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 EMPAG
NAME EXTENSION (JR,SR.) N/A
FIRST NAME RONA

MIDDLE NAME CESISTA

3. DATE OF BIRTH
(mm/dd/yyyy) 04/10/1976 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH LAS NAVAS, NORTHERN SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS N/A H. JOLEJOLE ST.
Widowed Separated House/Block/Lot No. Street
N/A H. JOLEJOLE POBLACION
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.55 m LAS NAVAS NORTHERN SAMAR
City/Municipality Province
8. WEIGHT (kg) 53 kg ZIP CODE 6420

9. BLOOD TYPE O
18. PERMANENT ADDRESS N/A H.JOLEJOLE STREET
House/Block/Lot No. Street
10. GSIS ID NO. 2004121624
N/A H.JOLEJOLE POBLACION
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-0961-9045 LAS NAVAS NORTHERN SAMAR

City/Municipality Province

12. PHILHEALTH NO. 132010936490 ZIP CODE 6420

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

14. TIN NO. 408-567-663-000 20. MOBILE NO. 09456545115

15. AGENCY EMPLOYEE NO. 4554086 21. E-MAIL ADDRESS (if any) rona.empag2@deped.gov .ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME EMPAG 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION(JR.SR.)N/A SALVACION MA. MIKAELA C. EMPAG
FIRST NAME AIREL 06/20/1999

MIDDLE NAME PLATON SEAN ANTHONY C. EMPAG 11/18/2002

OCCUPATION PAINTER PRINCESS AYIENA MAY C. EMPAG 05/07/2006

EMPLOYER/BUSINESS NAME AYE EMPAG ART AND SIGN

BUSINESS ADDRESS LAS NAVAS NORTHERN SAMAR

TELEPHONE NO. N/A

24. FATHER'S SURNAME CESISTA

NAME EXTENSION(JR.SR.)N/A
FIRST NAME PEDRO

MIDDLE NAME LOPEGA

25. MOTHER'S MAIDEN NAME

SURNAME OLINAN

FIRST NAME NENA

MIDDLE NAME ONG (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 LAS NAVAS CENTRAL ELEMENTARY SCHOOL ELEMENTARY 1982 1988 N/A 1988 N/A

SECONDARY LAS NAVAS AGRO INDUSTRIAL SCHOOL HIGH SCHOOL 1988 1992 N/A 1992 N/A

VOCATIONAL/TRADE TECHNICAL EDUCATION AND SKILLS DRESSMAKING/TRAINERS METHODOLOGY

COURSE DEVELOPMENT AUTHORITY COURSE LEVEL -I
2009 2009 N/A 2009 N/A

ACADEMIC
COLLEGE COLEGIO DE LAS NAVAS BACHELOR OF SECONDARY EDUCATION 2005 2009 N/A 2009 EXCELLENCE

MASTER OF ARTS IN EDUCATION Major in

GRADUATE STUDIES UNIVERSITY OF EASTERN PHILIPPINES
Administration & Supervision
2012 2013 33 units N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 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

Licensure Examination for Teachers (LET) 76. 8% 04/18/2010 UNIVERSITY OF THE EAST- MANILA 1061553 04/10/2024

(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)
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2023 PRESENT HEAD TEACHER II 36619.00 15-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2022 12/31/2022 HEAD TEACHER II 35097.00 15-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
11/252021 12/31/2021 HEAD TEACHER II 33575.00 15-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2021 11/24/2021 HEAD TEACHER I 30799.00 14-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
02/24/2020 12/31/2020 HEAD TEACHER I 29277.00 14-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2020 02/23/2020 TEACHER III/TIC 26754.00 13-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2019 12/31/2019 TEACHER III/TIC 25232.00 13-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2018 12/31/2018 TEACHER III/TIC 24224.00 13-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT of EDUCATION LAS REGULAR/
06/09/2017 12/31/2017 TEACHER III/TIC 23257.00 13-1 PERMANENT Y
NAVAS II DISTRICT
DEPARTMENT of EDUCATION LAS REGULAR/
01/01/2017 06/08/2017 TEACHER III 23257.00 13-1 PERMANENT Y
NAVAS II DISTRICT
DEPARTMENT of EDUCATION LAS REGULAR/
01/20/2016 12/31/2016 TEACHER III 22328.00 13-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT Of EDUCATION LAS REGULAR/
01/01/2016 01/19/2016 TEACHER III 19077.00 13-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT Of EDUCATION LAS REGULAR/
06/1/2012 12/31/2015 TEACHER I 18549.00 11-2 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT Of EDUCATION LAS REGULAR/
06/15/2011 05/31/2012 TEACHER I 17099.00 11-1 Y
NAVAS II DISTRICT PERMANENT
DEPARTMENT Of EDUCATION LAS
02/09/2011 03/03/2011 TEACHER I 15649.00 11-1 SUBSTITUTE Y
NAVAS II DISTRICT
07/10/2010 01/31/2011 TEACHER COLEGIO DE LAS NAVAS 4000.00 N/A CONTRACTUAL Y

