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

MIDDLE NAME MERCADER

3. DATE OF BIRTH
(mm/dd/yyyy) 4/12/1996 16. CITIZENSHIP Filipino

4. PLACE OF BIRTH LAOANG N. SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS 042 D. ADORO

6 CIVIL STATUS SINGLE
House/Block/Lot No. Street
STO. NIŇO
Subdivision/Village Barangay
LAOANG NORTHERN SAMAR
7. HEIGHT (m) 5'6
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 6411
18. PERMANENT ADDRESS 042 D. ADORO
9. BLOOD TYPE O
House/Block/Lot No. Street
STO. NIŇO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LAOANG NORTHERN SAMAR
11. PAG-IBIG ID NO. 121327806159
City/Municipality Province
12. PHILHEALTH NO. 020277282608 ZIP CODE 6411

13. SSS NO. 3527681022 19. TELEPHONE NO. N/A

14. TIN NO. 6331911320 20. MOBILE NO. 09066188252

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) recheleparane@gamail.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 N/A

FIRST NAME N/A
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME PARANE

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

MIDDLE NAME PINCA

25. MOTHER'S MAIDEN NAME

SURNAME MERCADER

FIRST NAME CORAZON

MIDDLE NAME DULAY (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
UNITS ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From To
graduated)
ELEMENTARY P.M. GETA. MEM. ELEM. SCHOOL ELEMENTARY 6/8/2003 3/27/2009 GRADUATED 2009 WITH HONOR

VOCATIONAL /
SECONDARY LAOANG NATION HIGH SCHOOL SECONDARY 6/7/2009 3/21/2013 GRADUATED 2013 WITH HONOR

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

UNIVERSITY OF EASTERN PHILIPPINE
COLLEGE TRADE BACHELOR OF ELEMENTARY EDUCTION 6/8/2013 4/4/2017 GRADUATED 2017 N/A
COURSE LAOANG

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE May 20, 2024

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 81.0 JUNE 26,2021 CATARMAN N. SAMAR 1953579 4/12/2026

(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/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
UTOPIA SECURITY SAFETY SOLUTIONS 16470.00
9/28/2023 2/3/2024 HUMAN RESOURCES N/A CONTRACTUAL N
INCORPORATED
COMMUNITY BASED MONITORING
12/1/2022 7/21/2023 ENUMERATOR 6000.00 N/A CONTRACTUAL Y
SYSTEM
4/5/2021 7/4/2021 GOVERNMENT INTERNSHIP PROGRAM P.M. GETA. MEM. ELEM. SCHOOL 7475.00 N/A CONTRACTUAL Y

08/23/2021 10/25/2021 ENUMERATOR LEYTE CENTER FOR DEVELOPMENT 10000.00 N/A CONTRACTUAL N

8/4/2021 4/7/2021 GOVERNMENT INTERNSHIP PROGRAM LAOANG GOVERNMENT UNIT 6325.00 N/A CONTRACTUAL Y

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 20, 2024

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
SAINT MICHAEL KINDERGARTEN SCHOOL OF
2/12/2024 PRESENT 198 HOURS VOLUNTEER TEACHER
LAOANG, INCORPORATED
BARANGAY CALINTAAN POB. DAY CARE
8/22/2022 12/9/2022 260 HOURS VOLUNTEER TEACHER AIDE
CENTER

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

INCIDENT COMMAND SYSTEM AND MASS MUNICIPAL DISASTER RISK REDUCTION

07/23/2021 07/25/2021 36 HOURS TECHNICAL
CASUALTY CRASH COURSE TRAINING AND MANAGEMENT OFFICE
BREAD AND PASTRY PRODUCTION 9/1/2018 10/30/2018 118 HOURS TECHNICAL
FAIR GEMS ACADEMY
COMMUNITY BASED MONITORING SYSTEM 11/7/2022 11/11/2022 40 HOURS TECHNICAL
MUNICIPALITY OF LAOANG

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

BAKING

READING BOOKS

COOKING

DANCING

SINGING

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 20, 2024

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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
N/A

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
N/A
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
__N/A______________________________
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 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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
RESIGNED
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? N/A
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the
last 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?
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?
If YES, please specify: N/A
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:

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

ID picture taken within

NAME ADDRESS TEL. NO.
the last 6 months
3.5 cm. X 4.5 cm
LAOANG NORTHERN SAMAR
LEONARDO S. NERZA SAMAR
9153357616 (passport size)

With full and handwritten

LAOANG NOTHERN SAMAR name tag and signature over
JOEY BEA ACEBRON SAMAR
9672042855
printed name

Computer generated
HENRY BRAYAN FUŇE TACLOBAN CITY 9153357616 or photocopied picture
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 ID

ID/License/Passport No.: 1953579

Signature (Sign inside the box)
MAY 20, 2024
Date/Place of Issuance: 01/25/2023 TACLOBAN 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