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 cas
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.

I. PERSONAL INFORMATION
2. SURNAME SANCHEZ
FIRST NAME JANNETH
MIDDLE NAME LACAO
3. DATE OF BIRTH
(mm/dd/yyyy) 8/5/1996 16. CITIZENSHIP ✘ Filipino Dual Citize

4. PLACE OF BIRTH BALAT-AN, MAMBUSAO, CAPIZ If holder of dual citizenship,

please indicate the details.

5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.

Other/s:
Subdivision/Village
MAMBUSAO
7. HEIGHT (m) 4'10''
City/Municipality
8. WEIGHT (kg) 50 kg. ZIP CODE 5807

18. PERMANENT ADDRESS

9. BLOOD TYPE
House/Block/Lot No.

10. GSIS ID NO.

Subdivision/Village
MAMBUSAO
11. PAG-IBIG ID NO.
City/Municipality

12. PHILHEALTH NO. 11-250541904-1 ZIP CODE 5807

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09979160762

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) jannethlacaosanchez@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME SANCHEZ

NAME EXTENSION (JR., SR)
FIRST NAME JIMMY
MIDDLE NAME LEONARDO
25. MOTHER'S MAIDEN SURNAME LACAO
FIRST NAME ROSINI
MIDDLE NAME LUNA (Continue on separate sheet

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE

LEVEL
(Write in full) (Write in full)
From To
JUNE, MARCH,
ELEMENTARY MAMBUSAO ELEMENTARY SCHOOL
2003 2008
VOCATIONAL / JUNE, MARCH,
SECONDARY MAMBUSAO NATIONAL HIGH SCHOOL
2009 2012

BACHELOR OF SECONDARY EDUCATION JUNE, MARCH,

COLLEGE TRADE CAPIZ STATE UNIVERSITY BURIAS CAMPUS
COURSE (ENGLISH) 2013 2016
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
 T15282166
AL DATA SHEET Unique Applicant Number
Experience Sheet shall cause the filing of administrative/criminal case/s against the person

S) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

✘ Filipino Dual Citizenship

✘ by birth by naturalization

Pls. indicate country:

Street
BALAT- AN
Barangay
CAPIZ
Province
5807

Street
BALAT- AN
Barangay
CAPIZ
Province

09979160762

jannethlacaosanchez@gmail.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

N/A

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/

YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

2009

2013

2017
e on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSED PROFESSIONAL TEACHER 80.2 9/24/2017 ILOILO

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

Homebased- Online ESL (English as a

7/27/2018 PRESENT 51talk 30, 000 1500/DAY
Second Language) Teacher
 (Continue on separate sheet if necessary)

SIGNATURE DATE
 LICENSE (if applicable)

NUMBER Date of
Validity

1595840 8/5/2020

e on separate sheet if necessary)

es should be indicated in the attached Work Experience sheet.

GOV'T SERVICE
STATUS OF
APPOINTMENT
(Y/ N)

SELF-
N
EMPLOYED
e on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / N
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

TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPON
PROGRAMS (Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

Practice Teaching Internship 7/15/2016 10/15/2016 400 Hours Vicente Andaya S

Computer Literacy Training 1/11/2018 2/27/2018 56 Hours Capiz State Unive

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Computer Literate (MS Word, MS Excel, SUPREME STUD

SERVICE AWARDEE (S.Y. 2014 - 2017)
MS Powerpoint) TREASURER (S

THE HIGHLAND
2013 UNIVERSITY OF THE PHILIPPINES COLLEGE ADMISSION TEST (UPCAT)
Singing Skills (SCHOOL PAPE
PASSER
2012 - 2013)

THE HIGHLAND
Dancing Skills Dean's Lister 2016-2017 (SCHOOL PAPE
- 2011)
 SUPREME STUD
Communication Skills Best in Demonstration (2017) COLLEGE OF E
(S.Y. 2013 - 201

RUMBUHAN TE
Reading
(S.Y. 2015 - 201

FUTURE LEADE
Drawing (FLP) SUB CHA
(S.Y.2016 - 2017
TEACHER
Photography ORGANIZATIO

(Continue on separate sheet if necessary)

SIGNATURE DATE
NMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

e on separate sheet if necessary)

ING PROGRAMS ATTENDED
for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Vicente Andaya Sr. National High School

Capiz State University Sigma

e on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

SUPREME STUDENT GOVERNMENT(SSG),

TREASURER (S.Y.2012- 2013)

THE HIGHLAND ECHO (SCHOOL PAPER

(SCHOOL PAPER), PHOTOGRAPHER (S.Y.
2012 - 2013)

THE HIGHLAND ECHO (SCHOOL PAPER

(SCHOOL PAPER), NEWS EDITOR (S.Y. 2010
- 2011)
 SUPREME STUDENT COUNCIL (SSC),
COLLEGE OF EDUCATION SECRETARY
(S.Y. 2013 - 2016)

RUMBUHAN TEEN CENTER, SGT. AT ARMS

(S.Y. 2015 - 2017)

FUTURE LEADERS OF THE PHILIPPINES

(FLP) SUB CHAPTER 3 SECRETARY
(S.Y.2016 - 2017)
TEACHER EDUCATION STUDENT
ORGANIZATION (TESO), SECRETARY(S.Y.
2013 - 2016)
e on separate sheet if necessary)

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:

________________________________
N/A

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

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: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
MAMBUSAO NATIONAL HIGH the last 6 months
MRS. EMILY L. SIBUG SCHOOL
9278109732 3.5 cm. X 4.5 cm
(passport size)
CAPIZ STATE UNIVERSITY BURIAS
PROF. NOEME V. BARGO CAMPUS
9778079642 With full and handwritten
name tag and signature over
CAPIZ STATE UNIVERSITY BURIAS printed name
PROF. GERARD LEE L. ATIENZA CAMPUS
9166842747
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
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.: 1595840 Signature (Sign inside the box)

Date/Place of Issuance: ILOILO 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 o

 If YES, give details (country):

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4