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 CANON
NAME EXTENSION (JR., SR)
FIRST NAME ERICA

MIDDLE NAME LASALITA

3. DATE OF BIRTH
(mm/dd/yyyy) 9/24/1990 16. CITIZENSHIP
✘ Filipino Dual Citizenship

by birth by
4. PLACE OF BIRTH VALENZUELA, METRO MANILA If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS BLOCK 16 LOT 4
6 CIVIL STATUS Single
✘ Married House/Block/Lot No. Street
Widowed Separate MORAN ESTATE SUBDIVISION MATAGBAC
Other/s: d Subdivision/Village Barangay
TABACO ALBAY
7. HEIGHT (m) 1.524
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 4511

18. PERMANENT ADDRESS BLOCK 16 LOT 4

9. BLOOD TYPE O
House/Block/Lot No. Street
MORAN ESTATE SUBDIVISION MATAGBAC
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-4412-558 TABACO ALBAY

City/Municipality Province

12. PHILHEALTH NO. 100-501-691-164 ZIP CODE 4511

13. SSS NO. 0510-622-486 19. TELEPHONE NO. (052) 8742-3322

14. TIN NO. 460-685-120 20. MOBILE NO. 09563881724

15. AGENCY EMPLOYEE NO. 5826262 21. E-MAIL ADDRESS (if any) ericacanon80@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) SOPHIA THERESE CANON
FIRST NAME N/A 10/28/2009

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME CANON

NAME EXTENSION (JR., SR)
FIRST NAME ARSENIO

MIDDLE NAME BORROMEO

25. MOTHER'S MAIDEN NAME

SURNAME LASALITA

FIRST NAME EDNA

MIDDLE NAME HILUTIN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
From To

ELEMENTARY MATAGBAC ELEMENTARY PRIMARY EDUCATION 1997 2003 N/A 2003 VALEDICTO
RIAN

SECONDARY TABACO NATIONAL HIGH SCHOOL SECONDARY EDUCATION 2003 2007 N/A 2007 NONE
VOCATIONAL /

BOOKKEEPING NC II VOCATIONAL 2018 2018 N/A 2018 NC II

HOLDER
TRADE
COURSE
COLLEGE BICOL UNIVERSITY TABACO CAMPUS TERTIARY EDUCATION 2011 2018 N/A 2018 ACADEMIC
AWARDEE

GRADUATE STUDIES BICOL UNIVERSITY GRADUATE SCHOOL GRADUATE STUDIES 2019 2023 CAR N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 29,2025

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity
PROFESSIONAL LICENSURE EXAMINATION FOR 87.0 9/30/2018 ST. RAFAEL ACADEMY 1710406 9/24/2024
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
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)

1/1/2021 PRESENT TEACHER (SHS) DEPARTMENT OF EDUCATION 23, 877.00 SG11 REGULAR Y

10/19/2020 12/31/2020 TEACHER (SHS) DEPARTMENT OF EDUCATION 22, 316.00 SG11 REGULAR Y

7/19/2019 10/29/2019 TEACHER (SHS) DEPARTMENT OF EDUCATION 20, 754.00 SG11 SUBSTITUTE Y

1/15/2018 5/31/2020 ADMINISTRATIVE AIDE I DEPARMENT OF EDUCATION 7, 000.00 JOB ORDER Y

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 29,2025

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

BOY SCOUT OF THE PHILIPPINES 2018 PRESENT TROOP LEADER

BOY SCOUT OF THE PHILIPPINES 2018 PRESENT MEMBER

MATHEMATICS TEACHERS ASSOCIATION OF THE PHILIPPINES INC. 2018 PRESENT MEMBER/FACILITATOR

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

SHS LEARNING ACTION CELL (3RD QUARTER 2024) 3/6/2024 8 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

INTERNATIONAL WEBINAR-WORKSHOP ON LEADERSHIP AND FINANCIAL 05/16/25 05/20/25 40 TECHNICAL MARCO REVIEW CENTER
MANAGEMENT FOR TEACHING AND NON-TEACHING PERSONNEL

VAWCFREE SANHS: A SAFE HOME FOR EVERY WOMANTONIAN 2/8/2023 24 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

SLAC (DEPED MEMO NO. 8 S. 2023) 2/28/2023 8.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

5-DAY SCHOOL-BASED INSET 1/24-26/2024 1/29-30/24 40.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

KADUNUNG CONFERENCE 7/26/2022 7/26/2022 8.0 TECHNICAL BICOL UNIVERSITY

PROJECT "SACTO" 2022 6/15/2024 8.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

CY 2022 FIRST QUARTER REBUZ @DEPED ROV 3/4/2024 8.0 TECHNICAL DEPED ROV

KADUNUNG TOPICS: INTEGRATION IN K-12 CURRICULUM 3/24/2022 8.0 TECHNICAL BICOL UNIVERSITY

4-DAY MIDYEAR INSET 2/2/2022 2/5/2022 32.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

