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

MIDDLE NAME CABAÑERO

3. DATE OF BIRTH
(mm/dd/yyyy) 10/26/1958 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth ✘ by naturalization
4. PLACE OF BIRTH ASTURIAS, CEBU If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female P

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK-9

Widowed Separated House/Block/Lot No. Street
FILI
Other/s:
Subdivision/Village Barangay
BAYUGAN AGUSAN DEL SUR
7. HEIGHT (m) 4'11"
City/Municipality Province
8. WEIGHT (kg) 63 ZIP CODE 8502

18. PERMANENT ADDRESS N/A PUROK-9

9. BLOOD TYPE "A"
House/Block/Lot No. Street

10. GSIS ID NO. 006-0106-7037-6 N/A FILI

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 3101-65410007 BAYUGAN AGUSAN DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 18-000008000-2 ZIP CODE 8502

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

14. TIN NO. 916-057-615 20. MOBILE NO. 09070538082

15. AGENCY EMPLOYEE NO. 5028766 21. E-MAIL ADDRESS (if any) eleonor.templado001@deped.gov.ph.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TEMPLADO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME FELICIANO N/A ELY ROY C. TEMPLADO 09/23/1982

MIDDLE NAME CORGIO GUENDOLYN C. TEMPLADO 01/27/1987

OCCUPATION RETIRED DRIVER EVA C. TEMPLADO 10/30/1987

EMPLOYER/BUSINESS NAME N/A ERA C. TEMPLADO 10/30/1987

BUSINESS ADDRESS N/A JOVETH C. TEMPLADO 02/19/1993

TELEPHONE NO. N/A

24. FATHER'S SURNAME CABAÑERO

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

MIDDLE NAME BACUNAWA

25. MOTHER'S MAIDEN NAME

SURNAME CIMAFRANCA

FIRST NAME CELIRINA (deceased)

MIDDLE NAME BARGANMENTO (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 ASTURIAS CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1969 1974 GRADUATED 1974 CERT.

SECONDARY /
VOCATIONAL MOALBOAL SCHOOL OF FISHERIES HIGH SCHOOL-OLD CURRICULUM 1975 1979 GRADUATED 1979 CERT.

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

TRADE
CEBU STATE COLLEGE OF SCIENCE & BACHELOR IN SCIENCE OF ELEMENTARY
COURSE
COLLEGE
TECHNOLOGY COLLEGE OF FISHERIES EDUCATION
1987 1993 GRADUATED 1993 CERT.

GRADUATE STUDIES BUKIDNON STATE COLLEGE 1997 2000 GRADUATED 2000 CERT.
(Continue on separate sheet if necessary)

SIGNATURE DATE February 7, 2022

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% 08/24/1996 CAGAYAN DE ORO CITY 0207762 10/26/2020

(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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)

01/01/2023 PRESENT TEACHER III DEPARTMENT OF EDUCATION 31,320.00 13-03 PERMANENT Y

01/01/2021 12/31/2022 TEACHER III DEPARTMENT OF EDUCATION 28,589.00 13-03 PERMANENT Y

PHP
1/1/2020 01/31/2020 TEACHER III DEPARTMENT OF EDUCATION 21,387.00
13-02 PERMANENT Y
PHP
01/01/2019 12/31/2019 TEACHER III DEPARTMENT OF EDUCATION 21,387.00
13-02 PERMANENT Y
PHP
01/01/2018 01/31/2018 TEACHER III DEPARTMENT OF EDUCATION 21,387.00
13-01 PERMANENT Y
PHP
01/01/2017 12/31/2017 TEACHER III DEPARTMENT OF EDUCATION 21,387.00
13-01 PERMANENT Y
PHP
06/15/2016 12/31/2016 TEACHER III DEPARTMENT OF EDUCATION 21,387.00
13-01 PERMANENT Y
PHP
01/01/2016 06/14/2016 TEACHER II DEPARTMENT OF EDUATION 21,387.00
12-02 PERMANENT Y
PHP
12/01/2014 12/31/2015 TEACHER II 12-02' PERMANENT Y
DEPARTMENT OF EDUCATION 20,140.00
PHP
06/01/2012 11/30/2014 TEACHER II DEPARTMENT OF EDUCATION 12-01' PERMANENT Y
19,940.00
PHP
12/01/2011 05/31/2012 TEACHER II DEPARTMENT OF EDUCATION 12-01' PERMANENT Y
18,333.00
PHP
01/20/2011 11/30/2011 TEACHER I DEPARTMENT OF EDUCATION 11-04' PERMANENT Y
17,994.00
PHP
01/11/2011 01/19/2011 TEACHER I DEPARTMENT OF EDUCATION 11-04' PERMANENT Y
16,687.00
PHP
06/24/2010 01/10/2011 TEACHER I DEPARTMENT OF EDUCATION 11-04' PERMANENT Y
16,419.00
PHP
07/01/2009 06/23/2010 TEACHER I DEPARTMENT OF EDUCATION 11-04' PERMANENT Y
15,072.00
PHP
07/01/2008 06/30/2009 TEACHER I DEPARTMENT OF EDUCATION 11-04' PERMANENT Y
12,951.00
PHP
01/11/2008 06/30/2008 TEACHER I DEPARTMENT OF EDUCATION 11-03' PERMANENT Y
11,774.00
PHP
07/01/2007 01/10/2008 TEACHER I DEPARTMENT OF EDUCATION 10-03' PERMANENT Y
11,486.00
PHP
01/11/2005 06/30/2007 TEACHER I DEPARTMENT OF EDUCATION 10-03' PERMANENT Y
10,442.00
PHP
01/11/2002 01/10/2005 TEACHER I DEPARTMENT OF EDUCATION 10-02' PERMANENT Y
10,188.00
PHP
01/01/2001 01/10/2002 TEACHER I DEPARTMENT OF EDUCATION 10-01' PERMANENT Y
9,939.00
PHP
01/01/2000 06/30/2000 TEACHER I DEPARTMENT OF EDUCATION 10-01' PERMANENT Y
9,466.00
PHP
01/11/1999 TEACHER I DEPARTMENT OF EDUCATION 10-01' PERMANENT Y
12/31/1999 8,605.00
PHP
08/21/1998 10/19/1998 TEACHER I DEPARTMENT OF EDUCATION 10-01' PERMANENT Y
8,605.00
(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 26,2023

