CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

WARNING: Any misinterpretation 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 CAÑEBA

FIRST NAME JESSEL ANDRIA

MIDDLE NAME RODRIGUEZ

3. DATE OF BIRTH
(mm/dd/yyyy)
Thursday, August 31, 1995 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH SAN ROQUE, CABIAO, NUEVA ECIJA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street

Other/s: SAN RAMON

Subdivision/Village Barangay

7. HEIGHT (m) 1.5 PILI CAMARINES SUR

City/Municipality Province
8. WEIGHT (kg) 43.1 ZIP CODE 4418
18. PERMANENT ADDRESS
9. BLOOD TYPE AB
House/Block/Lot No. Street

10. GSIS ID NO. 2005236014

DECA HOMES, LANGON VISTA SAN RAMON
Subdivision/Village Barangay
IRIGA CITY CAMARINES SUR
11. PAG-IBIG ID NO. 121143915393
City/Municipality Province

12. PHILHEALTH NO. 100502269474 ZIP CODE 4431

13. SSS NO. 0513763070 19. TELEPHONE NO. N/A

14. TIN NO. 708396011 20. MOBILE NO. 09662686988

15. AGENCY EMPLOYEE NO. 6321925 21. E-MAIL ADDRESS (if any) jesselandria.caneba@deped.gov.ph
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)

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CAÑEBA

FIRST NAME BERNARDO

MIDDLE NAME BANTAYAN

25. MOTHER'S MAIDEN NAME RODRIGUEZ, REMERCITA RAMOS

SURNAME CAÑEBA

FIRST NAME REMERCITA

MIDDLE NAME RODRIGUEZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SAN RAMON ELEMENTARY SCHOOL PRIMARY 2001 2007 GRADUATE 2007 N/A

SECONDARY OCAMPO NATIONAL HIGH SCHOOL SECONDARY 2007 2011 GRADUATE 2011 N/A

VOCATIONAL / ELECTRONIC PRODUCTS ASSEMBLY

GLOBAL IT INSTTUTE, INC. 7/15/2016 10/15/2016 GRADUATE 2016 2016
TRADE COURSE AND SERVICING NC II
CENTRAL BICOL STATE UNIVERSITY OF
COLLEGE BACHELOR OF ELEMENTARY EDUCATION 2011 2015 GRADUATE 2015 N/A
AGRICULTURE
UNIVERSITY OF NORTHEASTERN MASTER OF ARTS IN SUPERVISION AND
GRADUATE STUDIES 2020 2022 27 units N/A
PHILIPPINES ADMINISTRATION

(Continue on separate sheet if necessary)

SIGNATURE DATE February 2, 2022

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