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 agai
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 u

I. PERSONAL INFORMATION
2. SURNAME SUMANDE
NAME EXTENSION (JR., SR) N/A
FIRST NAME TRISTANE ERIC

MIDDLE NAME PADILLA

3. DATE OF BIRTH
(mm/dd/yyyy) 5/18/1986 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturaliz
4. PLACE OF BIRTH HAMTIC, ANTIQUE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS N/A N/A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
N/A SEMIRARA
Other/s:
Subdivision/Village Barangay
CALUYA ANTIQUE
7. HEIGHT (m) 4'11''
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 5711
18. PERMANENT ADDRESS N/A N/A
9. BLOOD TYPE "B"
House/Block/Lot No. Street
N/A SEMIRARA
10. GSIS ID NO. 02005036662
Subdivision/Village Barangay
CALUYA ANTIQUE
11. PAG-IBIG ID NO. 1211-2218-3472
City/Municipality Province
12. PHILHEALTH NO. 01-025643-458-3 ZIP CODE 5711

13. SSS NO. 34-1187198-0 19. TELEPHONE NO. N/A

14. TIN NO. 318122750-0000 20. MOBILE NO. 09363660587

15. AGENCY EMPLOYEE NO. NA 21. E-MAIL ADDRESS (if any) sumandetaneric18@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRT
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A NA N

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME SUMANDE

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

MIDDLE NAME MATANDAC

25. MOTHER'S MAIDEN NAME

SURNAME PADILLA

FIRST NAME GEORGETTA

MIDDLE NAME CORDERO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/
26. PERIOD OF ATTENDANCE YEAR
UNITS
LEVEL (Write in full) EARNED
GRADUATED
(Write in full) (if not
From To
graduated)
ELEMENTARY TIOLAS ELEMENTARY SCHOOL ELEMENTARY 1997 1999 N/A 1999
VOCATIONAL / MOSCOSO- RIOS NATIONAL HIGH
SECONDARY
SCHOOL
HIGH SCHOOL 1999 2003 N/A 2003
CEBU HEALTH PROFESSIONAL
INCORPORATED
EMERGENCY MEDICAL SEVICES 2017 2017 N/A 2017
TRADE
 UNIVERSITY OF ANTIQUE- HAMTIC
COLLEGE
CAMPUS
BACHELORS IN SECONDARY EDUCATION 2010 2014 N/A 2014
UNIVERSITY OF ANTIQUE -MAIN
GRADUATE STUDIES
CAMPUS
MASTERS IN PUBLIC ADMINISTRATION 2017 NA 36 UNITS N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Re
s against the person

not fill up. For CSC use only)

uralization

et
ARA
gay
UE
ce

et
ARA
gay

ce

F BIRTH (mm/dd/yyyy)

N/A

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

N/A

N/A

N/A
 N/A

N/A

212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicab
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

PROFESSIONAL LICENSURE TEACHER

75.80 SEPTEMBER 2017 ILOILO NATIONAL SCHOOL 1595328
EXAMINATION

(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/
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
MONTHLY STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To

LOCAL GOVERNMENT UNIT OF BARANGAY CONTRACT OF

01/03/2019 PRESENT LOCAL SCHOOL BOARD TEACHER 5,000.00 N/A
SEMIRARA SERVICE
LOCAL GOVERNMENT UNIT OF BARANGAY CONTRACT OF
08/01/2018 12/31/2018 LOCAL SCHOOL BOARD TEACHER 5,000.00 N/A
SEMIRARA SERVICE
OFFICE OF THE SANGGUNIANG
01/01/2018 07/30/2018 LOCAL LEGISLATIVE STAFF EMPLOYEE 10,134.00 N/A CO-TERMINUS
PANLALAWIGAN -ANTIQUE
OFFICE OF THE SANGGUNIANG
07/01/2017 12/31/2017 LOCAL LEGISLATIVE STAFF EMPLOYEE 10,134.00 N/A CO-TERMINUS
PANLALAWIGAN -ANTIQUE
OFFICE OF THE SANGGUNIANG
01/01/2017 06/31/2017 LOCAL LEGISLATIVE STAFF EMPLOYEE 9,651.00 N/A CO-TERMINUS
PANLALAWIGAN -ANTIQUE
OFFICE OF THE SANGGUNIANG
12/01/2016 12/31/2016 LOCAL LEGISLATIVE STAFF EMPLOYEE 9,651.00 N/A CO-TERMINUS
PANLALAWIGAN -ANTIQUE
OFFICE OF THE SANGGUNIANG
07/01/2016 11/30/2016 LOCAL LEGISLATIVE STAFF EMPLOYEE 9,191.00 N/A CO-TERMINUS
PANLALAWIGAN -ANTIQUE
CONTRACT OF
08/17/2015 02/12/2016 ASSISTANT SUPERVISOR T-SHUTTLE SERVICES INCORPORATED 18,000.00 N/A
SERVICE

