CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes

with "

T15092244

1. CS ID
No.

" and use separate sheet if necessary.

(to be filled up by CSC)

I. PERSONAL INFORMATION
VILLACERAN

2. SURNAME
FIRST NAME

RUTH KLARIBELLE

MIDDLE NAME

CRUZ

3. NAME EXTENSION (e.g. Jr., Sr.)

05 / 21 / 1993

4. DATE OF BIRTH (mm/dd/yyyy)

16. RESIDENTIAL ADDRESS

Baliwag Bulacan

5. PLACE OF BIRTH

MALE

6. SEX

FEMALE

7. CIVIL STATUS

ZIP CODE

Single

Widowed

Married

Separated

Annuled

Others, specify
_________

8. CITIZENDSHIP

Filipino

9. HEIGHT (m)

163

10. WEIGHT (kg)

80

11. BLOOD TYPE

O+

031 F. Estrella St. Sto Cristo, CITY OF MALOLOS

(Capital), BULACAN

3000

17. TELEPHONE NO.

305 0414

18. PERMANENT ADDRESS

031 F. Estrella St. Sto Cristo, CITY OF MALOLOS

(Capital), BULACAN

ZIP CODE

3000

19. TELEPHONE NO.

305 0414

12. GSIS ID NO.

20. EMAIL ADDRESS (if any)

rkvillaceran@gmail.com

13. PAGIBIG ID NO.

21. CELLPHONE NO. (if any)

09237060347

14. PHILHEALTH NO.

21-025260701-8

22. AGENCY EMPLOYEE NO.

15. SSS NO.

34-44628634

23. TIN

463-590-483

II. FAMILY BACKGROUND

25. NAME OF CHILD (Write full name and list all)

24. SPOUSE'S SURNAME

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

Villaceran

FIRST NAME

Ruel

MIDDLE NAME

Briones

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME

Cruz

FIRST NAME

Claribelle

MIDDLE NAME

Clavio

III. EDUCATIONAL BACKGROUND

LEVEL

NAME OF SCHOOL
(Write in full)

DEGREE COURSE
(Write in full)

YEAR
GRADUATED
(if graduated)

Immaculate Conception
School of Malolos

HIGHEST
GRADE/
LEVEL/ UNITS
EARNED
(if not
graduated)

INCLUSIVE DATES OF
ATTENDANCE

From

To

1998-0615

2004-0316

SCHOLARSHIP/ ACADEMIC
HONORS RECEIVED

ELEMENTARY

SECONDARY

Holy Spirit Academy of

Malolos

2006

June 2004

March
2006

Living Angels Christian

Academy

2010

June 2006

March
2010

2014

June 2010

March
2014

VOCATIONAL/ TRADE
COURSE
COLLEGE

La Consolacion University
Philippines

VILLACERAN, RUTH KLARIBELLE CRUZ - T15092244

Bachelor of
Secondary Education

CS FORM 212 (Revised 2005), Page 1 of 4

III. EDUCATIONAL BACKGROUND

LEVEL

NAME OF SCHOOL
(Write in full)

DEGREE COURSE
(Write in full)

HIGHEST
GRADE/
LEVEL/ UNITS
EARNED
(if not
graduated)

Master of Arts in
Education

Bulacan State University

GRADUATE STUDIES

YEAR
GRADUATED
(if graduated)

15

INCLUSIVE DATES OF
ATTENDANCE

From

To

July 2015

Present

SCHOLARSHIP/ ACADEMIC
HONORS RECEIVED

IV. CIVIL SERVICE ELIGIBILITY

29.
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
UNDER SPECIAL LAWS/ CES/ CSEE

LET (LICENSURE EXAMINATION FOR

TEACHER)

LICENSE (if applicable)

DATE OF
EXAMINATION /
CONFERMENT

RATING

80.60

03 / 29 / 2015

PLACE OF EXAMINATION / CONFERMENT

DATE OF
RELEASE

NUMBER

Manuel L. Quezon University

1372588

05/22/2015

STATUS OF
APPOINTMENT

GOV'T SERVICE
(Yes / No)

V. WORK EXPERIENCE
30.

INCLUSIVE DATES
(mm/dd/yyyy)
From

To

06/02/2014

PRESENT

POSITION TITLE (Write in full)

DEPARTMENT / AGENCY / OFFICE /

COMPANY (Write in full)

MONTHLY
SALARY

SALARY
GRADE &
STEP
INCREMENT
(Format "00-0")

Elementary Teacher

Immaculate Conception School

of Malolos

13 000

0-0

No

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31.

