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 NU ÑEZ
FIRST NAME IRENE NAME EXTENSION (JR., SR) N/A

MIDDLE NAME MANACHO

3. DATE OF BIRTH
16. CITIZENSHIP Dual Citizenship
(mm/dd/yyyy)
JANUARY 30, 1970 Filipino
by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, please Pls. indicate country:
MASBATE, MASBATE
indicate the details.
5. SEX Male Female
̸
Single Married 17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
House/Block/Lot No. Street
Widowe Separated
F. MAGALLANES
d Subdivision/Village Barangay
Other/s:

7. HEIGHT (m) 1.6 m MASBATE MASBATE

City/Municipality Province
ZIP CODE
8. WEIGHT (kg) 78 kg. 5400
18. PERMANENT ADDRESS
9. BLOOD TYPE
-O House/Block/Lot No. Street

10. GSIS ID NO. F. MAGALLANES

000-5081-0100-3 Subdivision/Village Barangay

11. PAG-IBIG ID NO. MASBATE MASBATE

1210-9759-4608 City/Municipality Province
ZIP CODE
12. PHILHEALTH NO. 5400
10-025008129-9
13. SSS NO. 19. TELEPHONE NO.
05-0810100-3 N/A
14. TIN NO. 20. MOBILE NO.
438 – 771 – 878 - 000 09091208889
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)
4659946 irene.nunez@deped.gov.ph.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NUÑEZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME NONILON N/A MARIAN JANNETH MANACHO NUÑEZ OCTOBER 06, 1991

MIDDLE NAME DE MESA IAN NEIL MANACHO NUÑEZ OCTOBER 29, 1992
OCCUPATION DRIVER NONIE LYN MANACHO NUÑEZ AUGUST 29, 1999
EMPLOYER/BUSINESS NAME N/A NONILON MANACHO NUÑEZ JR. NOVEMBER 30, 2000
BUSINESS ADDRESS N/A NORIELYN MANACHO NUÑEZ NOVEMBER 15, 2005
TELEPHONE NO. N/A
24. FATHER'S SURNAME MANACHO
NAME EXTENSION (JR., SR)
FIRST NAME ORLANDO N/A

MIDDLE NAME LLANTADA

25. MOTHER'S MAIDEN NAME

SURNAME DELARA
FIRST NAME
AURORA
SAURO (Continue on separate sheet if necessary)
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
SCHOLARSHIP/
26. PERIOD OF ATTENDANCE HIGHEST LEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS EARNED
HONORS
(Write in full) (Write in full) GRADUATED
(if not graduated)
From To RECEIVED

JOSE ZURBITO SR. ELEMENTARY

ELEMENTARY JUNE MARCH MARCH ACADEMIC
SCHOOL N/A
ELEMENTARY 1976 1982 1982 HONOR
(JZSES)
MASBATE NATIONAL COMPREHENSIVE JUNE MARCH MARCH
SECONDARY SECONDARY N/A N/A
HIGH SCHOOL (MNCHS) 1982 1986 1986

VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE
BACHELOR OF SCIENCE IN COMMERCE JUNE 1986 MARCH
COLLEGE MASBATE COLLEGES (MC) MAJOR IN ACCOUNTING (BSC major ACCTG.) 1990 N/A MARCH 1990
UNIVERSITY OF CEBU (UC) BACHELOR OF ELEMENTARY EDUCATION MARCH MARCH 1999 N/A
(BEED) JUNE 1995 1999

BACHELOR OF ARTS IN EDUCATION MARCH

GRADUATE STUDIES MASBATE COLLEGES (MC) JUNE 2009 45 UNITS N/A N/A
(MAED) 2017
(Continue on separate sheet if necessary)

SIGNATURE DATE
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 / Validity
CONFERMENT
JOSE ZURBITO SR. ELEMENTARY SCHOOL (JZSES),
LICENSURE EXAMINATION FOR TEACHERS (LET) 75% SEPTEMBER 30, 2012 1186412 12/5/2012
MASBATE CITY

LAND TRANSPORTATION OFFICE

DRIVING TEST 85% JULY 2020 EO3-20-002291 07/2020
(LTO)