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017)
 LICENSE (if applicable)

Date of
Validity

05/18/20

eparate sheet if necessary)

GOV'T
SERVICE

(Y/
N)

eparate sheet if necessary)

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) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/ (Write in full)
(Write in full) (mm/dd/yyyy) Technical/etc)
From To
PROVINCIAL RISK REDUCTION MANAGEMENT
SEMIRARA ISLAND EMERGENCY ACTION
OFFICE,SEMIRARA MINING POWER
GROUP COMMUNITY BASED DISASTER RISK 12/03/2018 12/07/2018 40HOURS TECHNICAL
CORPORATION,BARANGAY SEMIRARA
REDUCTION AND MANAGEMENT TRAINING
DISASTER RISK REDUCTION OFFICE
SEMIRARA NATIONAL HIGH SCHOOL IN DEPARTMENT OF EDUCATION/SEMIRARA
10/23/2018 10/27/2018 40HOURS TECHNICAL
SERVICE TRAINING 2018 NATIONAL HIGH SCHOOL
2018 CLUSTER 5 CAMPUS JOURNALISM
08/10/2018 08/12/2018 24 HOURS TECHNICAL
TRAINING DEPARTMENT OF EDUCATION DIVISION OF ANTIQUE

EMERGENCY MEDICAL SERVICES NC II 03/13/2018 04/21/2018 280 HOURS TECHNICAL

CEBU HEALTH PROFESSIONAL INCORPORATED
PHILIPPINE LIFESAVINGS SWIM AND
09/13/2016 11/13/2016 24 HOURS TECHNICAL
SURVIVE TRAINING PHILIPPINE LIFESAVING -ANTIQUE CHAPTER
9TH REGIONAL TEACHERS CONGRESS 02/07/2014 02/08/2014 16 HOURS TECHNICAL
DEPARTMENT OF EDUCATION REGION VI

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES (Write in
(Write in full)
full)
PHILIPPINE LIFE SAVING INCORPORATED
NET SURFING LEADERSHIP AWARD
ANTIQUE CHAPTER
SINGING CERTIFICATE OF COMMENDATION
SWIMMING SERVICE AWARD
EXCEL AND POWER POINT
CERTIFICATE OF COMPLETION
PRESENTATION
6TH PLACE IN EDITORIAL WRITING IN 2018 CLUSTER 5
HAIR AND MAKE UP CAMPUS JOURNALISM TRAINING
5TH PLACE IN EDITORIAL WRITING IN 2018 CLUSTER 5
COOKING CAMPUS JOURNALISM TRAINING

HOSTING

TABLE SKIRTING
(Continue on separate sheet if necessary)
SIGNATURE DATE
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 theof bureau or office or to the person who has immediate supervision over you in the
chief
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
YES ✘ NO
regulation 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 If YES, give details:
phased 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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
a.
items:
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
CHERYL D. VILLANUEVA ILAYA, BUGASONG, ANTIQUE 9209728407 3.5 cm. X 4.5 cm
(passport size)
VILLAVERT-JIMENEZ, HAMTIC,
RICHARD M. NOLASCO ANTIQUE
9173050451 With full and handwritten
name tag and signature over
printed name
FRANCIS JOHN GABAWA CALALA, HAMTIC, ANTIQUE 9065627676
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
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 PHOTO
of 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.: 1595328

Signature (Sign inside the box)

Date/Place of Issuance: 12/21/2017 PRC ILOILO

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
CFK
...................................... . . . . ......M...