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 SUAREZ
NAME EXTENSION (JR., SR)
FIRST NAME ALDRICH

MIDDLE NAME DOMINGO

3. DATE OF BIRTH
5/8/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH DINGRAS, ILOCOS NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
✘ Male Female
17. RESIDENTIAL ADDRESS SITIO 4
6 CIVIL STATUS Single ✘ Married House/Block/Lot No. Street
Widowed Separate BARANGAY 55C VIRA
Other/s: d Subdivision/Village Barangay
LAOAG CITY ILOCOS NORTE
7. HEIGHT (m) 1.73
City/Municipality Province
8. WEIGHT (kg) 80 ZIP CODE

18. PERMANENT ADDRESS SITIO 4

9. BLOOD TYPE B
House/Block/Lot No. Street
BARANGAY 55C VIRA
10. GSIS ID NO. 2005624874
Subdivision/Village Barangay
LAOAG CITY ILOCOS NORTE
11. PAG-IBIG ID NO. 121158492552
City/Municipality Province

12. PHILHEALTH NO. 052501015091 ZIP CODE

13. SSS NO. 01-2589890-6 19. TELEPHONE NO.

14. TIN NO. 486-563-544 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 4204570 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME SUAREZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) YAWHANUM CROWN FOURTH S. SUAREZ
FIRST NAME NORALYN 1/8/2019

MIDDLE NAME SACOCO

OCCUPATION TEACHING

EMPLOYER/BUSINESS NAME DEPARTMENT OF EDUCATION ILOCOS NORTE

BUSINESS ADDRESS LAOAG CITY, ILOCOS NORTE

TELEPHONE NO. N/A

24. FATHER'S SURNAME SUAREZ

NAME EXTENSION (JR., SR)
FIRST NAME VIRGILIO SR

MIDDLE NAME VINLUAN

25. MOTHER'S MAIDEN NAME

SURNAME DOMINGO

FIRST NAME ADELAIDA

MIDDLE NAME DOMINGO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY SHAMROCK ELEMENTARY SCHOOL ELEMENTARY 2001 2007 GRADUATED 2007 N/A

ILOCOS NORTE COLLEGE OF ARTS AND

SECONDARY /
VOCATIONAL HIGH SCHOOL 2007 2011 GRADUATED 2011 N/A
TRADE

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

TRADE
COURSE
MAGNA CUM
COLLEGE DATA CENTER COLLEGE OF THE PHILIPPINES BACHELOR OF SCIENCE IN CRIMINOLOGY 2011 2015 GRADUATED 2015
LAUDE
MARIANO MARCOS STATE UNIVERSITY-
COLLEGE PROFESSIONAL EDUCATION 2018 2019 18 UNITS N/A N/A
COLLEGE OF TEACHER EDUCATION

MASTER OF ARTS IN EDUCATION MAJOR

GRADUATE STUDIES MARIANO MARCOS STATE UNIVERSITY 2019 PRESENT 33 UNITS N/A N/A
IN SOCIAL STUDIES
(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2021

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 LICENSURE EXAMINATION FOR PROFESSIONAL
81.2% 03/24/2019 BAGUIO CITY, BENGUET 1785662 5/8/2022
TEACHERS

CRIMINOLOGIST LICENSURE EXAMINATION 86.40% 10/23/2015 BAGUIO CITY, BENGUET 0124778 5/8/2022

PD 907 HONOR GRADUATE ELIGIBILITY N/A 04/14/2016 LAOAG CITY, ILOCOS NORTE 100101160344 N/A

CAREER SERVICE SUBPROFESSIONAL ELIGIBILITY 81.88% 10/26/2014 LAOAG CITY, ILOCOS NORTE 602072 N/A

(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)
DEPARTMENT OF EDUCATION- SCHOOLS
1/1/2021 PRESENT SHS TEACHER I 22, 316 11-1 PERMANENT YES
DIVISION OFFICE OF ILOCOS NORTE
DEPARTMENT OF EDUCATION- SCHOOLS
1/1/2020 12/31/2020 SHS TEACHER I 22, 316 11-1 PERMANENT YES
DIVISION OFFICE OF ILOCOS NORTE
DEPARTMENT OF EDUCATION- SCHOOLS
06/19/2019 12/31/2010 SHS TEACHER I 22, 316 11-1 PERMANENT YES
DIVISION OFFICE OF ILOCOS NORTE