WEST DISTRICT 1 UPSKILLING SCIENCE TEACHER ON CLASSROOM (RESOURCE 12/13/2021 12/14/2021 16.0 TECHNICAL SDO TABACO CITY
SPEAKER )

DIVISION CAPACITY BUILDING ON ICT TOOLS 12/8/2021 12/10/2021 24.0 TECHNICAL SDO TABACO CITY

2-DAY SCHOOL-BASED SEMINAR-WORKSHOP ON ACTION RESEARCH (RESEARCH 6/29/2021 6/30/2021 24.0 TECHNICAL MAGAPO ELEMENTARY SCHOOL
PRESENTER)
SKILLS ENHANCEMENT PROGRAM CUM CONTEXTUALIZATION OF RESEARCH 3/23/2021 3/26/2021 32.0 TECHNICAL SDO TABACO CITY
PROJECTS
INTERNATIONAL WEBINAR WORKSHOP ON ADVANCING SCIENTIFIC RESEARCH 4/20/2021 4/21/2021 8.0 TECHNICAL MARCO REVIEW CENTER
COMPETENCIES FOR 21ST CENTURY SPECIALIST

RESEARCH PAPER ORAL PRSESENTER 3/22/2021 3/22/2021 8.0 TECHNICAL INSTABRIGHT INTERNATIONAL GUILD OF
RESEARCHERS AND EDUCATORS INC.
EHANCING EDUCATIONAL PRACTICES FOR A BETTER TEACHING-LEARNING 3/22/2022 5/2/2022 24.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL
EXPERIENCES IN THE NEW-NORMAL
3-DAY INSERVICE TRAINING 3/17/2021 3/19/2021 24.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL
SECOND INSTABRIGHT INTERNATIONAL RESEARCH CONFERENCE AND
5/3/2021 7/3/2021 24.0 TECHNICAL INSTABRIGHT INTERNATIONAL GUILD OF
PRESENTATION (RESEARCH PRESENTER AND PARTICIPANT, RESEARCH RESEARCHERS AND EDUCATORS INC.
PUBLICATION

MID-YEAR INSET 12/14/2020 12/18/2020 40.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

INTERNATIONAL SEMINAR-WORKSHOP ON RESEARCH CAPACITY BUILDING 12/18/2020 12/22/2020 40.0 TECHNICAL INNOVIZON CREATIVE SOLUTIONS INC.

REVISITING EDUCATION PRACTICES TO ADDRESS LEARNING DIFFICULTIES FOR A 3/17/2021 3/19/2021 24.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL
BETTER NORMAL

SANHS CAPACITY BUILDING OF TEACHERS FOR THE NEW NORMAL 8/10/2020 8/17/2020 64.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

INTERNATIONAL SEMINAR-WORKSHOP ON RESEARCH CAPACITY BUILDING 12/18/2020 12/22/2020 40.0 TECHNICAL INNOVIZON CREATIVE SOLUTIONS INC.

INTERNATIONAL SEMINAR WORKSHOP ON ENHANCING THE K-12 CURRICULUM 2/22/2020 2/24/2020 40.0 TECHNICAL MARCO REVIEW CENTER
THROUGH THE 21ST CENTURY TEACHING AND LEARNING STRATEGIES

KEEPING SERVICE AFALME AMIDST EDUCATIONAL CRISIS 8/2/2021 10/2/2021 24.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

TEACHER ENHANCEMENT TRAINING WORKSHOP FOR OPLAN-BALIK ESKWELA 2019- 5/27/2019 5/28/2019 16.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL
2020
SANHS INSET AND MIDYEAR REVIEW AND EVALUATION FOR TEACHING AND NON- 10/21/2019 12/25/2019 40.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL
TEACHING

26TH PROVINCIAL SCOUT JAMBORETTE 12/24/2019 12/28/2019 40.0 TECHNICAL MAYON ALBAY (BSP COUNCIL)

2ND GIRL SCOUTS OF THE PHILIPPINES (GSP) TABACO CITY DIVISION CAMP 5/11/2019 7/11/2019 24.0 TECHNICAL SAN ANTONIO NATIONAL HIGH SCHOOL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write in
full)

DEMO TEACHING 1ST RUNNER-UP MEMBER (KADUNUNG-BICOL PROGRAM)

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 29,2025

 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
by any court or tribunal? YES ✘ NO
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 YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES
election to promote/actively campaign for a national or local candidate? ✘ NO
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
Ms. Rhea B. Beren Mariroc, Tabaco city 9959438619 4.5 cm. X 3.5 cm
(passport size)

Mrs. Rodita Borbor Mariroc, Tabaco city 9957280790

Computer generated
or photocopied picture
Mrs. Matilde B. Borjal Mariroc, Tabaco city 9122358290 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
administrative/criminal case/s against me. PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: NATIONAL ID

ID/License/Passport No.: 9026-3748-7142-3519

Signature (Sign inside the box)

Date/Place of Issuance: TABACO 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