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 CATUDAY
NAME EXTENSION (JR., SR) N/A
FIRST NAME SHEENA MARIE

MIDDLE NAME ERES

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 07/08/1991 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MEYCAUAYAN CITY, BULACAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 107 ABENIS

Widowed Separated House/Block/Lot No. Street
N/A PUROK B (POB.)
Other/s:
Subdivision/Village Barangay
BORONGAN EASTERN SAMAR
7. HEIGHT (m) 1.56
City/Municipality Province
8. WEIGHT (kg) 55.2 ZIP CODE 6800

18. PERMANENT ADDRESS 107 ABENIS

9. BLOOD TYPE A+
House/Block/Lot No. Street
N/A PUROK B (POB.)
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BORONGAN EASTERN SAMAR
11. PAG-IBIG ID NO. 121223170530
City/Municipality Province

12. PHILHEALTH NO. 13-201934051-5 ZIP CODE 6800

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 720 103 231 000 20. MOBILE NO. 09366956974

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) sheenaeres@gmail.com
CATUDAY 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A FEONNA SHAZEYN ERES CATUDAY
RAMIR 12/24/2015

MIDDLE NAME CILLO

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ERES

NAME EXTENSION (JR., SR)
FIRST NAME ROMEO N/A

MIDDLE NAME VERZOSA

25. MOTHER'S MAIDEN NAME

SURNAME BALDOMAR

FIRST NAME ASUNCION

MIDDLE NAME LASCANO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY TABOC ELEMENTARY SCHOOL ELEMENTARY 1997 2003 GRADUATED 2003 N/A

EASTERN SAMAR NATIONAL COMPREHENSIVE

SECONDARY
VOCATIONAL / HIGH SCHOOL
HIGH SCHOOL 2003 2007 GRADUATED 2007 N/A

N/A N/A N/A N/A N/A N/A N/A

TRADE
COURSE
COLLEGE ST. MARY'S COLLEGE OF BORONGAN BACHELOR OF ELEMENTARY EDUCATION 2010 2014 GRADUATED 2010 N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 30,2020

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
SAN JOSE ELEMENTARY SCHOOL
BOARD OF PROFESSIONAL TEACHERS 78.8 MARCH 25,2018 1639242 07/08/2021
TACLOBAN CITY

(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
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)
INFORMATION CLERK
07/01/2014 08/01/2014 BORONGAN DOCTORS HOSPITAL 4000.00 N/A CONTRACTUAL N
RECORD OFFICER
NUEBE SERVICE COOPERATIVE
04/24/2018 06/24/2018 CASHIER PUREGOLD BORONGAN
7930.00 N/A CONTRACTUAL N

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 30,2020

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
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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
RURAL IMPACT SOURCING TECHNICAL TRAINING-DIGITAL MARKETING AND E- DEPARTMENT OF INFORMATION AND
09/18/2018 11/29/2018 248.0 TECHNICAL
COMMERCE COURSE COMMUNICATION TECHNOLOGY
TECHNICAL EDUCATION AND SKILLS
MASSAGE THERAPY 10/16/2017 01/20/2018 560.0 TECHNICAL
DEVELOPMENT AUTHORITY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A N/A

BASIC ADOBE PHOTOSHOP

DANCING

COOKING

BAKING

SEWING

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 30,2020

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? ________________________________
RESIGNATION
________________________________
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
ROSE MARIE N. LOSTE BORONGAN CITY,ESTERN SAMAR 9357020873 4.5 cm. X 3.5 cm
(passport size)

ELLEN GRACE S. ABUDE BORONGAN CITY,ESTERN SAMAR 9265435982

Computer generated
or photocopied picture
WILMA C. DE GRACIA CATBALOGAN,SAMAR 9057653012 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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/License/Passport No.: 1639242

Signature (Sign inside the box)
SEPTEMBER 30,2020
Date/Place of Issuance: TACLOBAN CITY JUNE 11,2018
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