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 SALUDES
NAME EXTENSION (JR., SR)
FIRST NAME WAYNE

MIDDLE NAME PANES

3. DATE OF BIRTH
6/21/1996 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH BARANGAY INITAN TAPAZ, CAPIZ If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS N/A N/A
House/Block/Lot No. Street
Separat
Widowed N/A INITAN
Other/s: ed Subdivision/Village Barangay
TAPAZ CAPIZ
7. HEIGHT (cm) 164
City/Municipality Province
8. WEIGHT (kg) 54 ZIP CODE 5814

18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE 0+
House/Block/Lot No. Street
N/A INITAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A TAPAZ CAPIZ

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 5814

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

14. TIN NO. N/A 20. MOBILE NO. 0948-420-8022/ 0977-693-6867

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) waynesaludes21@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) N/A
FIRST NAME N/A N/A

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME SALUDES N/A N/A

FIRST NAME NEMESIO

SR. N/A N/A

MIDDLE NAME SARMIENTO N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME PANES N/A N/A

FIRST NAME SUSAN N/A N/A

MIDDLE NAME CORNEL (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

WITH
ELEMENTARY TAPAZ CENTRAL ELEMENTARY SCHOOL ELEMENTARY 2004 2009 GRADUATED 2009 HONORS

SECONDARY /
VOCATIONAL TAPAZ NATIONAL HIGH SCHOOL SECONDARY 2009 2013 GRADUATED 2013 N/A

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

TRADE
CAPIZ STATE UNIVERSITY - TAPAZ SATELLITE
COURSE
COLLEGE
COLLEGE
BACHELOR IN ELEMENTARY EDUCATION 2013 2017 GRADUATED 2017 N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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 TEACHER 76.2 3/25/2018 ILOILO CITY 1606677 6/21/2021

(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. SALARY/ JOB/ PAY SERVICE
INCLUSIVE DATES 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)
01/04/2018 05/17/2018 ELEMENTARY TEACHER KING'S MEADOW SCHOOL-TAPAZ ₱4,000.00 N/A CONTRACTUAL NO

04/1/2018 05/21/2018 ELEMENTARY TEACHER KING'S MEADOW SCHOOL-TAPAZ ₱4,000.00 N/A CONTRACTUAL NO

12/1/2018 12/31/2018 COMMUNITY BASED MONITORING SYSTEM (ENUMERATOR) Local Government Unit-TAPAZ ₱6,000.00 N/A CONTRACTUAL YES

6/1/2018 04/5/2019 ELEMENTARY TEACHER KING'S MEADOW SCHOOL-TAPAZ ₱4,000.00 N/A CONTRACTUAL NO

9/17/2019 11/7/2019 SUBSTITUTE TEACHER LUCERO ELEMENTARY SHOOL ₱20,756.00 11-1 CONTRACTUAL YES

1/7/2020 2/29/2020 SUBSTITUTE TEACHER JAMINDAN ELEMENTARY SCHOOL ₱20,756.00 11-1 CONTRACTUAL YES

6/1/2019 3/15/2020 ELEMENTARY TEACHER KING'S MEADOW SCHOOL-TAPAZ ₱4,000.00 N/A CONTRACTUAL NO

7/23/2018 3/15/2020 SANGGUNIANG KABATAAN CHAIRPERSON BLGU-BARANGAY INITAN ₱5,000.00 N/A TEMPORARY YES

9/1/2020 9/30/2020 Census Area Supervisor Philippine Statistics Authority ₱21,000.00 N/A CONTRACTUAL YES

Philippine Statistics Authority/Philippine Identification

10/1/2020 12/31/2020 Registration Officer II/Supervising Work
System
₱41,000.00 N/A CONTRACTUAL YES
Philippine Statistics Authority/Philippine Identification
1/1/2021 3/30/2021 Registration Officer II/Supervising Work
System
₱21,000.00 N/A CONTRACTUAL YES
Philippine Statistics Authority/Philippine Identification
4/1/2021 7/30/2021 Kit Operator
System
₱24,000.00 N/A CONTRACTUAL YES
Statistical Researcher for Labor Foce Survey and Family
8/1/2021 8/31/2021
Income and Expenditures 2021
Philippine Statistics Authority ₱15,000.00 N/A CONTRACTUAL YES
Philippine Statistics Authority/Philippine Identification
9/1/2021 11/25/2021 Kit Operator
System
₱20,800.00 N/A CONTRACTUAL YES
Statistical Researcher for Labor Force Survey and Family Philippine Statistics Authority/Philippine Identification
1/10/2022 1/31/2022
Income and Expenditures 2021 System
₱15,000.00 N/A CONTRACTUAL YES
Philippine Statistics Authority/Philippine Identification
2/16/2022 4/30/2022 Birth Registration Agent System
₱19,900.00 N/A CONTRACTUAL YES
 (Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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

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

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

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

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

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

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

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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
FOOD AND BEVERAGE SERVICES 04/20/27 04/25/2017 45 TECHNICAL DUMALAG VOCATIONAL TECHNICAL SCHOOL
BREAD AND PASTRY PRODUCTION NCII 8/31/2018 12/8/2018 141 TECHNICAL DUMALAG VOCATIONAL TECHNICAL SCHOOL
SUMMER BREAK IN SERVICE TRAINING (INSET) 5/27/2019 5/29/2019 24 TECHNICAL TAPAZ WEST DISTRICT
TRAINING ON DEVELOPMENT APPROPRIATE PRACTICE 10/21/2019 10/23/2019 24 TECHNICAL DISTRICT OF JAMINDAN
SEMINAR WORKSHOP ON THE DIFFERENT APPROACHES IN REMEDIAL READING 10/24/2019 10/25/2019 9.0 TECHNICAL DISTRICT OF JAMINDAN

2020 CENCUS OF POPULATION AND HOUSING 3RD LEVEL TRAINING 8/3/2020 8/8/2020 54.0 SUPERVISORY HOTEL VERONICA, LAWAAN, ROXAS CITY, CAPIZ

2020 CENCUS OF POPULATION AND HOUSING 4TH LEVEL TRAINING 8/17/2020 8/22/2020 54.0 SUPERVISORY SAN JOSE GYM, BARANGAY TAPAZ, CAPIZ

COOKERY NC II 9/6/2021 11/26/2021 42.0 TECHNICAL DUMALAG VOCATIONAL TECHNICAL SCHOOL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

GOOD IN ORAL AND WRITTEN

N/A N/A
COMMUNICATION SKILLS

FLEXIBLE AND COMPETENT N/A N/A

HOSTING N/A N/A

N/A N/A

N/A N/A

N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE May 19, 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 ✘ 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: N/A
________________________________
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:
________________________________
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
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):
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
3.5 cm. X 4.5 cm
GLENDA G. GERVERO TAFT, TAPAZ, CAPIZ 0999-992-2036 (passport size)

With full and handwritten

KRISTIE M. GARGOLES LAGDUNGAN, TAPAZ, CAPIZ 0908-627-7299 name tag and signature over
printed name
RONALD F. LEGADA INITAN TAPAZ, CAPIZ 0950-022-1377
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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

ID/License/Passport No.: 1606677

Signature (Sign inside the box)
May 19, 2022
Date/Place of Issuance: 01/8/2018 /Iloilo City
Date/Place of Issuance: 01/8/2018 /Iloilo City
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

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