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 VILLASANA
NAME EXTENSION (JR., SR) N.A.
FIRST NAME JANET

MIDDLE NAME FLORENO

3. DATE OF BIRTH
(mm/dd/yyyy) 3/23/1972 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MASAGUD ,SAN JOAQUIN, ILOILO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS Block 11 lot 12 Phase F

Widowed House/Block/Lot No. Street

Separated Francisco Homes Narra
Other/s:
Subdivision/Village Barangay
San Jose Del Monte Bulacan
7. HEIGHT (m) 1.55 m
City/Municipality Province
8. WEIGHT (kg) 60kg ZIP CODE 3023

18. PERMANENT ADDRESS Block 11 lot 12 Phase F

9. BLOOD TYPE O
House/Block/Lot No. Street
Francisco Homes Narra
10. GSIS ID NO.
Subdivision/Village Barangay
San Jose Del Monte Bulacan
11. PAG-IBIG ID NO. 030243517807
City/Municipality Province

12. PHILHEALTH NO. 190265886144 ZIP CODE 3023

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

14. TIN NO. 185-862-964 20. MOBILE NO. 09274683526

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
4272246 21. E-MAIL ADDRESS (if any) janet.villasana1972@gmail.com
VILLASANA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N.A DEMI NATALIE FLORENO VILLASANA
CHARLIE 4/23/2001

MIDDLE NAME EVANGELISTA LOUISE STEPHANY FLORENO VILLASANA 6/13/2002

OCCUPATION OFW CHARLEMAGNE FLORENO VILLASANA 1/13/2005

EMPLOYER/BUSINESS NAME DALE WINE

BUSINESS ADDRESS Valleyview Alberta Canada

TELEPHONE NO. N.A.

24. FATHER'S SURNAME FLORENO

NAME EXTENSION (JR., SR) N.A
FIRST NAME DEMETRIO

MIDDLE NAME SASDANE

25. MOTHER'S MAIDEN NAME

SURNAME GERAFIL

FIRST NAME NATIVIDAD

MIDDLE NAME GEOLLEGUE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY CABASI - STA ROSA ELEMENTARY SCHOOL PRIMARY EDUCATION 1979 1985 GRADUATED 1985 N.A.

SECONDARY /
VOCATIONAL GUIMBAL HIGH SCHOOL HIGH SCHOOL 1985 1989 GRADUATED 1989 N.A.

N.A. N. A. N.A N.A N.A N.A N.A.

TRADE
WESTERN VISAYAS COLLEGE OF SCIENCE AND
COURSE
COLLEGE
TECHNOLOGY
BACHELOR OF ELEMENTARY EDUCATION 1989 1993 GRADUATED 1993 N.A.

GRADUATE STUDIES UNIVERSITY OF CALOOCAN MASTER OF ARTS IN SCIENCE EDUCATION 1998 1999 24 UNITS N.A N.A.
(Continue on separate sheet if necessary)

SIGNATURE DATE May 2, 2017

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

PROFESSIONAL BOARD FOR TEACHERS 70.4 MAY 1995 QUEZON CITY 0137152

(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)
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
1/1/2017 present TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P20,811 11-6 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
1/1/2016 12/31/2016 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P20,142 11 -6 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
1/9/2013 12/31/2015 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P19,495 11 - 6 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
6/1/2012 1/8/2013 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P19,302 11-6 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
6/1/2011 5/31/2012 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P17,994 11 -5 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
6/24/2010 5/31/2011 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P16,687 11-5 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
1/9/2010 6/23/2010 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P15,379 11-5 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY OF SAN JOSE DEL
10/12/2009 1/8/2010 TEACHER 1 MONTE FRANCISCO HOMES ELEMENTARY SCHOOL P15,072 11-5 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
7/1/2009 10/11/2009 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P15,072 11-5 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
7/1/2008 6/30/2009 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P12951 11-4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
7/1/2007 6/30/2008 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P11,774 11-4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
1/9/2007 6/30/2007 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P10,704 11-4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
1/9/2004 1/8/2007 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P10,442 11-4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
7/1/2001 1/8/2004 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P10,188 11-4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
1/9/2001 6/30/2001 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P9,703 11 - 4 PERMANENT YES
DEPARTMENT OF EDUCATION DIVISION OF CITY SCHOOLS CALOOCAN
1/1/2000 1/8/2001 TEACHER 1 CAMARIN ELEMENTARY SCHOOL P9,466 10-0 PERMANENT YES
DEPARTMENT OF EDUCATION CULTURE AND SPORTS DIVISION OF
1/9/1998 12/31/1999 TEACHER 1 CITY SCHOOLS CALOOCAN CAMARIN ELEMENTARY SCHOOL P8,605 10-0 PERMANENT YES
DEPARTMENT OF EDUCATION CULTURE AND SPORTS DIVISION OF
9/1/1997 12/19/1997 TEACHER 1 CITY SCHOOLS CALOOCAN CAMARIN ELEMENTARY SCHOOL P7,309 10-0 SUBSTITUTE YES
DEPARTMENT OF EDUCATION CULTURE AND SPORTS DIVISION OF
8/1/1997 8/31/1997 TEACHER 1 CITY SCHOOLS CALOOCAN CAMARIN ELEMENTARY SCHOOL P7,309 10-0 SUBSTITUTE YES
DEPARTMENT OF EDUCATION CULTURE AND SPORTS DIVISION OF
7/7/1997 7/31/1997 TEACHER 1 CITY SCHOOLS CALOOCAN CAMARIN ELEMENTARY SCHOOL P7,309 10-0 SUBSTITUTE YES

(Continue on separate sheet if necessary)

SIGNATURE DATE 5/2/2017

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
(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

IN-SERVICE TRAINING SEMINAR FOR TEACHERS 10/24/2016 10/28/2016 40 TECHNICAL FRANCISCO HOMES ELEMENTARY SCHOOL

IN-SERVICE TRAINING SEMINAR FOR TEACHERS 10/26/2015 10/30/2015 40 TECHNICAL FRANCISCO HOMES ELEMENTARY
SCHOOL

IN-SERVICE TRAINING SEMINAR FOR TEACHERS 10/20/2014 10/24/2014 40 TECHNICAL FRANCISCO HOMES ELEMENTARY SCHOOL

(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)

COOKING ,SEWING N.A. SCHOOL FACULTY CLUB

TEACHER'S DIGNITY COALITION

GOVERNMENT SECURITY INSURANCE
SERVICES
PUBLIC SCHOOLS TEACHERS AND
EMPLOYEES ASSOCIATION
RONDALYA

(Continue on separate sheet if necessary)

SIGNATURE DATE 5/2/2017

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
LILYBETH D .DASCO FRANCISCO HOMES ELEM. SCHOOL 9176645053 3.5 cm. X 4.5 cm
(passport size)

RAUL G .PANIMBATAN TOWERVILLE ELEM. SCHOOL 9178411383 With full and handwritten
name tag and signature over
printed name
FLORDELIZA M. LIMON TUNGKONG MANGGA ELEM. SCHOOL 9178411490
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: GSIS UMID CRN 006-0091-2093-0

ID/License/Passport No.: ECO641319

Signature (Sign inside the box)
5 /2 2017
Date/Place of Issuance: CUBAO QUEZON CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

JANE D. RIGOR
Person Administering Oath/ Administrative Officer IV

CS FORM 212 (Revised 2017), Page 4 of 4