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 PEREZ
NAME EXTENSION (JR., SR)
FIRST NAME SHERYLIN

MIDDLE NAME IBIAS

3. DATE OF BIRTH
07/29/1992 16. CITIZENSHIP Dual
(mm/dd/yyyy) ✘ Filipino
Citizenship
by by
4. PLACE OF BIRTH LABO, CAMARINES NORTE If holder of dual citizenship, birth country: naturalization
Pls. indicate
please indicate the details.
5. SEX Male
Female
17. RESIDENTIAL ADDRESS PUROK 3
6 CIVIL STATUS ✘ Single Marrie House/Block/Lot No. Street
Widowed Separa
d SAN ANTONIO
Other/s: ted Subdivision/Village Barangay
LABO CAMARINES NORTE
7. HEIGHT (m) 1.49
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 4606

18. PERMANENT ADDRESS PUROK 3

9. BLOOD TYPE O
House/Block/Lot No. Street
SAN ANTONIO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LABO CAMARINES NORTE
11. PAG-IBIG ID NO. 1211-2151-60031
City/Municipality Province

12. PHILHEALTH NO. 080257937749 ZIP CODE 4606

13. SSS NO. 34-4625354-4 19. TELEPHONE NO. N/A

14. TIN NO. 746-134327 20. MOBILE NO. 09533793779

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) [email protected]
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)
FIRST NAME N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PEREZ

NAME EXTENSION (JR., SR)
FIRST NAME EDWIN

MIDDLE NAME VILLAFRANCA

25. MOTHER'S MAIDEN NAME SHIRLEY CAMACHO IBIAS

SURNAME PEREZ

FIRST NAME SHIRLEY

MIDDLE NAME IBIAS (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 G. PALADO SR. ELEMENTARY SCHOOL 2004-2005 TOP 5

SECONDARY /
VOCATIONAL TULAY NA LUPA NATIONAL HIGH SCHOOL 2008-2009 N/A

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

TRADE BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE CAMARINES NORTE COLLEGE MAJOR IN TECHNOOGY AND LIVELIHOOD 2017-2018
EDUCATION

GRADUATE STUDIES MABINI COLLEGES Inc. MAED. EDUC. LEADERSHIP AUG.2022 DEC. 2022 6 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE June 16, 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

BOARD FOR PROFESSIONAL TEACHERS 78.2 3/31/2019 LUCENA, PROVINCE OF QUEZON 1801791 7/29/2025

(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)

3/4/2024 06/30/2024 TEACHING LEARNING AID ANICETA DE LARA PIMENTEL HIGH SCHOOL 8,000.00

1/8/2022 12/31/2022 PROJECT AID DILG Provincial Office 10,000.00

4/6/2019 04/30/2021 TEACHER NORTHILLS COLLEGE OF ASIA, Inc. 7,000.00

04/15/2014 05/20/2014 PRODUCTION OPERATOR P. IMES 9,000.00

07/20/2013 02/15/2014 CASHIER TAALEMI FOODS 8,000.00

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 16, 2024

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

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

MASSAGE THERAPY NC II 10/1/2023 10/4/2023 700.0 ST. HELENA CARETECH INSTITUTE

DR. DENNIS S. LAGUMEN / EXECUTIVE TRAINING

INTERNATIONAL TRAINING ON PHILANTHROPIC LEADERSHIP IN
ACTION: SOCIAL RESPONSIBILITIES AT THE TIME OF CRISIS
9/1/2023 10/1/2023 12.0 DIRECTOR /
PCPD TRAINING CENTER, INC.
DR. DENNIS S. LAGUMEN / EXECUTIVE TRAINING
NATIONAL TRAINING ON FOUNDATIONS IN SELF-IMPROVEMENT FOR A
7/1/2023 8/1/2023 12.0 DIRECTOR /
BETTER TOMORROW PCPD TRAINING CENTER, INC.
DR. DENNIS S. LAGUMEN / EXECUTIVE TRAINING
NATIONAL ONLINE TRAINING ON ALTERNATIVE TRENDS AND MODELS
5/1/2023 6/1/2023 12.0 DIRECTOR /
IN EDUCATION 5.0 FOR 21ST CENTURY EDUCATORS AND SCHOOL PCPD TRAINING CENTER, INC.
NATIONAL SEMINAR WORKSHOP ON TEACHING LITERACY, CENTER FOR THE PROFESSIONAL ADVANCEMENT OF
9/9/2022 11/9/2022 24.0
DEVELOPING A COMMUNITY OF READERS EDUCATORS, INC. / VIVIAN I. BUHAIN, EdD
DICT REGION IV-B MIMAROPA / DIR. CHERYL C.
CYBER ESSENTIALS FOR TEACHER 9/9/2022 11/9/2022 24.0
ORTEGA

SEMINAR WORKSHOP ON CLASS INTERACTIVE MODULES 07/14/2019 07/17/2019 40.0 DAET, CAMARINES NORTE / DR. ALEX P. ALANGCO

TEACHER'S ORIENTATION ON LEARNING MODALITIES 07/13/2020 07/13/2020 8.0 LABO, CAMARINES NORTE / DR. ALEX P. ALANGCO
MORENO INTEGRATED SCHOOL, DAET, CAMARINES
ORIENTATION AND UPDATES ON CONTINUING PROFESSIONAL
12/11/2019 12/11/2019 12.0 NORTE /
DEVELOPMENT PRC REGION V

(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)

MAKING ART CRAFT N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 16, 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? 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
by any court or tribunal? YES NO
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
DR. ALEX P. ALANGCO DAET, CAMARINES NORTE 09182050673 4.5 cm. X 3.5 cm
(passport size)

SHARY R. DEFEO VINZONS, CAMARINES NORTE 09124738832

Computer generated
or photocopied picture
GRANT A. BONUM FUNDADO ELEMENTARY SCHOOL 09665312713 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/License/Passport No.: 1801791

Signature (Sign inside the box)
JUNE 16, 2024
Date/Place of Issuance: 12/13/2019 / LUCENA 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