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 ag
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

I. PERSONAL INFORMATION
2. SURNAME PEÑAS
NAME EXTENSION (JR., SR
FIRST NAME ROSEMARIE

MIDDLE NAME OMANDAM

3. DATE OF BIRTH
(mm/dd/yyyy) 10/8/1969 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH BINONI, SALUG ZN. If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

17. RESIDENTIAL ADDRESS PUROK RUBIA INFRONT OF VICTORIA COUNTRY HOMES

6 CIVIL STATUS Single ✘ Married
House/Block/Lot No. S
Widowed Separated
O
Other/s: Subdivision/Village Ba
POLANCO ZAMBO.
7. HEIGHT (m) 163.2 CM
City/Municipality Pr
8. WEIGHT (kg) 50 KGS ZIP CODE 7106

18. PERMANENT ADDRESS PUROK RUBIA INFRONT OF VICTORIA COUNTRY HOMES

9. BLOOD TYPE O
House/Block/Lot No. S
O
10. GSIS ID NO. 02004077985
Subdivision/Village Ba
POLANCO ZAMBO. D
11. PAG-IBIG ID NO. 1210-7686-9625
City/Municipality Pr

12. PHILHEALTH NO. 14-025104719-3 ZIP CODE 7106

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

14. TIN NO. 400-418-941 20. MOBILE NO. 09355236036

15. AGENCY EMPLOYEE NO. 0260002 21. E-MAIL ADDRESS (if any) rosemariepenas_95@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME PEÑAS 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) PETER JUSTIN OMANDAM PEÑAS
FIRST NAME ELMERE

MIDDLE NAME ALVAREZ CLAYTON JAY OMANDAM PEÑAS

OCCUPATION BUSINESSMAN PETER JASON OMANDAM PEÑAS

EMPLOYER/BUSINESS NAME PHILIPPINE PUBLISHING HOUSE PRINCESS OMANDAM PEÑAS

BUSINESS ADDRESS OZAMIS CITY

TELEPHONE NO. NONE

24. FATHER'S SURNAME OMANDAM

NAME EXTENSION (JR., SR)
FIRST NAME PEDRO
 MIDDLE NAME CLAPANO

25. MOTHER'S MAIDEN NAME

SURNAME DIONG-AN

FIRST NAME CRESENCIA

MIDDLE NAME BACONGGA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

SINDANGAN SEVENTH DAY

ELEMENTARY 1997 1983
ADVENTIST ELEMENTARY SCHOOL

SECONDARY /
VOCATIONAL SALUG NATIONAL HIGH SCHOOL 1985 1988

NONE NONE NONE NONE NONE

TRADE
BACHELOR OF ARTS IN EDUCATION
COURSE
COLLEGE PHILIPPINE ADVENT COLLEGE DOCTOR OF EDUCATION (EDD)
1988 1994 186
MISAMIS UNIVERSITY OZAMIS CITY 2010 2012
MASTER OF ARTS IN EDUCATION 45
GRADUATE STUDIES MISAMIS UNIVERSITY DOCTOR OF EDUCATION (EDD) 2012 2013 48
OZAMIS CITY
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization
Pls. indicate country:

Street
OBAY
Barangay
ZAMBO. DEL NORTE
Province
7106

Street
OBAY
Barangay
ZAMBO. DEL NORTE
Province

DATE OF BIRTH (mm/dd/yyyy)

11/11/2001

10/23/2003

3/18/2005

7/5/2013
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1982-83 CERTIFICATE

1987-88 CERTIFICATE

NONE NONE

1993- 1994 DIPLOMA

2011-2012 DIPLOMA
parate sheet if necessary)

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 TEACHER 82.80 10/4/2009 OZAMIS CITY 1052589 2/26/2010

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/
N)
DEPARTMENT OF EDUCATION
10/12/1998 11/11/1998 TEACHER I 103.26 NONE SUB. YES
CULTURE AND SPORTS
DEPARTMENT OF EDUCATION
6/7/1999 8/15/1999 TEACHER I 103.26 NONE SUB. YES
CULTURE AND SPORTS
DEPARTMENT OF EDUCATION
1/3/2000 8/31/2000 TEACHER I 103.26 NONE SUB. YES
CULTURE AND SPORTS
DEPARTMENT OF EDUCATION
8/16/2001 1/29/2001 TEACHER I 113.592 NONE SUB. YES
CULTURE AND SPORTS
DEPARTMENT OF EDUCATION
11/17/2001 3/31/2001 TEACHER I 113.592 NONE SUB. YES
CULTURE AND SPORTS
12/13/2010 4/7/2015 TEACHER I DEPARTMENT OF EDUCATION 20,549.00 NONE REG/PERM YES

4/7/2015 5/10/2017 TEACHER I DEPARTMENT OF EDUCATION 21,077.00 NONE REG/PERM YES

5/10/2017 1/29/2018 TEACHER I DEPARTMENT OF EDUCATION 22,179.00 NONE REG/PERM YES

1/29/2018 PRESENT TEACHER III DEPARTMENT OF EDUCATION 22,179.00 NONE REG/PERM YES
 (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 /
From To

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

NONE NONE NONE NONE

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

JOINT SLAC ON THE REVIEW OF THE RPMS-PPST ASSESSMENT 10/22/2018 10/23/2018 16.0

ADVANCE TRAINING COURSE FOR KAWAN LEADERS 9/11/2018 9/16/2018 48.0

DISTRICT TRAINING ON PEDAGOGICAL RETOOLING IN MATHEMATICS I

8/1/2018 8/3/2018 24.0
LANGUAGES AND SCIENCE (PRIMALS) FOR GRADE 4-6
DISTRICT ROLL-OUT ON TRAINING AND SEMINAR WORKSHOP FOR TEACHERS
7/25/2018 7/27/2018 24.0
ON RPMS-PPST BASED