(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

KABALIKAT CIVICOM NORTHERN SAMAR COUNCIL 892 LAS NAVAS CHAPTER 07/11/2016 PRESENT N/A MEMBER/ASSISTANCE/RESCUE
(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
Capability Building on Teachers Learning and Development Needs-cum Deped Policies & Priority
01/24/2024 01/26/2024 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION
Programs

UPSKILLING OF SCHOOL HEADS ON ELLN WITH FOCUS ON THE SCIENCE OF READING (ELLN-SOR) 12/10/2023 12/14/2023 40 HOURS TECHNICAL DEPARTMENT OF EDUCATION
SIMULTANEOUS REFRESHER COURSE ON THE CONDUCT ON THE DIFFERENT SPORTS
EVENTS FOR TOURNAMANT MANAGERS OFFICIATINFFOFFICIALS COACHES AND 03/07/2023 03/09/2023 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION
ASSISTANT COACHES
INSET;REVITALIZING PROFESSIONAL DEVELOPMENT STRATEGY FOR THE IMPROVEMENT OF TEACHING AND
LEARNING PROCESS
02/08/2023 02/10/2023 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

WRITER/DEVELOPER RESOURCE PACKAGE DEVELOPMENT FOR THE PRIORITY LEARNING NEEDS

OF SENIOR HIGH SCHOOL TEACHERS
12/12/2022 12/14/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

LEARNING SESSIONS ON POSITIVE DISCIPLINE IN THE CLASSROOMS 10/04/2022 10/07/2022 32 HOURS TECHNICAL DEPARTMENT OF EDUCATION

WRITER/DEVELOPER RESOURCE PACKAGE DEVELOPMENT FOR THE PRIORITY LEARNING NEEDS

OF SCHOOL DISBURSING OFFICERS AND BOOKKEEPERS
09/26/2022 09/28/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

ALPHA TESTING OF THE DEVELOPED LEARNING PACKAGE FOR THE PRIORITY LEARNING NEEDS
OF THE NON TEACHING AND TEACHING RELATED PERSONNEL
06/01/2022 06/03/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

CAPABILITY BUILDING ON L&D AND SUBSYSTEMS CUM ORIENTATION ON IPBT 05/25/2022 05/27/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

ADMINISTRATION OF PHIL-IRI AND RRE LESSON PANNING )TRAINING PROPONENT) 04/27/2022 04/29/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

ACTION RESEARCH MIXED METHODS WRITESHOP AND PAPER PRESENTATION OF DEPED

EMPLOYEES
03/02/2022 03/04/2022 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

WRITER/DEVELOPER RESOURCE PACKAGE DEVELOPMENT FOR THE PRIORITY LEARNING NEEDS

OF THE NON TEACHING AND TEACHING RELATED PERSONNEL
10/26/2021 10/28/2021 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

LUNDUYAN SA KAHUSAYAN PROGRAM FOR SCHOOL HEADS 04/18/2022 05/27/2022 50 HOURS TECHNICAL DEPARTMENT OF EDUCATION

MICROSOFT VIRTUAL CARAVAN 04/13/2021 04/14/2021 14 HOURS TECHNICAL DEPARTMENT OF EDUCATION

IMPACTS OF THE NEW NORMAL ON MENTAL WELL BEING; A DISCUSSION WITH TACHERS AND
LEARNERS
03/25/2021 03/25/2021 8 HOURS TECHNICAL DEPARTMENT OF EDUCATION

FIRST SPACE SUMMIT IN THE PHILIPPINES 03/24/2021 03/24/2021 8 HOURS TECHNICAL DEPARTMENT OF EDUCATION

DIVISION ORIENTATION ON PPSSH AND PPSS 03/22/2021 03/22/2021 8 HOURS TECHNICAL DEPARTMENT OF EDUCATION

STRAND INTERFACE ON PROGRAMS & GUIDEINES 02/22/2021 02/26/2021 12 HOURS TECHNICAL DEPARTMENT OF EDUCATION

DIGITAL TRANSFORMATION IN THE AGE OF COVID-19 INTERNATIONAL ENGAGMENT FROM THE OLD
NORMAL TO THE NEW NORMAL
02/16/2021 02/16/2021 4 HOURS TECHNICAL DEPARTMENT OF EDUCATION

