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

MIDDLE NAME VILLAVERDE

3. DATE OF BIRTH
(mm/dd/yyyy) 05/28/1970 16. CITIZENSHIP Dual
✘ Filipino
Citizenship
by by
4. PLACE OF BIRTH MULANAY, QUEZON If holder of dual citizenship, Pls. birth
indicate country: naturalization
please indicate the details.
5. SEX
Male ✘
Female
17. RESIDENTIAL ADDRESS N/A BONCAN
6 CIVIL STATUS Single ✘
Married House/Block/Lot No. Street
Widowed Separa N/A 07
Other/s: ted Subdivision/Village Barangay
CATANAUAN QUEZON
7. HEIGHT (m) 1.51
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 4311

18. PERMANENT ADDRESS N/A BONCAN

9. BLOOD TYPE AB
House/Block/Lot No. Street
N/A 07
10. GSIS ID NO. 70052801085
Subdivision/Village Barangay
CATANAUAN QUEZON
11. PAG-IBIG ID NO. 1444600042998
City/Municipality Province

12. PHILHEALTH NO. 0000033199 ZIP CODE 4311

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 935-045-642 20. MOBILE NO. 0946 545 3389

15. AGENCY EMPLOYEE NO. 0006648 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME VASQUEZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME GILBERT N/A JON MIRBERT V. VASQUEZ 8/31/1995

MIDDLE NAME ABENILLA JESTER V. VASQUEZ 2/12/1997

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME VILLAVERDE

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

MIDDLE NAME MERLE

25. MOTHER'S MAIDEN NAME

SURNAME MAGBANTA

FIRST NAME ERLINDA

MIDDLE NAME DELA CRUZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MULANAY CENTRAL SCHOOL PRIMARY 1977 1984 GRADUATED 1984 WITH
HONORS

BONDOC PENINSULA AGRICULTURAL 1ST

SECONDARY
HIGH SCHOOL SECONDARY 1988 1992 GRADUATED 1992 HONORABLE
VOCATIONAL / MENTION

N/A
TRADE
COURSE MANUEL S. ENVERGA UNIVERSITY BACHELOR OF SECONDARY ACADEMIC
COLLEGE
FOUNDATION CATANAUAN,INC. EDUCATION - FILIPINO 1992 1996 GRADUATED 1996 EXCELLENCE

GRADUATE STUDIES
FAR EAST SCHOOL OF THEOLOGY MASTER OF ARTS IN VALUES 2014 2017 GRADUATED 2017 N/A
INTERNATIONAL (BACOOR) EDUCATION
(Continue on separate sheet if necessary)

SIGNATURE DATE 2/25/2025

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

LICENSURE EXAMINATION FOR TEACHERS 75.00 08/24-25/1996 PACO MANILA 0083181 11/19/1996

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

DEPARTMENT OF EDUACTION/CATANAUAN
01//01/2025 PRESENT SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL PHP 31,277.00 12-1 PERMANENT YES

01//01/2024 12/31/2024 SECONDARY SCHOOL TEACHER II DEPARTMENT OF EDUACTION/CATANAUAN PHP 31,277.00 12-1 PERMANENT YES
NATIONAL HIGH SCHOOL

DEPARTMENT OF EDUACTION/CATANAUAN
01//01/2023 12/31/2023 SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL PHP 27,892.00 12-2 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
01//01/2022 12/31/2022 SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL PHP 27,892.00 12-2 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/1/2021 12/31/2021 SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL PHP 26,336.00 12-2 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/1/2020 12/31/2020 SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL PHP 24,495.00 12-1 PERMANENT YES

1/1/2019 12/31/2019 SECONDARY SCHOOL TEACHER II DEPARTMENT OF EDUACTION/CATANAUAN P 20, 963 12-1 PERMANENT YES
NATIONAL HIGH SCHOOL

1/1/2018 12/31/2018 SECONDARY SCHOOL TEACHER II DEPARTMENT OF EDUACTION/CATANAUAN P 20, 963 12-1 PERMANENT YES
NATIONAL HIGH SCHOOL

DEPARTMENT OF EDUACTION/CATANAUAN
1/1/2017 12/31/2018 SECONDARY SCHOOL TEACHER II NATIONAL HIGH SCHOOL P 20, 963 12-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
01/30/2017 02/07/2017 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 20, 326 11-4 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
06/01/2012 12/31/2016 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 18, 375 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
6/1/2011 5/21/2012 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 18, 333 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
6/24/2010 5/21/2011 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 16, 726 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2009 6/23/2010 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 15, 119 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2008 6/30/2009 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 12, 748 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2007 6/30/2008 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 12, 026 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/24/2005 6/30/2007 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 10, 933 11-1 PERMANENT YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/1/2005 1/23/2005 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 5, 147 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2004 12/31/2004 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 5, 147 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/2/2004 6/31/2004 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 5, 147 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/2/2003 12/31/2003 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 5, 147 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/2/2003 6/31/2003 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 5, 147 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2002 12/31/2002 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 4, 901.80 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
1/2/2002 6/31/2002 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 4, 901.80 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/1/2001 12/31/2001 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 4, 901.80 N/A CASUAL YES

DEPARTMENT OF EDUACTION/CATANAUAN
7/2/1998 6/31/2001 SECONDARY SCHOOL TEACHER I NATIONAL HIGH SCHOOL P 4, 901.80 N/A CASUAL YES

(Continue on separate sheet if necessary)

