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 NUÑEZ
NAME EXTENSION (JR., SR)
FIRST NAME RHEA

MIDDLE NAME DELEGENCIA

3. DATE OF BIRTH
NOVEMBER 08, 1987 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH MASINLOC, ZAMBALES If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 180 A BONIFACIO

Widowed House/Block/Lot No. Street

Separate
VETERANS PASONG TAMO
Other/s: d
Subdivision/Village Barangay
QUEZON CITY METRO MANILA
7. HEIGHT (m) 1.55 meters
City/Municipality Province
8. WEIGHT (kg) 67 kilograms ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
SAN SALVADOR
10. GSIS ID NO. 2004182867
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121006596574 MASINLOC ZAMBALES

City/Municipality Province

12. PHILHEALTH NO. 02-050583400-4 ZIP CODE 2211

13. SSS NO. 3421808150 19. TELEPHONE NO. 288124531

14. TIN NO. 295-402-719 20. MOBILE NO. 9330356766

15. AGENCY EMPLOYEE NO. 4632922 21. E-MAIL ADDRESS (if any) rhea.nunez@depedqc.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)

FIRST NAME GEORGE MARSHALL

NAME EXTENSION (JR., SR) GEORGE MARSHALL D. NUÑEZ II 10/20/2017

MIDDLE NAME CARIÑO LUCAS JIREH D. NUÑEZ 10/29/2020

OCCUPATION N/A

EMPLOYER/BUSINESS NAME GEORGE MARSHALL C NUNEZ DELIVERY SERVICES

BUSINESS ADDRESS CAPRICORN ST. CARMEL 5, TANDANG SORA, QUEZON CITY

TELEPHONE NO. 9566303040

24. FATHER'S SURNAME DELEGENCIA

NAME EXTENSION (JR., SR)
FIRST NAME FLORO

MIDDLE NAME INOC

25. MOTHER'S MAIDEN NAME

SURNAME ABULAG

FIRST NAME AMALIA

MIDDLE NAME DUMARAN (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY SAN SALVADOR ELEMENTARY SCHOOL PRIMARY EDUCATION 1994 2000

SECONDARY /
VOCATIONAL SAN ANDRES SCHOOL OF MASINLOC SECONDARY EDUCATION 2000 2004

TRADE
COURSE BACHELOR OF ARTS IN THEOLOGY MAJOR IN
COLLEGE FEBIAS COLLEGE OF BIBLE
CHRISTIAN EDUCATION
2005 2010

GUIDANCE AND COUNSELLING EDUCATIONAL 2010, 2022- CERT OF ACADEMIC

GRADUATE STUDIES PACE GRADUATE STUDIES 2011, 2014
MANAGEMENT present REQS

(Continue on separate sheet if necessary)

SIGNATURE DATE May 22, 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

PRC LICENSE 75.0 10/12/2010 UNIVERSITY OF THE EAST MANILA 1073674 8/11/2024

(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)

5/3/2012 PRESENT TEACHER 2 MANUEL A. ROXAS HIGH SCHOOL 29449.00 PERMANENT YES

1/6/2010 1/4/2011 TEACHER CALOOCAN EVANGELICAL SCHOOL INC. 6000.00 CONTRACTUAL NO

(Continue on separate sheet if necessary)

SIGNATURE DATE May 22, 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
(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

In-Service Training for Teachers 2/2/2023 10/2/2023 40

Manuel A. Roxas High School

Virtual In-Service Training for Teachers 08/30/2021 3/9/2021 40 Department of Education - National
Information and Communications Technology Service in
Three-day Free International Multidisciplinary Webinar Series on the Use of Technology and its collaboration with Global Educators Network Association
06/30/2021 2/7/2021 24
Application in Different Subject Areas with a Special Session on Mental Health Issues of Teachers as a Foreign Language (GENTFL),
Thailand
Information and Communications Technology Unit
Virtual In- Service Training for Public School Teachers 03/15/2021 03/19/2021 40
(ICTS-EdTech)
Virtual In- Service Training for Teachers, "Revisiting and Up skilling the Technological
10/8/2020 08/14/2020 40
Competencies of Teachers" Manuel A. Roxas High School
Virtual In- Service Training for Teachers, "MRHS Bayanihan: Responding to the Call and Needs
8/6/2020 11/6/2020 40
for Education Amidst the Global Pandemic " Manuel A. Roxas High School
Division of City Schools, Quezon City and GENDER Education
Gender Mainstreaming Training of Trainers 10/21/2019 10/25/2019 34 for National Development and Recovery
Division Learning Action Cell for Edukasyon sa Pagpapakatao Department Heads and
11/20/2018 11/21/2018 16 Division of City Schools, Quezon City
Coordinators through the Divion LAC Session and Research

In- Service Training for Teachers 10/22/2018 10/26/2018 40

Manuel A. Roxas High School
SEMINAR/WORKSHOP during Learning Action Cell (LAC) Sessions for Grades 7- 10 and Senior
09/23, 09/26, 10/03/2018 24
High School SY 2018- 2019 Manuel A. Roxas High 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)

(Continue on separate sheet if necessary)

SIGNATURE DATE May 22, 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? ________________________________
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:
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
UNIT 18 CAPRICORN ST, TANDANG the last 6 months
HANILITA R. YSULAT SORA, QUEZON CITY
9273811083 3.5 cm. X 4.5 cm
(passport size)
47 FELIX MANALO STREET, CUBAO,
MARBIN M. PELAYO QUEZON CITY
9228394718 With full and handwritten
name tag and signature over
printed name

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: PRC

ID/License/Passport No.: 1073674

Signature (Sign inside the box)
MAY 22, 2023
Date/Place of Issuance: DECEMBER 10, 2010
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