CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

WARNING: Any misinterpretation 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 TUNDAG

NAME EXTENSION (JR., SR) N/A

FIRST NAME ROSELYN

MIDDLE NAME REMECIAL

3. DATE OF BIRTH
05/28/1996 16. CITIZENSHIP
(mm/dd/yyyy)

4. PLACE OF BIRTH San Pablo, Zamboanga Del Sur If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS Purok Mangga
House/Block/Lot No. Street
Lataban
Subdivision/Village Barangay

7. HEIGHT (m) 5'1"

Liloan Cebu
City/Municipality Province

8. WEIGHT (kg) 48 kg. ZIP CODE

18. PERMANENT ADDRESS Purok Mangga

9. BLOOD TYPE O+
House/Block/Lot No. Street
Lataban
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Liloan Cebu
11. PAG-IBIG ID NO. 121188010471
City/Municipality Province

12. PHILHEALTH NO. 140502158909 ZIP CODE 6002

13. SSS NO. 1011901003 19. TELEPHONE NO. NONE

14. TIN NO. 485688998 20. MOBILE NO. 0915-268-4516 / 0962-041-6720

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) tundag938@gmail.com
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 Samantha Tundag Pacey 03-07-18

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME TUNDAG

NAME EXTENSION (JR., SR)
FIRST NAME NILO N/A
MIDDLE NAME ELTAGUNDE

25. MOTHER'S MAIDEN NAME

SURNAME REMECIAL

FIRST NAME ROSALINA

MIDDLE NAME COGALITO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LATABAN ELEMENTARY SCHOOL PRIMARY EDUCATION 2001 2007 2007

SECONDARY LATABAN NATIONAL HIGH SCHOOL SECONDARY EDUCATION 2008 2012 2012

VOCATIONAL /
N/A
TRADE COURSE

BACHELOR OF SCIENCE IN SOCIAL

COLLEGE SOUTHERN MINDANAO COLLEGES 2013 2016 2016
WORK

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE June 14,2024

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
Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

N/A

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

September December Department of Social & Welfare

Community Empowerment Facilitator ₱36,619.00 Grade 15 COS Y
13, 2021 31, 2023 Development (DSWD)

Septemebr December Department of the Interior and Local

Contact Tracer ₱18,000 Grade 8 Contractual Y
1, 2020 31, 2020 Government (DILG)

January 18, November

ESL Teacher Home Based Tutorial Services ₱16,000 Contractual N
2019 30, 2019

September December
Store Supervisor Close Out Overruns Designer Outlet ₱14,000 Contractual N
7, 2018 18, 2018

March 11, May 27,

Cashier Jollibee, Pagadian City ₱6,000 Contractual N
2015 2015

(Continue on separate sheet if necessary)

SIGNATURE DATE June 14,2024

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES

29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS

From To POSITION / NATURE OF WORK

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 Type of LD

30. ATTENDANCE ( Managerial/
NUMBER OF HOURS
(mm/dd/yyyy) Supervisory/
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Technical/etc) CONDUCTED/ SPONSORED BY
(Write in full) From To (Write in full)
Project Implementation, Process Review and Community
06/28/23 06/30/23 8 hours Technical DSWD KALAHI CIDSS
Organizing
Grievance Redress System Traning 12/20/2022 12/20/2022 8 hours Technical DSWD KALAHI CIDSS

Roll-out Traning For ACT/MCT on Additional Financing For Group

10/15/2021 10/15/2021 2 Municipalities
8 hours Technical DSWD KALAHI CIDSS

Gender Sensitivity In Social Work Practice 05/28/2016 05/28/2016 8 hours Technical Southern Mindanao Colleges

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION

31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

Efficient in Microsoft Office Programs such as: NONE NONE

** Microsoft Office Word ** Microsoft Office Excel

** Microsoft Office Power Point ** Microsoft Outlook

(Continue on separate sheet if necessary)

SIGNATURE DATE June 14,2024

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?

b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:

35.

If YES, give details:

a. Have you ever been found guilty of any administrative offense?

If YES, give details:

Date Filed:
b. Have you been criminally charged before any court?
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?
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 If YES, give details:
out (abolition) in the public or private sector? Resigned
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:

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?

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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No: 1826

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
Geraldine C. Mejares Tapon Norte, San Jose, Negros Oriental 0927-202-7326 3.5 cm. X 3.5
4.5 4.5 cm
(passport size)

Jill C. Wong Poblacion, Liloan Cebu 0920-553-2465 With full and handwritten
nameComputer
tag and signature
generatedover
or photocopied
printed name
picture
Jhommela Furia Hilongos, Leyte 0995-463-3823 is not acceptable
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: Driver License

ID/License/Passport No.: G09-23-003293

Signature (Sign inside the box)

Date/Place of Issuance: 05/28/22

June 14,2024
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