SIGNATURE DATE 2/25/2025

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

BLUE DOLPHIN ASSOCIATION (SEPAK TAKRAW) 11/28/2015 PRESENT N/A 3RD DISTRICT SECRETARY GENERAL

(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

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Type of LD
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/ (Write in full)
Technical/etc)
From To
BUILDING A STRONGER SPORTS Future: Revitalized Training for coaches and 05/12/2024 05/07/2024 24 technical DEPARTMENT OF EDUCATION, PAGBILAO,
officials of Quezon Dolphins DISTRICT

division Training On various sports Discipline for Coachea and officials 04/03/2024 04/06/2024 24 TECHNICAL DEPARTMENT OF EDUCATION - Pagbilao, Quezon

District Rfresher Course for coacing and Officiating Officials in Sports Management 01/30/2024 01/31/2024 16 Manegerial
DEPARTMENT OF EDUCATION
Palarong Quezon: "Redefining the Role of Sports in Bridging Learning Recovery Initiatives 05/03/2023 07/03/2023 24 Manegerial DEPARTMENT OF EDUCATION
Division Training On Sports Skills for Teachers-Coaches and Officiaiting Officials 05/03/2023 03/07/2023 8 TECHNICAL
DEPARTMENT OF EDUCATION, Atimonan Quezon
SCHOOL BASED-BASED-IN-SERVICE-TRAINING 2023 02/09/2023 02/10/2023 16 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

CATANAUAN I & 2 SECONDARY IN-SERVICE TRAINING for TEACHERS 2023 02/07/2023 02/08/2023 16 TECHNICAL
DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
CATANAUAN I & 2 DISTRICT ELEMENTARY AND SECONDARY IN-SERVICE 02/06/2023 02/06/2023 8 TECHNICAL
TRAINING 2023 DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
capacity building on the development of learning resources for school heads and 02/06/2023 02/06/2023 8 TECHNICAL
teachers of catanauan District I DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
2022 CATANAUAN NHS, CATANAUAN DISTRICT I: 11/18/2022 11/18/2022 8 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

SCHOOL BASED-BASED-IN-SERVICE-TRAINING 2022 01/31/2022 11/18/2022 8 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

division conference workshop of all district pess coordinators as per republic act
10588 the policies and guideluines that govern the conduct of related school 1/29/2021 02/05/2021 40 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
based sports activiyies leading to Palarong Pambansa

VIRTUAL IN-SERVICE TRAINING FOR TEACHERS 2020 12/14/2020 12/15/2020 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

SCHOOL-BASED IN-SERVICE TRAINING 10/24/2019 10/25/2019 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
DISTRICT IN SERVICE TRAINING 2019 - MAKING THE GREAT TECHNICAL
TEACHERS IMPROVING THE LEADERS OF 21ST CENTURY 10/21/2019 10/23/2019 24 DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

DISTRICT IN SERVICE TRAINING 2019 05/27/2019 05/29/2019 24 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
GENDER SENSITIVITY AND DEVELOPMENT SEMINAR AND CAPACITY BUILDING 11/29/2018 11/30/2018 16 TECHNICAL
PROGRAM DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

DISTRICT IN-SERVICE TRAINING ON INCLUSIVE EDUCATION AND ROLL-OUT (PPST/RPMS) TECHNICAL DEPARTMENT OF EDUCATION - MATAAS NA KAHOY,
10/22/2018 10/26/2018 24 BATANGGAS CITY

DISTRICT PROFESSIONAL IN-SERVICE-TRAINING 5/23/2018 5/24/2018 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

PROFESSIONAL IN-SERVICE-TRAINING 5/21/2018 5/22/2018 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON
Seminar on the Outstanding Teacher 03/24/2018 3/24/2018 8 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

GENDER SENSITIVITY AND DEVELOPMENT SEMINAR AND TEAM BUILDING 11/23/2017 11/24/2017 16 TECHNICAL DEPARTMENT OF EDUCATION - MATAAS NA KAHOY,
BATANGGAS CITY

IN-SERVICE TRAINING for TEACHERS 10/26/2017 10/27/2017 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

IN-SERVICE TRAINING for TEACHERS 10/23/2017 10/24/2017 16 TECHNICAL

DEPARTMENT OF EDUCATION - CATANAUAN QUEZON

Training/seminar for SERU coordinators and students 08/25/2017 08/27/2017 24 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN
QUEZON
GAD and Team Building of Public Secondary school of Cluster 7 11/17/2016 11/18/2016 16 TECHNICAL
DEPARTMENT OF EDUCATION - lumban laguna
INSET 2016 10/26/2016 10/28/2016 24 TECHNICAL DEPARTMENT OF EDUCATION - CATANAUAN
QUEZON
GAD 2015 12/19/2015 12/19/2015 8.0 TECHNICAL
DEPARTMENT OF EDUCATION - LUCENA CITY
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write
in full)
COOKING N/A
SPORTS COACHING BLUE DOLPHIN ASSOCIATION

(Continue on separate sheet if necessary)

SIGNATURE DATE 2/25/2025
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
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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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.

DANILO T. FORNESTE CATANAUAN NATIONAL HIGH SCHOOL

CAPT. BENJIE A. CABANGON BRGY. 07 CATANAUAN, QUEZON

MELECIA C. CUETO OLONGTAO NATIONAL HIGH SCHOOL 9076222105

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
administrative/criminal case/s against me. PHOTO

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

ID/License/Passport No.: 0083181

Signature (Sign inside the box)
2/25/2025
Date/Place of Issuance: 06/06/2019/PRC LUCENA
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

MARIA VIOLETA D. ELISES

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4