INERNATIONAL OF WOMEN AND GIRLS IN SCIENCE 02/11/2021 02/11/2021 4 HOURS TECHNICAL DEPARTMENT OF EDUCATION

NATIONAL WEBINAR ON KINDERGARTEN REMOTE TEACHING AND LEARNING:DEVELOPMENTALLY

APPROPRIATE RESPONSES IN THE TIME OF COVID 19
09/21/2020 09/25/2020 32 HOURS TECHNICAL DEPARTMENT OF EDUCATION

GIONAL ORIENTATION ON LDM2 FOR DIVISION AND SCHOOL LEADERS UNDER BE-LCP 09/09/2020 09/10/2020 16 HOURS TECHNICAL DEPARTMENT OF EDUCATION

GIONAL ORIENTATION ON LDM1 FOR DIVISION AND SCHOOL LEADERS UNDER BE-LCP 07/20/2020 07/20/2020 8 HOURS TECHNICAL DEPARTMENT OF EDUCATION

DIVISION TRAINING WORKSHOP ON ENHANCING EFFECTIVE COMMUNICATION SKILLS IN

01/27/2020 01/31/2020 40 HOURS TECHNICAL DEPARTMENT OF EDUCATION
ENGLISH

SEMINAR ON DEPED CHILD PROTECTION POLICY AND OTHER BASIC EDUCATION LAWS 12/'04/2019 12/'06/2019 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION

PALIHAN SA PAGPAPAHUSAY SA PAGTUTURO SA FILIPINO 09/12/2019 09/14/2019 25 HOURS TECHNICAL DEPARTMENT OF EDUCATION

SCHOOL HEADS DEVELOPMENT PROGRAM FOUNDATION COURSE-MODULE 1 02/26/2019 03/04/2019 65 HOURS MANAGERIAL DEPARTMENT OF EDUCATION

SCHOOL HEADS DEVELOPMENT PROGRAM FOUNDATION COURSE-MODULE 2 02/11/2019 02/17/2019 56 HOURS TECHNICAL DEPARTMENT OF EDUCATION

SCHOOL HEADS DEVELOPMENT PROGRAM FOUNDATION COURSE-MODULE 3 01/21/2019 01/28/2019 56 HOURS TECHNICAL DEPARTMENT OF EDUCATION

DIST.ROLL OUT ON THE ENHANCEMENT OF PEDAGOGICAL SKILS IN TEACHING READING

10/23/2018 10/25/2019 24 HOURS TECHNICAL DEPARTMENT OF EDUCATION
IN THE MOTHER TONGUE & BRIDGING PROCESS FOR G1 TEACHERS

ORIENTATION WORKSHOP ON PPST & RPMS MANUAL 08/29/2018 08/31/2018 25 HOURS TECHNICAL DEPARTMENT OF EDUCATION

DIVISION TRAINING OF TRAINERS ON THE ENHANCEMENT OF PEDAGOGICAL SKILLS IN TEACHING

READING IN THE MOTHER TONGUE & BRIDGING PROCESS FOR GRADE 1TEACHERS
06/14/2018 06/17/2018 32 HOURS TECHNICAL DEPARTMENT OF EDUCATION

ORIENTATION WORKSHOP OF SCHOOL HEADS ON FINANCIAL MANAGEMENT

04/17/2018 04/20/2018 33 HOURS TECHNICAL DEPARTMENT OF EDUCATION
OPERATIONS MANUAL
REGION-WIDETRAINING OF TRAINERS ON THE ENHANCEMENT OF PEDAGOGICAL SKILLS IN
TEACHING READING IN THE MOTHER TONGUE & BRIDGING PROCESS FOR GRADE 1TEACHERS
02/08/2018 02/12/2018 40 HOURS TECHNICAL DEPARTMENT OF EDUCATION

(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
(Write in full)
in full)

SIGMA LAMBDA PHI FRATERNITY AND

Computer Literate N/A
SORORITY
(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? 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 regulation NO
YES ✘
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? ________________________________
RESIGNATION
________________________________
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
ERNIL BRUNDI A. ESPELITA LAS NAVAS N. SAMAR 9351122713 3.5 cm. X 4.5 cm
(passport size)

ALMA G. SLAYAO LAS NAVAS N. SAMAR 9102634423 With full and handwritten
name tag and signature over
printed name
ROWEL G. BALBUENA LAS NAVAS N. SAMAR 9165560079
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
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.: 1061553

Signature (Sign inside the box)

Date/Place of Issuance: 5/12/2021/PRC TACLOBAN

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