2016

MIDDLE NAME ILAN

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME RACELIS 9/29/1960

NAME EXTENSION (JR., SR)
FIRST NAME ELMER

MIDDLE NAME DELA CRUZ

25. MOTHER'S MAIDEN NAME

SURNAME BACERDO 10/5/1964

FIRST NAME LORNA

MIDDLE NAME HUFANCIA (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 GUINACUTAN ELEMENTARY SCHOOL GRADE 1-6 2003 4/1/2009 GRADUATED 2009 N/A

SECONDARY /
VOCATIONAL VINZONS PILOT HIGH SCHOOL First year-Fourth year 2009 2013 GRADUATED 2013 N/A

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

TRADE
BACHELOR OF ELEMENTARY EDUCATION
COURSE
COLLEGE CAMARINES NORTE COLLEGE
MAJOR IN GENERAL EDUCATION
JUNE, 2017 JULY, 2021 GRADUATED 2021 SCHOLAR

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
LICENSURE EXAMINATION FOR PROFESSIONAL
81.6 10/2/2022 LUCENA CITY NATIONAL HIGHSCHOOL 2035224 03/26/2026
TEACHER

(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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
DEPARTMENT OF EDUCATION BRIGADA
9/5/2022 7/30/2023 Gorgonio Obusan Elementary School N/A N/A No
PAGBASA PROGRAM
2/1/2023 7/31/2023 LEARNING SUPPORT AIDE FOOD FOR THE HUNGRY PHILIPPINES ₱6,000 N/A N/A No

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

DEPARTMENT OF EDUCATION BRIGADA PAGBASA PROGRAM 9/5/2022 7/30/2023 10 months BRIGADA PAGBASA VOLUNTEER TUTOR

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

FOOD FOR THE HUNGRY CAPACITY BUILDING 3-DAYS TRAINING 5/1/2023 1/7/2023 24 HOURS N/A FOOD FOR THE HUNGRY

LEARNING SUPPORT AIDES RETOOLING: Developmentally Appropriate Practices in Teaching

6/20/2023 6/20/2023 8 HOURS N/A
Mathematics for Grades 2&3 FOOD FOR THE HUNGRY PHILIPPINES

USING EDUCATIONAL TECHNOLOGY IN THE ENGLISH LANGUAGE CLASSROOM 1/29/2024 1/29/2024 8 HOURS
TESDA ONLINE PROGRAM

ENGLISH AS A MEDIUM OF INSTRUCTION 1/30/2024 1/30/2024 8 HOURS

TESDA ONLINE PROGRAM

TEACHING ENGLISH AS FOREIGN LANGUAGE COURSE 6/1/2024 6/15/2024 120 HOURS TECHNICAL
INFORMATION AND TECH SERVICES

(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)

COMPUTER LITERATE N/A N/A

SINGING N/A N/A

DANCING N/A N/A

GOOD IN COMMUNICATION SKILLS N/A N/A

WRITING STORIES AND POEMS N/A N/A

COOKING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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, No
a. within the third degree?
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:
________________________________
________________________________
b. Have you been criminally charged before any court? 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 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, 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 No
Barangay election)?
If YES, give details:
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:
39. Have you acquired the status of an immigrant or permanent resident of another country? 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? 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? No
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

ID picture taken within

NAME ADDRESS TEL. NO.
the last 6 months
4.5 cm. X 3.5 cm
RANDY ESPINA Vinzons, Camarines Norte 9127991350 (passport size)

Computer generated
MARIA KRISTELA GUINTO Napilihan, Vinzons Camarines Norte 9053779061 or photocopied picture
is not acceptable
ELIZALDY DANIEL Guinacutan Vinzons, Camarines Norte 9392145992
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

ID/License/Passport No.: 2035224

Signature (Sign inside the box)
JUNE 18, 2024
Date/Place of Issuance: APRIL 26, 2023 at PRC LUCENA
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