DISTRICT ROLL-OUT ON CONTINOUS IMPROVEMENT (CI) PROGRAM 5/21/2018 5/23/2018 24.0

DISTRICT DRRM MODULE ROLL-OUT TRAINING WORKSHOP 5/16/2018 5/16/2018 8.0

BASIC TRAINING COURSES KAWAN, LEADERS, TROOP LEADERS & OUTFIT

8/25/2017 8/27/2017 24.0
ADVISORS
NATIONAL TRAINING AND WORKSHOP FOR MAPEH, SPORTS, WELLNESS,
10/13/2017 10/15/2017 24.0
RECREATION AND DANCE
5 DAY WRITESHOP OF LOCALIZED AND CONTEXTNALIZED LESSON
4/17/2017 4/21/2017 40.0
EMDLEMETATION PROGRAM CLOCK
SCHOOL TO SCHOOL PARTNERSHIP, WORKING FOR UNIVERSAL LITERACY
12/21/2016 12/21/2016 8.0
TOWARDS QUALITY EDUCATION

NATIONAL E-CLASSROOM TRAINING 3/16/2015 3/17/2015 16.0

1ST DIVISION KTO12 EDUCATION SUMMIT 2014 12/16/2014 12/17/2014 16.0

RESEARCH CAPABILITY BUILDING SEMINAR-WORKSHOP 11/21/2014 11/22/2014 16.0

ONE-DAY DISTRICT ORIENTATION OR RESULT-BASED PERFORMANCE

6/27/2014 6/27/2014 8.0
MANAGEMENT SYSTEM (RPMS)
TOWARDS OWNERSHIP OF KNOWLEDGE THROUGH MOTHER TONGUE BASED
4/2/2014 4/4/2014 24.0
ON MULTILINGUAL EDUC. MTB.MLE

SINING PATANGHALAN SA PAGTUTURO NG PILIPINO 9/21/2012 9/23/2012 24.0

MGA TEKNIK ISTRATIHIYA SA PAGTUTURO NG PANLUNAS SA PAGBASA 1/12/2012 1/14/2014 24.0

TEACHER TRAINED OF NEW STRATEGIES, TECHNIQUES FOR CONSTRUCTIONS

9/24/2012 9/25/2012 16.0
OF TEACHING AIDS

KTO12 TRAINING FOR GRADE I TEACHERS 5/21/2012 5/25/2012 40.0

 TWO DAY DISTRICT ORIENTATION OF TEACHERS ON THE USE OF STANDARDS/BASE
CLASSROOM OBSERVATION PROTOCOL OF EDUCATION (SCOPE)
10/24/2012 10/25/2012 16.0

DISTRICT TRAINING OF THE USE OF ENHANCED KINDERGARTEN CURRICULUM

11/28/2012 11/29/2012 16.0
OF THE KTO12 PROGRAM
DIVISION TRAINING OF TEACHERS ON DIFFERENCIATED INSTRUCTION IN
1/5/2011 1/9/2011 40.0
TEACHING STRATEGIES FOR STUDENT SPECIAL NEEDS
DIVISION TRAINING OF TRAINORS OF GENDER AND DEVELOPMENT (GAD)
4/13/2011 4/15/2011 24.0
WORK-SHOP SEMINAR
DISTRICT LEARNING PARTNERSHIP PROGRAM (LPP) CONTENT-BEST SEMINAR
5/18/2011 5/20/2011 24.0
FOR NON EQUALS
TEACHER TRAINING ON CHILD SEXUAL ABUSE PREVENTION THROUGH
5/31/2011 6/3/2011 32.0
PERSONAL SAFETY LESSON IN SCHOOLS

INFORMATION COMMUNICATION TECHNOLOGY (ICT) 10/2/2011 10/5/2011 24.0

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

SINGING, DANCING NONE

COOKING, READING NONE

BOOKS, MAGAZINES NONE

GARDENING NONE
(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

NONE

NONE

NONE

NONE
eparate sheet if necessary)
ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPED DISTRICT

DEPED NATIONAL

DEPED DISTRICT

DEPED DISTRICT

DEPED DISTRICT

DEPED DISTRICT

DEPED FACILITATOR

DEPED NATIONAL

DEPED DISTRICT

DIVISION FACILITATOR

DIVISION FACILITATOR

DIVISION FACILITATOR

DEPED DISTRICT

DEPED DISTRICT

DEPED NATIONAL

DEPED NATIONAL

DEPED DISTRICT

DEPED NATIONAL

DEPED NATIONAL
 DEPED DISTRICT

DEPED DISTRICT

DEPED DISTRICT

DIVISION FACILITATOR

DEPED DISTRICT

DEPED NATIONAL

DIVISION FACILITATOR

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

NONE

NONE

NONE

NONE
eparate 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:

________________________________

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
YES ✘ 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, 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? ________________________________
________________________________
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:
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
EDEN S. REYES VCH, OBAY, POLANCO ZN. NONE 3.5 cm. X 4.5 cm
(passport size)

LANI R. OCAMIA ANASTACIO, POLANCO ZN. NONE With full and handwritten
name tag and signature over
printed name
RONNIE C. ENOY BETHLEHEM, POLANCO ZN. NONE
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: TIN

ID/License/Passport No.: 400-418-941

Signature (Sign inside the box)
February 9, 2018
Date/Place of Issuance: NOVEMBER 11, 2010
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