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 TEOLULA
N/A
FIRST NAME RENATHEL

MIDDLE NAME VIGONTE

3. DATE OF BIRTH
March 24,1996 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH TACRAS, NARRA, PALAWAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS

Widowed House/Block/Lot No. Street

✘ Separate
N/A TACRAS
Other/s: d
Subdivision/Village Barangay
1.47m NARRA PALAWAN
7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) 39 KLS ZIP CODE
5303

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street

10. GSIS ID NO. N/A N/A TACRAS

Subdivision/Village Barangay

121236804958 NARRA PALAWAN

11. PAG-IBIG ID NO.
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 5303

09-202312981-9
N/A
13. SSS NO. 04-4147116-2 19. TELEPHONE NO.

14. TIN NO. 350-391-656-000 20. MOBILE NO. 09708108560

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) renathelteolula74@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A NAME EXTENSION (JR., SR) RENZ LIAM TEOLULA 1/25/2018

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME TEOLULA

FIRST NAME RENATO

MIDDLE NAME URBANO

MOTHERS MAIDEN NAME
25.

SURNAME VIGONTE

FIRST NAME THELMA

MIDDLE NAME LANTAP (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSH
26. NAME OF SCHOOL PERIOD OF ATTENDANCE
HIGHEST LEVEL/ YEAR IP/
BASIC EDUCATION/DEGREE/COURSE UNITS
LEVEL (Write in
(Write in full) EARNED GRADUA ACADEMIC
full) (if not graduated) TED HONORS
From To
RECEIVED
VALEDEC-
ELEMENTARY TACRAS, NARRA, PALAWAN N/A 6/3/2003 3/28/2009 2009 TORIAN
ARAMAYWAN, NATIONAL, 6/3/2009 3/28/2013 2013 N/A
SECONDARY
HIGHSCHOOL N/A
VOCATIONAL /

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

TRADE
COURSE REMNANT CHRISTIAN COLLEGES- BACHELOR OF SECONDARY
COLLEGE
PALAWAN EDUCATION MAJOR IN ENGLISH 6/13/2014 5/28/2018 2018 N/A

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

(Continue on separate sheet if necessary)

SIGNATURE RENATHEL VIGONTE TEOLULA DATE April 5, 2021

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

LISCENSURE EXAMINATION FOR TEACHER 81.0 1/30/2022 Palawan State University Puerto Princesa City 1909128 3/24/2025

N/A

N/A

N/A

N/A

N/A

N/A
(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)
6/1/2018 9/15/2018 COMPUTER ATTENDANT GH CYBERWORLD INTERNET CAFÉ 6000.00 CONTRACTUAL N

10/1/2018 8/24/2019 CUSTOMER SERVICE REPRESENTATIVE SITEL PALAWAN 9000.00 CONTRACTUAL N

Nothing follows

(Continue on separate sheet if necessary)

SIGNATURE RENATHEL VIGONTE TEOLULA DATE 04/05/2021

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

N/A

N/A

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

FIRE SAFETY AND PREVENTION SEMINAR 11/15/2018 11/15/2018 5.0 FIRE SAFTEY SITEL PALAWAN

PERSONAL COMPUTER OPERATION 03/8/20121 3/18/2021 80.0 TECHNICAL NITES

Nothing follows

(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)

CRITICAL THINKING GUEST SPEAKER ( 25TH GRADUATION CEREMONY at Tacras Elementary School) SOLO PARENT ORGANIZATION

COMMINICATION SKILLS Nothing follows Nothing follows

COMPUTER SKILLS

CREATIVITY

PATIENCE

TIME MANAGEMENT

ORGANIZATION
(Continue on separate sheet if necessary)

SIGNATURE RENATHEL VIGONTE TEOLULA DATE 4/5/2021

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? ________________________________End of Term
________________________________
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: PALAW-AN
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: N/A

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
AMY GALAURAN ABORLAN, PALAWAN 9503257022 4.5 cm. X 3.5 cm
(passport size)
FATIMA JANORAS ABORLAN PALAWAN 956637803
Computer generated
or photocopied picture
RICKY LABORDO SWORDS PUERTO PRINCESA CITY 9052819081 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: 09-202312981-9

ID/License/Passport No.:
Signature (Sign inside the box)
04/05/2021
Date/Place of Issuance: PUERTO PRINCESA CITY/2/20/2018
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