INCLUSIVE DATES
(mm/dd/yyyy)

NAME & ADDRESS OF ORGANIZATION

(Write in full)

ABAKADA ni Venerable Mo. Consuelo

From

To

12 / 11 / 2013

12 / 10 / 2014

NUMBER OF
HOURS

POSITION / NATURE OF WORK

Teacher

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

32.
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES
(Write in full)

INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yyyy)

NUMBER OF
HOURS

CONDUCTED/ SPONSORED BY
(Write in full)

From

To

When Employees Do Right and Go Wrong: Handling Employee Discipline

01 / 29 / 2016

01 / 29 / 2016

Rex Book Store

Increasing Faculty Engagement

11 / 28 / 2015

11 / 28 / 2015

Rex Book Store

Capacity Building Seminar on Data Management and Information

Technology for Private Schools

11 / 12 / 2015

11 / 12 / 2015

Division of City Schools (City of

Malolos, Bulacan)

Mass Training of Grade 4 and Grade 10 Private School Teachers of the K 12 Basic Education Program

05 / 25 / 2015

05 / 26 / 2015

16

Division of City Schools (City of

Malolos, Bulacan)

Strategies on How to Execute English and Math in Teaching

04 / 15 / 2015

04 / 15 / 2015

Center for Professional

Development of Academic
Leaders and Supervisors

Child Protection Policy and Whole Brain Literacy

11 / 05 / 2014

11 / 05 / 2014

Vicarish Publication and Trading,

Inc.

Standards Based Teaching & Assessment

05 / 30 / 2014

05 / 30 / 2014

Rex Book Store

Seminar - Workshop on English Proficiency and Professional Ethics

05 / 26 / 2014

05 / 29 / 2014

24

Immaculate Conception School

of Malolos

Anti - Bullying Act of 2013 and IRR on Anti - Bullying

03 / 25 / 2014

03 / 25 / 2014

La Consolacion University
Philippines

Seminar on Formative Assessment

01 / 30 / 2014

01 / 30 / 2014

Rex Book Store

1st Big EdukCircle International Convention on Behavior and Knowledge

Management in Education

01 / 26 / 2013

01 / 26 / 2013

10

International Center for

Communication Studies Manila

Code of Ethics, Rights and Privileges for Professional Teachers

09 / 19 / 2012

09 / 19 / 2012

La Consolacion University
Philippines

6th ICCS Convention on Media Communication: Dissecting Ethical

Standards in Multimedia Journalism

08 / 13 / 2011

08 / 13 / 2011

10

International Center for

Communication Studies Manila

Agustinong Lider Ka Nga!: Defining URC Core Values as Traits of an

Exemplary and Self- Conscious Agustinian Servant Leader

07 / 03 / 2010

07 / 04 / 2010

16

La Consolacion University
Philippines

Linggo ng Kabataan Boy/Girl Officials

12 / 02 / 2008

12 / 05 / 2008

32

Provincial Government of
Bulacan

VIII. OTHER INFORMATION

33.

SPECIAL SKILLS / HOBBIES:

34.

cooking
VILLACERAN, RUTH KLARIBELLE CRUZ - T15092244

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)

Best Student Teacher (Secondary)

35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION

(Write in full)

LCUP
CoEd
CS
FORM
212Bamboo
(RevisedEnsemble
2005), Page 2 of 4

VIII. OTHER INFORMATION

33.

SPECIAL SKILLS / HOBBIES:

34.

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)

35. MEMBERSHIP IN ASSOCIATION / ORGANIZATION

(Write in full)

Venerable Mo. Rita Barcelo Award

Future Educator's Society

arts and crafts

Special Service Award

Malolos City Private Schools Association

blogging

Best in Performing Arts

baking

watching movies

reading books

computer literate (MS Office)

VILLACERAN, RUTH KLARIBELLE CRUZ - T15092244

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):

appointing authority, recommending authority, chief of office/bureau/department or person who
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):

appointing authority or recommending authority where you will be appointed?

YES

NO

If YES, give details:

_____________________________________
_____________________________________
_____________________________________

YES

NO

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
regulation by any court or tribunal?

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
or phased out, in the public or private sector?

YES

NO

If YES, give details:

_____________________________________
_____________________________________
YES

NO

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:

_____________________________________
_____________________________________
41. 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 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.

Mrs. Raquel A. Balena

City of Malolos, Bulacan

09331835089

Ms. Aliana Concepcion Cruz

Paombong, Bulacan

09355972489

Mrs. Ma. Lourdes M. Dionisio

Tangos, Baliwag, Bulacan

09273564498

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and 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.

X
PHOTO

03398562
COMMUNITY TAX CERTIFICATE NO.
Malolos, Bulacan
ISSUED AT

SIGNATURE (Sign inside the box)

2016-02-15

12 / 17 / 2016

ISSUED ON (mm/dd/yyyy)

DATE ACCOMPLISHED

VILLACERAN, RUTH KLARIBELLE CRUZ - T15092244

RIGHT THUMBMARK

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