CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
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 CASCAYAN
NAME EXTENSION (JR., SR)
FIRST NAME FELIMAR

MIDDLE NAME CONSTANTINO

3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
✘ Filipino Dual Citizenship
04/19/1993 by
by birth
naturalization
4. PLACE OF BIRTH SOLANA, CAGAYAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
Male ✘

17. RESIDENTIAL ADDRESS

6 CIVIL STATUS Single Married
House/Block/Lot No. Street
✘ Widowed Separate
SAN ISIDRO SUR
Other/s: d
Subdivision/Village Barangay
LUNA APAYAO
7. HEIGHT (m) 1.5
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 3813

18. PERMANENT ADDRESS

9. BLOOD TYPE A
House/Block/Lot No. Street
SAN ISIDRO SUR
10. GSIS ID NO. 021-1582-4176-5
Subdivision/Village Barangay
LUNA APAYAO
11. PAG-IBIG ID NO. 1340-0080-2061
City/Municipality Province

12. PHILHEALTH NO. 06-050043774-2 ZIP CODE 3813

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 942-565-418 20. MOBILE NO. 09279055217

15. AGENCY EMPLOYEE NO. 4846319 21. E-MAIL ADDRESS (if any) felimar.cascayan@deped.gov.ph
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME CASCAYAN 23. NAME of CHILDREN (Write full name and list all) (mm/dd/yyyy)

FIRST NAME HERALD

NAME EXTENSION (JR., SR) HERALD FRITZ CASCAYAN 05/15/2007

MIDDLE NAME PULIDO HADREL FRANZ CASCAYAN 3/11/2012

OCCUPATION NONE HADLEY FRANCIS CASCAYAN 3/3/2014

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CONSTANTINO

JR.
FIRST NAME FELIX

MIDDLE NAME DE MATA

25. MOTHER'S MAIDEN NAME

SURNAME TAMAYAO

FIRST NAME MARTINA

MIDDLE NAME PAGULAYAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY NANGALISAN ELEM. SCHOOL ELEMENTARY 6/12/1990 3/18/1990 GRADUATED 1996 VAL

SECONDARY SAN VICENTE INSTITUTE HIGH SCHOOL 6/18/1996 3/22/2000 GRADUATED 2000 4TH
VOCATIONAL / HON.

F.L. VARGAS COLLEGE - ABULUG CAMPUS HEALTH CARE SERVICES NC-II 5/1/2013 11/30/2013 GRADUATED 2013
TRADE
COURSE CUM
COLLEGE CAGAYAN STATE UNIVERSITY - CARIG CAMPUS BACHELOR OF SCIENCE IN MATHEMATICS 6/5/2000 3/18/2004 GRADUATED 2004 LAUDE

MASTER OF SCIENCE IN TEACHING 01/31/2022 GRADUATED

GRADUATE STUDIES SAINT PAUL UNIVERSITY PHILIPPINES MATHEMATICS 3/1/2021 2023

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 03,2024 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 84.0 09/29/2013 TUGUEGARAO CITY 1236734 04/19/2022

CIVIL SERVICE ELIGIBILITY(PD 907) TUGUEGARAO CITY 10020216

(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)

11/22/2021 present TEACHER II BacDa NATIONAL HIGH SCHOOL 29,737.00 SG 12 - 3 PERMANENT Y

12/04/2017 12/31/2021 TEACHER II PUDTOL VOCATIONAL HIGH SCHOOL 26,336.00 SG 12 - 2 PERMANENT Y
08/17/15 12/03/2017 TEACHER 1 MATAGUISI COMP. NAT'L HIGH SCHOOL- ANNEX 19620.00 SG 11-1 PERMANENT Y
06/15/15 07/17/15 TEACHER 1 PIO DALIM MEMORIAL SCH. OF ARTS AND TRADE 18549.00 SG 11 SUBSTITUTE Y

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 3, 2024 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

02-28-2022 05-22-2022 60.0 TECHNICAL

GURO21 Course 2 (Developing Higher Order Thinking Skills) Southeast Asian Ministries of Education Organization

Review of the GRBE Policy with the Integration of VAWC, Abti-bullying and Child Protection Policy
and Capacitating Schools Personnel on Menatl and Psychological Support, and Stress 12-14-2019 12-16-2019 24.0 TECHNICAL Department of Education- Pudtol District
Management

Division Training on Competency-Based Learning for Senior High School Teachers 10-21-2019 10-24-2019 24.0 TECHNICAL Department of Education- Apayao

Division Roll-Out 1-24-2019 1-25-2019 16.0 TECHNICAL Department of Education- Apayao

Training for Career Advocates on Career Guidance Trends and Strategies
Capability Building and Experiential Education on GAD-Related Issues 12-17-2018 12-18-2018 16.0 TECHNICAL Department of Education- Pudtol District

SHS Teachers' Training of the K to 12 Basic Education Program 1/5/2018 05/13/2018 144.0 TECHNICAL DepEd - Cordillera Administrative Region

Mass Training of Teachers and Career Advocates for the Implementation of Grade 12 Career 4/12/2017 6/12/2017 24.0 TECHNICAL DepEd - Cordillera Administrative Region
Guidance Program

(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)

SINGING N/A WOMENS WELFARE ORGANIZATION

COOKING

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 3, 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?
YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? NO
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:
________________________________
RESIGNATION FROM PREVIOUS EMPLOYER(PRIVATE
________________________________
SECTOR)
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
RONALDO B. ANTOLIN CABATACAN, PUDTOL, APAYAO 3.5 cm. X 4.5 cm
(passport size)
PATROCINIA TRUMPO SAN ISIDRO SUR, LUNA, APAYAO With full and handwritten
name tag and signature
over
RONALD RAMIREZ SAN ISIDRO SUR, LUNA, APAYAO printed name

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete Computer generated
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I or photocopied picture
is not acceptable
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 LISENCE

ID/License/Passport No.: 1236734

Signature (Sign inside the box)
JUNE 3, 2024
Date/Place of Issuance: TUGUEGARAO 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