8/4/2018 03/30/2019 INSTRUCTOR AIE COLLEGE 8, 000 N/A PART TIME NO

6/6/2016 03/31/2017 INSTRUCTOR DATA CENTER COLLEGE OF THE PHILIPPINES 10, 000 N/A PART TIME NO

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2021

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

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

5 DAY INSET- OPEN BROADCAST SYSTEM 12/14/2020 12/18/2020 40 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL

WEBINAR SERIES: WHOLE BRAIN LITERACY SELF-MASTERY CAPABILITY BUILDING

12/14/2020 12/16/2020 24.0 TECHNICAL SCHOOLS DIVISION OFFICE OF ILOCOS NORTE
PROGRAM (BATCH 47)

WEBINAR: TEACHING COMPREHENSION THROUGH NARRATIVE TEXTS 07/24/2020 07/24/2020 4.0 TECHNICAL VIBAL GROUP

WEBINAR: DEVELOPING SOCIAL AWARENESS AND CIVIC MINDEDNESS AMONG

07/23/2020 07/23/2020 4.0 TECHNICAL VIBAL GROUP
LEARNERS THROUGH SOCIAL INQUIRY APPROACH

WEBINAR: TAILOR-FITTING THE LEARNING MODALITIES FOR THE YOUNG JUANS 07/14/2020 07/14/2020 4.0 TECHNICAL VIBAL GROUP

WEBINAR: EMBEDDING PEDAGOGY AND BLENDING EDTECH SOLUTIONS IN THE

2/7/2020 2/7/2020 4.0 TECHNICAL VIBAL GROUP
LEARNING DESIGN OF A VIRTUAL CLASSROOM: A RETROSPECT
WEBINAR: SUPPLIMENTARY LEARNING MATERIALS IN THE FOURTH INDUSTRIAL
1/7/2020 1/7/2020 4.0 TECHNICAL VIBAL GROUP
REVOLUTION
WEBINAR: ROLE OF CIVIC EDUCATION, CIVIC ENGAGEMENT, AND SOCIAL STUDIES
06/30/2020 06/30/2020 4.0 TECHNICAL VIBAL GROUP
DURING COVID-19 PANDEMIC
WEBINAR: CREATING ENGAGING LESSONS THROUGH THE USE OF SUPPLEMENTAL
06/30/2020 06/30/2020 4.0 TECHNICAL VIBAL GROUP
RESOURCE MATERIALS

ICT WEBINAR SERIES: DEVELOPMENT OF INTERACTIVE E-BOOK 06/17/2020 06/17/2020 8.0 TECHNICAL SCHOOLS DIVISION OFFICE OF ILOCOS NORTE

SCHOOL IN-SERVICE TRAINING & GAD SEMINAR 10/21/2019 10/25/2019 40.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL

SEMINAR ON DEVELOPING INTERACTIVE E-BOOK USING KOTOBEE AUTHOR SOFTWARE 06/15/2020 06/15/2020 8.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL

CAPABILITY BUILDING 12/13/2019 12/14/2019 16.0 TECHNICAL DUMALNEG NATIONAL HIGH SCHOOL

(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)
NATIONAL ORGANIZATION OF PROFESSIONAL
DIGITAL DRAWING N/A
TEACHERS

COMPUTER LITERATE

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/16/2021

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
VANESSA B. AGUINALDO DUMALNEG NATIONAL HIGH SCHOOL 985813184 3.5 cm. X 4.5 cm
(passport size)

MERINA G. RAMOS DUMALNEG NATIONAL HIGH SCHOOL With full and handwritten
name tag and signature over
DATA CENTER COLLEGE OF THE printed name
MATTHEW P. LANGBIS
PHILIPPINES 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.: 1785862

Signature (Sign inside the box)
11/16/2021
Date/Place of Issuance: 06/26/2019 BAGUIO 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