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 PARAN
NAME EXTENSION (JR., SR)
FIRST NAME VANESSA
MIDDLE NAME CADIO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 05/29/1988 ✘ Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH ITOGON, BENGUET If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 045 BALENBEN

House/Block/Lot No. Street
Separate
Widowed IRISAN
Other/s: d Subdivision/Village Barangay
7. HEIGHT (m) 0.13M BAGUIO BENGUET
City/Municipality Province
8. WEIGHT (kg) 58 KG ZIP CODE 2600
9. BLOOD TYPE "B" 18. PERMANENT ADDRESS 045 BALENBEN
House/Block/Lot No. Street

10. GSIS ID NO. NONE IRISAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO.

BAGUIO BENGUET
City/Municipality Province

12. PHILHEALTH NO. 04-200422633-4 ZIP CODE 2600

13. SSS NO. 0111-6431351-9 19. TELEPHONE NO. NONE

14. TIN NO. 430-710-171-000 20. MOBILE NO. 09092179541/09088109342

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) paranvanessa214@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PARAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JEVAN KYVER C.PARAN
FIRST NAME JERSEY 1/8/2008
MIDDLE NAME MANUDON VERSEY KYZER C. PARAN 07/30/2011
OCCUPATION PUJ DRIVER JARVEN KYNER C.PARAN 12/1/2019
EMPLOYER/BUSINESS NAME NONE
BUSINESS ADDRESS NONE 2000
1994
TELEPHONE NO. NONE 2005
2005
24. FATHER'S SURNAME CADIO
NAME EXTENSION (JR., SR)
FIRST NAME LOPE
MIDDLE NAME BOTIC
25. MOTHER'S MAIDEN NAME

SURNAME PUGA
FIRST NAME TERESITA
MIDDLE NAME APIDOS
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY LOACAN ELEMENTARY SCHOOL ELEMENTARY GRADUATED 2005 HONOR

SECONDARY /
VOCATIONAL ALS COMPLETER GRADUATED 2009

PHILIPINE WOMENS UNIVERSITY CAREGIVING 7/1/1905

TRADE
COURSE
COLLEGE
UNIVERSITY OF THE ETEEAP COMPLETER BEED- GRADUATED 2020
CORDILLERAS GEN.ED

GRADUATE STUDIES NONE

SIGNATURE DATE JUNE 1,2021

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

8/12/19

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)
1/6/2009 3/31/2017 DAYCARE WORKER ANTEG-IN DAYCARE CENTER LOACAN ITOGON P4,00.00 00 CONTRACTUAL YES
BENGUET

2/5/2017 PRESENT DAYCARE WORKER CITY CAMP PROPER DAYCARE CENTER P6,00.00. 00 CONTRACTUAL YES
BAGUIO CITY
SIGNATURE DATE JUNE 1,2021

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

NONE

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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
RESPONSIBLE PARENTHOOD:APPRECIATING ITS IMPORTANCE SOCIAL WELFARE AND DEVELOPMENT FIELD
4/18/2021 4/18/2021 8.0 OFFICE CAR
2019 CAPABILTY BUILDING OF CHILD DEVELOPMENT WORKERS CSWDO
5/27/2019 5/29/2019 24.0

2019 CHILD DEVELOPMENT WORKERS SUMMIT ALSWADOPI BAGUIO CITY

5/21/2019 5/23/2019 24.0

BUILDING INITIATIVE QOUTIENT NIIT BAGUIO CITY

2/3/2019 2/3/2019 8.0

EFFECTIVE WAYS IN BUILDING SELF CONFIDENCE NIIT BAGUIO CITY

1/20/2019 1/20/2019 8.0

RADIO DRAMA AND SCRIPT WRITING 2.0 NIIT BAGUIO CITY

1/19/2019 1/19/2019 8.0

INFORMATION AND COMMUNICATION TECHNOLOGY TRAINING (ICT) NIIT BAGUIO CITY

1/7/2019 1/19/2019 96.0

TALAKAYAN SA KOMUNIDAD
9/18/2018 9/18/2018 8.0 D.O.H CAR

CIVIL REGISTRATION LAWS AND PROCESSES

9/7/2018 9/7/2018 8.0 CITY CIVIL REGISTRY OFFICE & CSWDO

TRAINING ON EARLY DETECTION,PREVENTION AND INTERVENTION OF DISABILITY

(EDPID) 8/16/2018 8/17/2019 16.0
D.O.H CAR
ORIENTATION OF CHILD DEVELOPMENT WORKERS ON ORAL HEALTH CARE
5/31/2018 5/31/2018 8.0 H.S.O BAGUIO CITY

2018 CAPABILTY BUILDING OF CHILD DEVELOPMENT WORKERS

5/25/2018 5/25/2018 8.0
CSWDO

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)
MAKING INSTRUCTIONAL ITOGON DAYCARE WORKERS
NONE
MATERIALS ASSOCIATION
 SINGING

DANCING

READING

PASSION FOR THE KIDS

ENCODING

CRAFTING

SIGNATURE DATE JUNE 1,2021

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
JOY A. HILARIO CDRRMO LOWER ROCK QUARRY 9396082287 3.5 cm. X 4.5 cm
(passport size)

MARIETTE MAE D. YAPYAP CDRRMO LOWER ROCK QUARRY 9101746973 With full and handwritten
name tag and signature over
printed name

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: 0111-6431351-9
ID/License/Passport No.: N/A
Signature (Sign inside the box)

Date/Place of Issuance: N/A

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