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 SUERTE
NAME EXTENSION (JR., SR)
FIRST NAME ROWENA

MIDDLE NAME BALANSAG

3. DATE OF BIRTH
(mm/dd/yyyy) 10/10/1976 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH NANGKA, DINAS ZAMBOANGA DEL SUR Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK 6

Widowed Separated House/Block/Lot No. Street
LABUYO
Other/s:
Subdivision/Village Barangay
TANGUB CITY MISAMIS OCCIDENTAL
7. HEIGHT (m) 5'2"
City/Municipality Province
8. WEIGHT (kg) 65kg ZIP CODE 7214

18. PERMANENT ADDRESS PUROK 6

9. BLOOD TYPE
House/Block/Lot No. Street
LABUYO
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO.

TANGUB MISAMIS OCCIDENTAL
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 7214

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 376-304-598 20. MOBILE NO. 0975-225-0793

15. AGENCY EMPLOYEE NO. CTO-J-00316 21. E-MAIL ADDRESS (if any) suerterowena06@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SUERTE 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME BENJIE JOHN RYCE BENJIE B. SUERTE 12/11/2002
MIDDLE NAME CAMPOMANES BEN CENON B. SUERTE 10-19-2015
OCCUPATION N/A

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME BALANSAG

NAME EXTENSION (JR., SR)
FIRST NAME CENON DECEASED
MIDDLE NAME GENOBIA

25. MOTHER'S MAIDEN NAME REBECCA DE CASTRO PRIETO

SURNAME ASOY

FIRST NAME ALICIA

MIDDLE NAME EBARIAL (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 LABUYO, ELEMENTARY SCHOOL PRIMARY 1988 1989 1989

TANGUB AGRO INDUSTRIAL
SECONDARY /
VOCATIONAL SECONDARY 1992 1993 1993
SCHOOL (TANAIS)

TRADE
GOV. ALFONSO D. TAN COLLEGE BACHELOR OF ARTS IN
COURSE
COLLEGE 1996 1997 1997
(GADTC) ECONOMICS
GRADUATE STUDIES N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 23, 2023

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

(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)

4/8/2022 PRESENT ADMINISTRATIVE AIDE-1 CITY TREASURER'S OFFICE 375/DAY JOB ORDER Y

10/6/2018 5/3/2022 (PSU) PUROK SERVICE UNIT BARANGAY LABUYO

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 23, 2023

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

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

(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

DANCING

WRITING

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 23, 2023

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
HON. LEONIDA C. TALA LABUYO, TANGUB CITY 9281978530 4.5 cm. X 3.5 cm
(passport size)

MISS. DIANA MAE O. NUNEZ ALORAN, MISAMIS OCCIDENTAL 9516532293

Computer generated
or photocopied picture
MRS. EULALIA DECINA STA. CRUZ, TANGUB CITY 9989836673 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: VOTER'S CERTIFICATION

ID/License/Passport No.: 42150072 AJ1076 RBS20000-5

Signature (Sign inside the box)

Date/Place of Issuance: 08-30-2022

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