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 MERCADO
NAME EXTENSION (JR., SR) N/A
FIRST NAME LAURENCE ANTHONY

MIDDLE NAME VILLAHERMOSA

3. DATE OF BIRTH
08/26/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CEBU CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed
Separated CASAY
Other/s:
Subdivision/Village Barangay
DALAGUETE CEBU
7. HEIGHT (m) 163
City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 6022

18. PERMANENT ADDRESS

9. BLOOD TYPE AB
House/Block/Lot No. Street
CASAY
10. GSIS ID NO. 2005236571
Subdivision/Village Barangay
DALAGUETE CEBU
11. PAG-IBIG ID NO. 1212-1651-7379
City/Municipality Province

12. PHILHEALTH NO. 12-051316976-6 ZIP CODE 6022

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

14. TIN NO. 714-160-971-0000 20. MOBILE NO. 09498105480

15. AGENCY EMPLOYEE NO. 6086809 21. E-MAIL ADDRESS (if any) laurence.mercado5@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME MERCADO

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

MIDDLE NAME SUAREZ

25. MOTHER'S MAIDEN NAME

SURNAME VILLAHERMOSA

FIRST NAME RITA

MIDDLE NAME BELDAD (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

5TH HONORABLE
ELEMENTARY CASAY ELEMENTARY SCHOOL 1/1/2002 1/4/2002 GRADUATE 2008 MENTION

SECONDARY /
VOCATIONAL DALAGUETE NATIONAL HIGH SCHOOL 1/1/2008 1/4/2012 GRADUATE 2012 N/A

BACHELOR OF SECONDARY EDUCATION

CEBU NORMAL UNIVERSITY MAJOR IN ENGLISH 01/012012 1/4/2016 GRADUATE 2016 CUM LAUDE
TRADE
COURSE
COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 AND LICENSURE EXAMINATION FOR SEPTEMBER 29,
82.0 2016
UNIVERSITY OF CEBU MAIN CAMPUS 1526963 8/26/2020
PROFESSIONAL TEACHERS

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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 REGULAR
12/06/17 12/37/17 SENIOR HIGH SCHOOL TEACHER 2 21,387.00 GRADE 12
PERMANENT
Y
DIVISION OF CEBU PROVINCE
DEPARTMENT OF EDUCATION REGULAR
01/01/18 PRESENT SENIOR HIGH SCHOOL TEACHER 2 22, 149 GRADE 12
PERMANENT
Y
DIVISION OF CEBU PROVINCE

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

DALAGUETE VOLLEYBALL ASSOCIATION 11/9/2011 02/19/2020 8 HRS SECRETARY

(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

TEACHERS INDUCTION PROGRAM 05/16/2019 05/18/2019 24 HRS. DIVISION OF CEBU PROVINCE

IMPLEMENTATION OF CAREER GUIDANCE PROGRAM 08/19/19 08/22/19 32 HRS. DIVISION OF CEBU PROVINCE

VOLLEYBALL SEMINAR/ WORKSHOP FOR COACHES AND TRAINERS 11/22/18 11/24/18 24 HRS. MUNICIPALITY OF DALAGUETE

MID-YEAR IN SERVICE TRAINING FOR TEACHERS 10/22/2018 10/26/2018 40 HRS. DIVISION OF CEBU PROVINCE

(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
(Write in full)
in full)

VOLLEYBALL RESOURCE SPEAKER AND TRAINER DALAGUETE VOLLEYBALL ASSOCIATION

(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 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
YES ✘ NO
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 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
BERNARD CUANDOT BALISONG, ARGAO, CEBU 9334160254 3.5 cm. X 4.5 cm
(passport size)

JULIETO ENTIA CORO, DALAGUETE, CEBU 9498105380 With full and handwritten
name tag and signature over
printed name
SPYCA AMATONG POBLACION, DALAGUETE, CEBU 9455275070
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.: 1526963

Signature (Sign inside the box)
02/19/2020
Date/Place of Issuance: 01/30/2017
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