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
(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

3/15/2021 3/19/2021 40HRS. TECHNICAL DEPARTMENT OF EDUCATION CENTRAL OFFICE .

VIRTUAL IN-SERVICE TRAINING FOR PUBLIC SCHOOL TECHERS
IMPLEMENTATION COURSE FOR TEACHERS UNDER THE BASIC EDUCATION LEARNING CONTINUITY DEPARTMENT OF EDUCATION REGION
09/15/2021 09/20/2021 40 HRS. TECHNICAL
PLAN (BE-LCP) OFFICE
08/01/2019 08/02/2019 16 HRS. TECHNICAL DEPARTMENT OF EDUCATION- DIVISION
TWO-DAY TRAINING ON SCIENCE CRITICAL CONTENTS FOR TEACHERS

07/27/2018 8/10-17/2018 24HRS. TECHNICAL DEPARTMENT OF EDUCATION - DIVISION

SCHOOL ROLL-OUT ON THE RESULT-BSED PERFORMANCE MANAGEMENT SYSTEM

05/20/2015 05/24/2018 40HRS. TECHINICAL DEPARTMENT OF EDUCATION - SCHOOL

DIVISION PEDAGOGICAL RETOOLING IN MATHEMATICS LANGUAGES AND SCIENCE
SEVEN-DAY DIVISION MASS TRAINING OF GRADE IV TEACHERS ON THE
IMPLEMENTATION OF GRADE IV CURICULLUM IN THE K TO 12 BASIC EDUCATION 05/23/2015 05/30/2015 56 HRS TECHNICAL DEPARTMENT OF EDUCATION
PROGRAM
TWO-DAY DIVISIONAL ENHANCEMENT TRAINING-WORKSHOP ON ENTREPRENEURSHIP EDUCATION
FOR EPP, TLE TEACHERS AND DEPARTMENT HEADS 10/20/2014 10/21/2014 16 HRS. TECHNICAL DEPARTMENT OF EDUCATION
DIVISION TRAINING WORKSHOP ON TEACHING BEGINNING READING AND COMMUNICATE DEPARTMENT OF EDUCATION DIVISION
06/25/2010 06/27/2010 36 HRS TECHNICAL
LANGUAGE READING FOR UNTRAINED GRADE ONE TEACHERS PERSONNEL
FIVE-DAY REGION LED DIVISION BASED MASS TRAINING FOR ELEMENTARY TEACHERS ON DEPARTMENT OF EDUCATION REGION
05/14/2010 05/18/2010 40 HRS TECHNICAL
ENGLISH LANGUAGE AND READING ENHANCEMENT TRAINING PERSONNEL
TWO - DAY SEMINAR ON ACCREDITATION ON COACHING AND OFFICATIING ON DEPARTMENT OF EDUCATION SCHOOL
11/09/2010 11/10/2010 16 HRS TECHNICAL
SPORTS SPORTS OFFICIAL
DEPARTMENT OF EDUCATION REGION
TWO- DAY SEMINAR IN MAKABAYAN 01/24/2008 01/25/2008 16 HRS TECHNICAL
PERSONNEL
DEPARTMENT OF EDUCATION DIVISION &
PROJECT PAGTUON ORIENTATION 01/08/2008 01/08/2008 8 HRS TECHNICAL
PROVINCE PERSONNEL
DEPARTMENT OF EDUCATION DIVISION
12/08/2008 12/10/2008 24 HRS TECHNICAL
THREE- DAY SEMINAR IN FILIPINO PERSONNEL
DEPARTMENT OF EDUCATION DIVISION
THREE DAY SEMINAR ON FISH POND MANAGEMENT AND PRODUCTION 07/07/2006 07/09/2006 36 HRS TECHNICAL
PERSONNEL
UNITED NATION INTERNATIONAL
FIVE-DAY SEMINAR ON CCP 09/19/2006 09/24/2006 40 HRS TECHNICAL
EMERGENCY FUND
BASIC EDUCATION CURRICULUM 04/08/2002 04/12/2002 40 HRS TECHNICAL DEPARTMENT OF EDUCATION
DEPARTMENT OF EDUCATION DIVISION
SEMINAR IN SIBIKA AT KULTURA 10/16/2000 10/17/2000 24 HRS TECHNICAL
PERSONNEL
DEPARTMENT OF EDUCATION DIVISION
TWO DAY SEMINAR IN MATHEMATICS 06/25/1999 06/26/1999 16 HRS TECHNICAL
PERSONNEL
(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)

COOKING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE January 26, 2022

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 ✘

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
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
LETECIA C. DELIMA BRGY. FILI 3.5 cm. X 4.5 cm
(passport size)

ROMIRICO M. LUNA POBLACION With full and handwritten

name tag and signature over
printed name
RENE P. MORAL BRGY. ANDANAN
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

ID/License/Passport No.: 0207762

Signature (Sign inside the box)
JANUARY 26,2023
Date/Place of Issuance: 11/10/1997 BUTUAN 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