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 REBANAL
NAME EXTENSION (JR., SR) N/A
FIRST NAME KATHLEEN ANNE

MIDDLE NAME BATALUNA

3. DATE OF BIRTH
09/13/1996 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CEBU CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
17. RESIDENTIAL ADDRESS PUROK 4 ATIS
6 CIVIL STATUS Single ✘ Married
House/Block/Lot No. Street
Widowed Separated
ARGAWANON
✘ Other/s:
Subdivision/Village Barangay
SAN REMIGIO CEBU
7. HEIGHT (m) 5'1"
City/Municipality Province
8. WEIGHT (kg) 50kg. ZIP CODE 6011

18. PERMANENT ADDRESS PUROK 4 ATIS

9. BLOOD TYPE A+
House/Block/Lot No. Street
ARGAWANON
10. GSIS ID NO. N/A
Subdivision/Village Barangay
SAN REMIGIO CEBU
11. PAG-IBIG ID NO. 121249600526
City/Municipality Province

12. PHILHEALTH NO. 120256319433 ZIP CODE 6011

13. SSS NO. 0637899985 19. TELEPHONE NO. N/A

14. TIN NO. 70605641000 20. MOBILE NO. 09650630486

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) kathrebanal@gmail.com
REBANAL 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) REBANAL, ZEUS ELI NICHLOUS B.
JEZREEL N/A 09/13/2021

MIDDLE NAME DEMAPE REBANAL, ZAHIRA ELVYNICH MIZAEL B. 5/8/2017

OCCUPATION LGU Staff

EMPLOYER/BUSINESS NAME Municipality of San Remigio

BUSINESS ADDRESS Poblacion, San Remigio, Cebu

TELEPHONE NO. N/A

24. FATHER'S SURNAME BATALUNA

N/A
FIRST NAME SONNY

MIDDLE NAME BATUCAN

25. MOTHER'S MAIDEN NAME

SURNAME AMANCIO

FIRST NAME ELVIRA

MIDDLE NAME OLTIANO (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 ARGAWANON ELEMENTARY SCHOOL ELEMENTARY 2002 2008 GRADUATED 2008 N/A

SECONDARY /
VOCATIONAL SAN REMIGIO NATIONAL HIGH SCHOOL SECONDARY 2008 2012 GRADUATED 2012 N/A

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

TRADE
COURSE
COLLEGE CEBU NORMAL UNIVERSITY Bachelor of Secondary Education- Major in English 2012 2016 GRADUATED 2012 N/A

Master of Arts in Education- Major in Administration

GRADUATE STUDIES FELIPE R VERALLO MEMORIAL FOUNDATION, INC.
and Supervision
2023 PRESENT N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 8, 2024

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

LICENSURE EXAMINATION FOR TEACHERS 75.0 09/25/2016 UNIVERSITY OF CEBU- MAIN CAMPUS 1627418 09/13/25

(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)
FELIPE R VERALLO MEMORIAL
07/21/2023 01/18/2024 HR MANAGER 11, 590.00 N/A REGULAR N
FOUNDATION, INC.
CEBU TECHNOLOGICAL UNIVERSITY-
03/28/2022 01/22/2023 COLLEGE INSTRUCTOR 160/hour N/A PART-TIME Y
DAAN BANTAYAN CAMPUS
04/15/2021 01/28/2022 TALENT ACQUISITION SPECIALIST FREELANCE 40000.00 N/A FREELANCER N

09/30/2020 12/4/2021 CUSTOMER SERVICE REPRESENTATIVE SYKES Asia, Inc. 19500.00 N/A REGULAR N

02/18/2020 10/9/2020 ONLINE ENGLISH TUTOR Utalk 22000.00 N/A REGULAR N

05/30/2019 01/20/2020 TECHNICAL ADVISOR II Concentrix 23500.00 N/A REGULAR N

10/15/2018 04/25/2019 ONLINE ENGLISH TUTOR ABC360 18000.00 N/A REGULAR N

DepEd Cebu Province- San Remigio National
08/18/2018 8/10/2018 SUBSTITUTE TEACHER I 21790.00 N/A SUBSTITUTE Y
High School

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 8, 2024

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
120
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

TEACH ENGLISH AS A FOREIGN LANGAGE 6/4/2021 3/5/2021 120.0 ACADEMIC TEFL PROFESSIONAL DEVELOPMENT INSTITUTE

ST. VINCENT DE PAUL TECHNOLOGICAL

BASIC COMPUTER LITERACY 3/12/2018 12/14/2018 80.0 TECHNICAL
INSTITUTE, INC.

(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)

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 8, 2024

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
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
JOSEPHUS ARELLANO BOGO CITY, CEBU 9338541164 3.5 cm. X 4.5 cm
(passport size)

DENES CAMAY ARGAWANON, SAN REMIGIO, CEBU N/A With full and handwritten
name tag and signature over
printed name
MA. JANICE MARCELLA J. MAGLASANG BOGO CITY, CEBU N/A
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 LICENSE

ID/License/Passport No.: 1627418

Signature (Sign inside the box)

Date/Place of Issuance: 03/02/2018 CEBU 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