CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes q with "P" and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION

2. SURNAME PACHECO
FIRST NAME APRILE
MIDDLE NAME MANALO 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS

4. DATE OF BIRTH (mm/dd/yyyy) 02/28/1993
5. PLACE OF BIRTH STA. CRUZ, ZAMBALES BAYTO , SANTA CRUZ ZAMBALES
6. SEX  Male  Female
7. CIVIL STATUS ZIP CODE 2213
 Single  Widowed
 Married  Separated 17. TELEPHONE NO. n/a
 Annulled  Others, specify ___________ 18. PERMANENT ADDRESS

8. CITIZENSHIP FILIPINO PAMONORAN, STA. CRUZ, ZAMBALES

9. HEIGHT (m) 1.75 m
10. WEIGHT (kg) 55 kg ZIP CODE 2213
11. BLOOD TYPE B+ 19. TELEPHONE NO. n/a
12. GSIS ID NO. 2004692140 20. E-MAIL ADDRESS (if any) aprile.pacheco@deped.gov.ph
13. PAG-IBIG ID NO. 121106047845 21. CELLPHONE NO. (if any) 09270766948
14. PHILHEALTH NO. 07-000149681 22. AGENCY EMPLOYEE NO.
4162762
15. SSS NO. 23. TIN 454-183-162
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME PACHECO

FIRST NAME WARLITO
MIDDLE NAME AYRAN
27. MOTHER'S MAIDEN NAME

SURNAME MANALO
FIRST NAME AGNES
MIDDLE NAME ESTEBAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND YEAR

GRADUATED
28. HIGHEST GRADE/ INCLUSIVE DATES OF
NAME OF SCHOOL DEGREE COURSE LEVEL/ ATTENDANCE SCHOLARSHIP/
LEVEL (Write in (Write in full) UNITS EARNED ACADEMIC HONORS
full) (if not graduated) RECEIVED
From To
(if
Bayto Elementary School graduated)
ELEMENTARY Elementary Graduate 2004 1999 2004 Salutatorian

SECONDARY Don Brigido Miraflor IS High School Graduate 2009 2004 2009 n/a

VOCATIONAL n/a n/a n/a n/a n/a n/a n/a

COLLEGE
PRMSU 2013 2009 2013
Bachelor in Secondary
Education major in
Filipino

GRADUATE STUDIES MASTER OF ARTS

PRMSU MAJOR IN Filipino 2021 2019 2021 N/A
(Continue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
SPECIAL LAWS/ CES/ CSEE RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
CONFERMENT NUMBER DATE OF
RELEASE
Licensure Examination for Teachers 1239178 12/05/2013
78.85% 09/29/2013 Baguio City
(LET)

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
GOV'T SERVICE
30. INCLUSIVE DATES
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY GRADE
STATUS OF
& STEP
MONTHLY SALARY INCREMENT APPOINTMENT
(Write in full) (Write in full) (Format "00-0")
From To (Yes / No)

08/05/2020 PRESENT TEACHER II GUISGUIS NATIONAL HIGH 30,989.00 PERMANENT YES

SCHOOL
GUISGUIS NATIONAL HIGH
06-16-2016 4/8/2020 TEACHER I
SCHOOL 29,449.00 PERMANENT YES
CAMACHILES NATIONAL HIGH
PERMANENT YES
07-27-2014 06-15-2016 TEACHER I SCHOOL 276,000.00

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATIO
INCLUSIVE DATES
31. NAME & ADDRESS OF ORGANIZATION NUMBER OF
(Write in full) HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

ASSERT 11 / 05 / 2024
Present member

/ / / /

(Continue on separate sheet if necessary)

VII. TRAINING PROGRAMS (Start from the most recent training.)

INCLUSIVE DATES OF
ATTENDANCE
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT NUMBER OF CONDUCTED/ SPONSORED BY
COURSES (Write in full) HOURS (Write in full)
(mm/dd/yyyy)
From To
School Based Training of Teachers on the
### ### 40 days Department of Education
MATATAG Curriculum

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / MEMBERSHIP IN
33. SPECIAL SKILLS / HOBBIES: 34. RECOGNITION: 35. ASSOCIATION/ORGANIZATION
(Write in full) (Write in full)

COMPUTER LITERATE BEST IN DEMONSTRATION TEACHING

READING MERITORIOUS AWARD

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees):  YES NO
appointing authority, recommending authority, chief of office/bureau/department or person who If YES, give details:
has immediate supervision over you in the Office, Bureau or Department where you will be _____________________________________
appointed? _____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees):  YES  NO

appointing authority or recommending authority where you will be appointed? If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37 a. Have you ever been formally charged?  YES  NO

If YES, give details:
________________________________
________________________________
b. Have you ever been guilty of any administrative offense?
 YES  NO
If YES, give details:
________________________________
________________________________
38. 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:
________________________________
________________________________
39. 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, AWOL  YES  NO
or phased out, in the public or private sector?
If YES, give details:
________________________________
________________________________

40. Have you ever been a candidate in a national or local election (except Barangay election)?  YES  NO
If YES, give details:
________________________________
________________________________
4 Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
1. 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 differently abled?
 YES  NO
If YES, please specify: ____________________
c. Are you a solo parent?
 YES  NO
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)

NAME ADDRESS TEL. NO.

ROWENA D. MENDE SAN FERNANDO, STA. CRUZ, ZAMBALES

JANE M. MONTALLA MALABAGO, STA. CRU, AMBALES

ID picture taken
within
LORELEI E. RAFANAN SAN FERNANDO, STA. CRUZ, ZAMBALES 9467012640 the last 6 months
3.5 cm. X 4.5 cm
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and (passport size)
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines.

I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust
that this information shall remain confidential. PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT SIGNATURE (Sign inside the box)

12/11/2024
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4