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

MIDDLE NAME BRIONGOS

3. DATE OF BIRTH
(mm/dd/yyyy) 03/13/1978 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH OCAMPO, CAMARINES SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS ZONE 2

Widowed Separated House/Block/Lot No. Street
GATBO
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.55 OCAMPO CAMARINES SUR
City/Municipality Province
8. WEIGHT (kg) 63.5 ZIP CODE 4419

9. BLOOD TYPE O
18. PERMANENT ADDRESS ZONE 2
House/Block/Lot No. Street

10. GSIS ID NO. 0200-374-0476 GATBO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211-5211-2095 OCAMPO CAMARINES SUR

City/Municipality Province

12. PHILHEALTH NO. 10-000-090-98-44 ZIP CODE 4419

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 273-685-963 20. MOBILE NO. 09093192957

15. AGENCY EMPLOYEE NO. 0796525 21. E-MAIL ADDRESS (if any) phoebe.veras@deped.gov.ph

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME VERAS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) N/A NONE

FIRST NAME SERGIO N/A
MIDDLE NAME DOROSAN

OCCUPATION NONE

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME BRIONGOS

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

MIDDLE NAME BOGATE

25. MOTHER'S MAIDEN NAME

SURNAME BANASTAO
FIRST NAME FLORDELINA
MIDDLE NAME BAŇES (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 GOA CENTRAL SCHOOL ELEMENTARY 1985 1991 N/A 1991 NONE

VOCATIONAL
SECONDARY / PARTIDO STATE COLLEGE SECONDARY 1991- 1995 N/A 1995 NONE

NONE N/A N/A N/A N/A N/A N/A

TRADE BACHELOR IN ELEMENTARY
COLLEGE
COURSE PARTIDO STATE UNIVERSITY 1995 2002 N/A 2002 NONE
EDUCATION
UNIVERSITY OF NORTHEASTERN MASTER OF EDUCATION-
GRADUATE STUDIES 2021 2023 36 UNITS N/A NONE
PHILIPPINES ADMINISTRATION AND SUPERVISION
(Continue on separate sheet if necessary)
SIGNATURE DATE January 9, 2023
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 (LET) 77.60% 8/25/2002 NATIONAL CAPITAL REGION 0796525 03/13/2023

(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)
GATBO ELEMENTARY SCHOOL/OCAMPO
6/8/2008 PRESENT TEACHER 1 ₱28,304.00 ₱11.00 PERMANENT YES
DISTRICT/DIVISION OF CAMARINES SUR
GATBO ELEMENTARY SCHOOL/OCAMPO
01/15/2005 03/30/2005 TEACHER 1 ₱10,569.00 N/A SUBSTITUTE YES
DISTRICT/DIVISION OF CAMARINES SUR

(Continue on separate sheet if necessary)

SIGNATURE DATE OCTOBER 20, 2022

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

NONE 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
SCHOOL-BASED IN-SERVICE TRAINING FOR TEACHERS ON TEACHING
10/24/2016 10/28/2016 40 TECHNICAL GATBO ELEMENTARY SCHOOL
CAPABILITIES ENHANCEMENT IN TEACHING MATHEMATICS
SEMINAR WORKSHOP ON CRAFTING LOCALLY MADE INSTRUCTIONAL READING
11/25/2016 11/25/2016 8 TECHNICAL GATBO ELEMENTARY SCHOOL
MATERIALS
DIVISION DECENTRALIZED TRAINING IN SPORTS ON CACHING &N OFFICIATING DEPARTMENT OF EDUCATION / DIVISION OF
08/17/2017 08/19/2017 24 TECHNICAL
FOR 3RD CONGRESSIONAL DISTRICT CAMARINES SUR
DEPARTMENT OF EDUCATION / DISTRICT OF
SCHOOL-BASED IN-SERVICE TRAINING FOR TEACHERS ON READING PROGRAM 10/23/2017 10/27/2017 40 TECHNICAL
OCAMPO
DEPARTMENT OF EDUCATION / DISTRICT OF
TWO DAYS SCHOOL ROLL-OUT ON PPST AND RPMS IMPLEMENTATION 09/18/1 06/302018 24 TECHNICAL
OCAMPO
SCHOOL-BASED IN-SERVICE TRAINING FOR TEACHERS ON SKILLS
DEPARTMENT OF EDUCATION / DISTRICT OF
ENHANCEMENT/WORKSHOP FOR TEACHERS IN ENGLISH, MATH, SCIENCE & 10/22/2018 10/26/2018 40 TECHNICAL
OCAMPO
PREPARATION OF OPCRF/IPCRF
GIRL SCOUTS OF THE PHILIPPINES-NAGA
BASIC AND AGE LEVEL COURSES 11/24/2018 11/25/2018 19 TECHNICAL
COUNCIL
DEPARTMENT OF EDUCATION / DIVISION OF
2019 IN-SERVICE TRAINING FOR TEACHERS 10/21/2019 10/252019 40 TECHNICAL
CAMARINES SUR
GIRL SCOUTS OF THE PHILIPPINES-NAGA
OUTDOOR LEADERSHIP COURSE 11/30/2019 1/12/2019 20 TECHNICAL
COUNCIL
SCHOOL-BASED INSET 2020: A CONTINUING PROFESSIONAL DEVELOPMENT
12/14/2020 12/19/2020 48 TECHNICAL GATBO ELEMENTARY SCHOOL
FOR TEACHERS
VIRTUAL IN-SERVICE TRAINING FOR PUBLIC SCHOOL TEACHERS 8/30/2021 3/9/2021 40 TECHNICAL DEPARTMENT OF EDUCATION / NATIONAL
THREE-DAYS DIVISION LIVE-OUT TRAINING AND SEMINAR WORKSHOP IN
1/9/2021 3/9/2021 24 TECHNICAL DEPARTMENT OF EDUCATION / NATIONAL
EDUKASYON SA PAGPAPAKATAO
MID-YEAR BREAK IN- SERVICE TRAINING 01/31/2022 4/2/2022 40 TECHNICAL DEPARTMENT OF EDUCATION / NATIONAL

(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)

COMPUTER LITERATE NONE NONE

SINGING

DANCING

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE January 09, 2023

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,
N/A
a. within the third degree? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
If YES, give details:
________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
N/A
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s: N/A

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:
________________________________
N/A
________________________________
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? ________________________________
N/A
________________________________
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: N/A

b. Have you resigned from the government service during the three (3)-month period before the last YES NO
✘ NO
election to promote/actively campaign for a national or local candidate? If YES, give details: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):
✘ NO
N/A
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: N/A
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No: N/A

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
GRACE M. MARAVILLAS CANAMAN, CAMARINES SUR 0948-625-8173 4.5 cm. X 3.5 cm
(passport size)
SAN FRANCISCO, OCAMPO,
JERALYN C. PIDA 0948-111-2105
CAMARINES SUR Computer generated
or photocopied picture
BRGY. CAPTAIN RODEL BENOSA GATBO, OCAMPO, CAMARINES SUR 0907-387-9858 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 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.: 0796525 Signature (Sign inside the box)
January 09, 2023
Date/Place of Issuance: 12/16/2002 - LEGAZPI CITY, ALBAY
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