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 SORIAO
NAME EXTENSION (JR., SR)
FIRST NAME RACHELLE ANN

MIDDLE NAME LUNAS

3. DATE OF BIRTH
(mm/dd/yyyy) 4/15/1986 16. CITIZENSHIP
✘

4. PLACE OF BIRTH DARAGA, ALBAY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘

✘ 17. RESIDENTIAL ADDRESS 8TH ST

6 CIVIL STATUS
House/Block/Lot No. Street
OLV PANGPANG
Subdivision/Village Barangay
SORSOGON SORSOGON
7. HEIGHT (m) 1.51m
City/Municipality Province
8. WEIGHT (kg) 56kg ZIP CODE 4700

18. PERMANENT ADDRESS 8TH ST

9. BLOOD TYPE o
House/Block/Lot No. Street
OLV PANGPANG
10. GSIS ID NO. n/a
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A SORSOGON SORSOGON

City/Municipality Province

12. PHILHEALTH NO. 10-050-106627 ZIP CODE 4700

13. SSS NO. 05-0654-3414 19. TELEPHONE NO. 056-255-0328

14. TIN NO. 45-795-1731 20. MOBILE NO. 09099209031

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) annrachellunas@gmail.com
SORIAO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) RENE JIAN MAAT L. SORIAO
RENE JOSEPH 9/19/2008

MIDDLE NAME ABLEN RENA ELIJAH NAHEIL L. SORIAO 1/24/2015

OCCUPATION NURSE RENE JADEN CARL L. SORIAO 3/21/2017

EMPLOYER/BUSINESS NAME QUALIMED INCORPORATION MARIA KIRSTEN DAWN L. SORIAO 11/1/2019

BUSINESS ADDRESS QUEZON CITY, PHILIPPINES ANN THERESE FAYE L. SORIAO 9/24/2021

TELEPHONE NO. N/A

24. FATHER'S SURNAME LUNAS

NAME EXTENSION (JR., SR)
FIRST NAME RODOLFO

MIDDLE NAME LUDOVICE

25. MOTHER'S MAIDEN NAME

SURNAME MEDALLA

FIRST NAME ANTEA

MIDDLE NAME MIRANDA (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 DARAGA NORTH CENTRAL SCHOOL ELEMENTARY GRADUATE 1992 1998 N/A 1998 N/A

SECONDARY /
VOCATIONAL DARAGA NATIONAL HIGH SCHOOL HIGH SCHOOL GRADUATE 1998 2002 N/A 2002 N/A

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

TRADE
BICOL UNIVERSITY COOLLEGE OF
COURSE
COLLEGE BS FORESTRY 2002 2006 N/A 2006 N/A
AGRICULTURE AND FORESTRY
BICOL UNIVERSITY COLLEGE OF
GRADUATE STUDIES CERTIFICATE IN COLLEGE TEACHING 2010 2011 N/A 2011 N/A
EDUCATION
(Continue on separate sheet if necessary)

SIGNATURE DATE
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
RA 1080 LICENSURE EXAMINATION FOR
76.8 9/1/2012 DIVINE WORD COLLEGE OF LEGAZPI 1277470 4/15/2025
TEACHERS

(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)
COMMUNITY EMPOWERMENT DEPARTMENT OF SOCIAL WELFARE AND
9/2/2014 12/31/2017 26529.00 13 MOA Y
FACILITATOR DEVELOPMENT

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
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
TECHNICAL EDUCATION AND SKILLS
PERFORM MANICURE, PEDICURE, HAND SPA AND FOOT SPA 2/11/2019 2/15/2019 40.0 TECHNICAL
DEVELOPMENT AUTHORITY
PRODUCE ORGANIC FERTILIZERS (LEADING TO ORGANIC AGRICULTURE PRODUCTION TECHNICAL EDUCATION AND SKILLS
1/9/2018 1/14/2018 40.0 AGRICULTURE
NCII) DEVELOPMENT AUTHORITY
TECHNICAL EDUCATION AND SKILLS
PRODUCE ORGANIC VEGETABLES (LEADING TO ORGANIC AGRICULTURE PRODUCTION
NCII)
12/4/2017 12/9/2017 40.0 AGRICULTURE DEVELOPMENT AUTHORITY
COMMUNITY ORGANIZING, COMMUNITY DEVELOPMENT AND PROCUREMENT TRAINING COMMUNITY DEPARTMENT OF SOCIAL WELFARE
1/8/2016 1/6/2016 40.0
FOR COMMNUNITY EMPOWERMENT FACILITATOR ORGANIZING AND DEVELOPMENT

(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)

COMMUNITY ORGANIZING N/A N/A

ARTS AND CRAFTS

(Continue on separate sheet if necessary)

SIGNATURE DATE
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? ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? ✘

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘

If YES, give details:

________________________________
________________________________
b. Have you been criminally charged before any court? ✘

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 ✘
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, ✘
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 ✘
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the 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? ✘

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? ✘
If YES, please specify:
b. Are you a person with disability? ✘
If YES, please specify ID No:
c. Are you a solo parent? ✘
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
CHARLOTTE L. CERVANTES CRUZADA LEGAZPI CITY 09552163127 4.5 cm. X 3.5 cm
(passport size)

REYNANTE C. MILLENA DINORONAN, DARAGA, ALBAY 09277372599

Computer generated
or photocopied picture
JANICE D. YGONA PANGPANG SORSOGON CITY 09480250982 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: PRC

ID/License/Passport No.: 1277470

Signature (Sign inside the box)

Date/Place of Issuance: 12/21/2012 LEGAZPI CITY

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