CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shal l cause the fi li ng of administra ti ve/crimina l case/s
agai nst the person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOM PLISHING THE PDS FORM .
Print legibly. Tick appropriate box es ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIAT E. 1. CS ID No. (Do not fill up. For CSC use only )

I. PERSONAL INFORMATION
2. SURNAME VILLANUEVA
NAM E EXTENS ION (J R ., S R ) N/A
FIRST NAME MARK CESAR

MIDDLE NAME ROSALES

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/y y y y ) 07/27/1996 Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CATARMAN NORTHERN SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PUROK # 1 ESCAREAL ST.

6 CIVIL STATUS
Widowed Separated
House/Block/Lot No. Street
DALAKIT
Other/s:
Subdivision/Village Barangay
CATARMAN NORTHERN SAMAR
7. HEIGHT (m) 1.65
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 6400
18. PERMANENT ADDRESS PUROK # 1 ESCAREAL ST.
9. BLOOD TYPE B
House/Block/Lot No. Street
DALAKIT
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CATARMAN NORTHERN SAMAR
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 13-0502054486-5 ZIP CODE 6400

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

14. TIN NO. 457-206-587-000 20. MOBILE NO. 09776919796

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any ) villanuevasase@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/y y y y )
FIRST NAME N/A
NAME N/A N/A N/A
EXTENS ION
(J R ., S R )
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME VILLANUEVA
NAME EXTENS ION (J R., S R )
FIRST NAME CESAR JR
MIDDLE NAME SALAZAR
25. MOTHER'S MAIDEN NAME

SURNAME VILLANUEVA
FIRST NAME LOVELLA MARINO ROSALES
MIDDLE NAME ROSALES (Con tinue on separ ate sheet if necessary)

III. EDUCATIONAL BACKGROUND

S C HOLAR S HI
P ER IOD OF HIGHES T LEVEL/ YEAR P/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE
LEVEL ATTENDANC E UNITS EAR NED GR ADUATE AC ADEM IC
(Write in full) (Write in full) (if no t gra dua ted) D HONOR S
From To R EC EIVED

CATARMAN III CENTRAL

ELEMENTARY ELEMENTARY 2003 2009 N/A 2009 N/A
SCHOOL
CATARMAN NATIONAL HIGH
SECONDARY SECONDARY 2009 2013 N/A 2013 N/A
SCHOOL
VOCATIONAL / SAINT ANTHONY FARM INSTITUTE BREAD AND PASTRY
N/A N/A N/A 2018 N/A
TRADE COURSE AND TECHNOLOGY PRODUCTION NC II
UNIVERSITY OF EASTERN BACHELOR OF ARTS IN LANGUAGE
COLLEGE 2013 2017 N/A 2017 N/A
PHILIPPINES AND LITERATURE TEACHING

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

(Continue o n separate sheet if necessary)
SIGNATURE DATE JUNE 07, 2023

C S FOR M 212 (R evis e d 2017), P age 1 o f 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 CONFERMENT Validity

LICENSURE EXAMINATION FOR TEACHERS (LET) 75.00% 9/24/2017 CATARMAN NORTHERN SAMAR 1570897 7/27/2023

(Con tinue on separ ate 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.
SALARY/ JOB/
28. INCLUSIVE DATES PAY GRADE (if
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY M ONTHLY GOV'T
(mm/dd/y y y y ) ap p licab le)& S TATUS OF
S ER VIC E
(Write in full/Do not abbrev iate) (Write in full/Do not abbrev iate) S ALAR Y STEP (Fo rmat AP P OINTM ENT
" 0 0 -0 ")/
(Y/ N)
From To INC REM ENT

6/3/2018 PRESENT Junior High School Teacher Northern Samar Colleges 11,000 N/A CONTRACTUAL N

(Continue on separ ate sheet if necessary)

SIGNATURE DATE JUNE 07, 2023

C S FOR M 212 (R e v is e d 2017), P age 2 o f 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. NUMBER OF
(Write in full) (mm/dd/y y y y ) POSITION / NATURE OF WORK
HOURS
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 m ost 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 o f LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE NUMBER OF ( M ana ge ria l/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/y y y y ) HOURS S upervis o ry/ (Write in full)
Te c hnic al/etc)
From To
SAINT ANTHONY FARM INSTITUTE AND
BREAD AND PASTRY PRODUCTION NC II 8/1/2018 5/3/2018 141 N/A
TECHNOLOGY
MIND/BRIDGE THE GAPS: INSTRUCTIONAL SOLUTIONS AND STRATEGIES TO IDENTIFY
4/17/23 4/18/23 16 N/A PHOENIX PUBLISHING HOUSE
AND ADDRESS LEARNING GAPS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ASSOCIATION/ORGANIZ
(Write in full)
ATION
COMPUTER LITERATE N/A N/A

BOOK ENTHUSIAST N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 07, 2023

CS FOR M 212 (R ev is e d 2017), P age 3 o f 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 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
YES NO
regulation 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 YES NO
last 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
JOHN ALLEN BERBON ALLEN, NORTHERN SAMAR 9171445933 3.5 cm. X 4.5 cm
(passport size)

GEMMA TAN CATARMAN, NORTHERN SAMAR With f ull and handwritten

name tag and signature ov er
printed name
FELIX LADEñO CATARMAN NORT HERN SAMAR
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 .P a s s po rt, GS IS , S S S , P R C , Drive r's

Lic e ns e , e tc .) PLEASE INDICATE ID Number
Gov ernment Issued ID: PRC

ID/License/Passport No.: 1570897

Signature (Sign inside the box )

Date/Place of Issuance: 12/11/2017 / TA CL OBAN

JUNE 07, 2023
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

C S FOR M 212 (R e v is e d 2017), P age 4 o f 4