(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 MONTHL STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) Y (Format "00-0")/
APPOINTMENT
(Y/ N)
From To SALARY INCREMENT
DEPARTMENT OF EDUCATION, LUCIANO A.
JUNE 24, 2013 PRESENT TEACHER III CONDE ELEMENTARY SCHOOL, MOBO SOUTH 29,798.00 13 - 0 PERMANENT Y
DISTRICT
JANUARY TEACHER N. DELOS SANTOS ELEMENTARY SCHOOL,
MARCH 2013 5,000.00 N/A CONTRUCTUAL Y
2013 (LOCAL SCHOOL BOARD – LSB) MASBATE CITY

JUNE 2009 MARCH 2012 PRIVATE SCHOOL TEACHER MASBATE COLLEGES 6,500.00 N/A PARTIME N

(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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

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. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
January 31, February 5,
2022 School – Based In Training Service for Teachers (INSET) 48 hours Technical DepEd – Masbate Province, Mobo South -School
2022 2022

District Training Innovation March 22, 2022 March 22, 2022 8 hours Technical DepEd– Masbate Province, Mobo South -District

District Training on Basic Research April 25, 2022 April 25, 2022 8 hours Technical DepEd– Masbate Province, Mobo South -District

2021 School – Based in – Service Training for Teachers (INSET) March 15, 2021 March 19, 2021 40 hours Technical DepEd – Masbate Province, Mobo South -School

Training – Workshop of School Brigada Pagbasa Key Teacher July 12, 2021 July 12, 2021 8 hours Technical DepEd– Masbate Province, Mobo South -District

October 28, October 30,

2021 – International Conference on Education, Innovations and Community Development 24 hours Technical Bicol University , Legaspi City
2021 2021
November 9, November 10,
District Training Workshop on Teaching Grammar Communicatively 16 hours Technical DepEd– Masbate Province, Mobo South -District
2021 2021
November 29, December 03,
Pampaaralang Palihang Panliteral sa Filipino 40 hours Technical DepEd – Masbate Province, Mobo South -School
2021 2021
December 27, December 27,
District School Management Monitoring and Evaluation (SMEA) Technology Orientation 8 hours Technical DepEd– Masbate Province, Mobo South -District
2021 2021
Tanom Dunong: A DIVISION WEBINAR series on GPP Capacity Enhancement for Teacher
Episode 1 July 20, 2020 July 20, 2020 8 hours Technical DepEd– Masbate Province, Mobo South -Division

DepEd– Masbate Province, Mobo South -Division,

SHIELD II: A Strong Threshold for Modular Distance Learning Modality August 8, 2020 August 8, 2020 8 hours Technical
Masbate FB page
September 28, September 28,
Virtual Orientation on the SBFP Operational Guidelines for sy 2020 - 2021 8 hours Technical DepEd – SDO Masbate Province
2020 2020
December 14, December 18,
2020 School – Based In – Service Training for Teachers (INSET) 40 hours Technical DepEd – Masbate Province, Mobo South -School
2020 2020
August 13,
Accreditation Training on Coaches and Officiating Officials August 13, 2019 8 hours Technical DepEd– Masbate Province,
2019
October 21, October 25,
District In Service Training 2019 40 hours Technical DepEd– Masbate Province, Mobo South -District
2019 2019

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Sports – Truck and Filed N/A N/A

Computer Literacy

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 appointed̸,
a. within the third degree? YES NO
b. within the fourth degree (for Local Government Unit - Career Employees)?
YES NO
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 YES NO
or tribunal? If YES, give details:

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped YES NO
from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public If YES, give details:
or private sector?
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay
YES NO
election)? If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last election YES NO
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.

BAPTIST CHURCH, MABINI ID picture taken within
PSTR. WELLIAM SAHAGUN the last 6 months
MASBATE CITY
3.5 cm. X 4.5 cm
ISIDRO M. TUGBO MOBO, MASBATE (passport size)

With full and handwritten name

BRGY. CAPT. ISIDRO DE MESA IV BRGY. MARINTOC, MOBO, MASBATE tag and signature over 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 or
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize photocopied picture is
the agency head/authorized representative to verify/validate the contents stated herein. I agree that any misrepresentation made not acceptable

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: 000-5081-0100-3

ID/License/Passport No.: GSIS Signature (Sign inside the box)

Date/Place of Issuance:2013, MASBATE 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