CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 VILLANUEVA
NAME EXTENSION (JR., SR) N/A
FIRST NAME AILEEN

MIDDLE NAME ALLANIGUE

3. DATE OF BIRTH
02/18/1974 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
✘
birth naturalization
4. PLACE OF BIRTH LA UNION If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 502 16th

House/Block/Lot No. Street
Separat
Widowed N/A Lakandula
Other/s: ed Subdivision/Village Barangay
Mabalacat City Pampanga
7. HEIGHT (m) 1.75m
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 2010

18. PERMANENT ADDRESS 502 16th

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A Lakandula
10. GSIS ID NO. 2000877390
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1040-0338-7382 Mabalacat Citry Pampanga

City/Municipality Province

12. PHILHEALTH NO. 01-050070713-0 ZIP CODE 2010

13. SSS NO. 02-1795211-6 19. TELEPHONE NO. N/A

14. TIN NO. 237-427-243-0319 20. MOBILE NO. 09066106208

15. AGENCY EMPLOYEE NO. 4277055 21. E-MAIL ADDRESS (if any) aileen.villanueva@deped.gov.ph

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME VILLANUEVA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) SAIVILLA JARENA A. VILLANUEVA
FIRST NAME SOLOMON N/A 11/12/1994

MIDDLE NAME DIG-AWAN SAVIEL A. VILLANUEVA 11/27/1997

OCCUPATION STRUCTURAL DETAILER SHARMAINE A. VILLANUEVA 05/11/2000

EMPLOYER/BUSINESS NAME STEEL SYSTEM EXPRESS INCORPORATED ELAINA A. VILLANUEVA 12/14/2010

BUSINESS ADDRESS 6th Flr. Rima Bldg. 161Pasig Blvd.,Bagong Ilog, Pasig City ***Nothing follows***

TELEPHONE NO. 02-6720401

24. FATHER'S SURNAME ALLANIGUE

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

MIDDLE NAME DE LEON

25. MOTHER'S MAIDEN NAME

SURNAME VALDEZ

FIRST NAME RUTH

MIDDLE NAME DAQUING (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

FIFTH
ELEMENTARY SAN FRANCISCO ELEMENTARY SCHOOL PRIMARY EDUCATION 1980 1986 N/A 1986
HONORS
MODEL
SECONDARY /
VOCATIONAL REPUBLIC CENTRAL COLLEGES HIGH SCHOOL 1986 1990 N/A 1990
STUDENT

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

TRADE
BACHELOR OF SECONDARY EDUCATION
COURSE
COLLEGE SAINT LOUIS UNIVERSITY
MAJOR IN ENGLISH
1990 1994 N/A 1994 N/A

MASTER OF ARTS IN EDUCATION-MAJOR IN

GRADUATE STUDIES TARLAC STATE UNIVERSITY
FILIPINO
2015 2016 18 N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 05/08/2017

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

PHILIPPINE BOARD EXAMINATION FOR SINDALAN ELEMENTARY

75.6 05/08/1995 0620490
TEACHERS SCHOOL,PAMPANGA

***Nothing follows***

(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.
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

DEPARTMENT OF EDUCATION-DIVISION OF MABALACAT

01/01/2016 present Secondary School Teacher I MAUAQUE RESETTLEMENT HIGH SCHOOL P22,326 11-4 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF MABALACAT
06/02/2014 12/31/2015 Secondary School Teacher I MAUAQUE RESETTLEMENT HIGH SCHOOL P19,111 11-2 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
06/01/2012 06/01/2014 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P18,735 11-2 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
06/01/2011 05/31/2012 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P17,318 11-2 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
06/24/2010 05/31/2011 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P15,900 11-2 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
03/01/2010 06/23/2010 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P14,482.75 11-2 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
07/01/2009 02/28/2010 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P14,198 11-1 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
07/01/2008 06/30/2009 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P12,026 10-1 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
07/01/2007 06/30/2008 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P10,933 10-1 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
03/01/2007 06/30/2007 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL P9,939 10-1 PERMANENT
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
01/01/2007 02/28/2007 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL SUN VALLEY ANNEX P9,939 10-1 Casual
DEPARTMENT OF EDUCATION-DIVISION OF PARANAQUE
09/21/2006 12/31/2006 Elementary School Teacher I F.SERRANO SR. ELEMENTARY SCHOOL SUN VALLEY ANNEX P9,939 10-1 Casual

06/01/2005 10/31/2005 Teacher Great Christian of Faith P8,000 N/A Contractual

06/01/2004 03/31/2005 Teacher Great Christian Academy P7,500 N/A Contractual

06/01/2003 03/31/2004 Teacher Bongabon Essential School P4,000 N/A Contractual

01/01/1999 03/31/2001 Teacher Clarkfield Christian School P4,500 N/A Contractual

***Nothing follows***
 (Continue on separate sheet if necessary)

SIGNATURE DATE 05/08/2017

CS FORM 212 (Revised 201
 LICENSE (if applicable)

Date of
Validity

12/04/1999

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

N
arate sheet if necessary)

05/08/2017
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

***Nothingfollows***

(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
DEPARTMENT OF EDUCATION DIVISION OF
GENDER AND DEVELOPMENT TRAINING 04/28/2016 04/30/2016 24.0 TECHNICAL MABALACAT MAUAQUE RESETTLEMENT HIGH
SCHOOL
DEPARTMENT OF EDUCATION DIVISION OF
IN-SERVICE TRAINING CLASSROOM MANAGEMENT 06/08/2016 06/08/2016 8.0 TECHNICAL MABALACAT MAUAQUE RESETTLEMENT HIGH
SCHOOL
DEPARTMENT OF EDUCATION DIVISION OF
MIND EDUCATION SPECIALIST TRAINING 11/06/2015 11/08/2015 24.0 MANAGERiAL
MABALACAT

***Nothing follows***

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

SEWING N/A N/A

COOKING N/A N/A

***Nothing follows***

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/08/2017

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:
________________________________

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
METROCLARK SUBDIVISION the last 6 months
RAQUIEL DEL MANDO ,MABALACAT CITY,PAMPANGA
N/A 3.5 cm. X 4.5 cm
(passport size)
MAUAQUE RESETTLEMENT, SAPANG
DIANA D. CLEMENTE BIABAS,MABALACAT CITY
N/A With full and handwritten
name tag and signature over
CUL DE SAC, SUN printed name
MA. DIGNA ATIENZA VALLEY,PARANAQUE CITY
N/A
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.: 0620490

Signature (Sign inside the box)
05/08/2017
Date/Place of Issuance: 12/04/1999
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