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 TADENA
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARK JESTER

MIDDLE NAME CAMACHO

3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP Dual
✘ Filipino
04/15/1993 Citizenship
by by
4. PLACE OF BIRTH TARLAC, TARLAC If holder of dual citizenship, Pls. birth
indicate country: naturalization
please indicate the details.
5. SEX ✘ Male
Female
17. RESIDENTIAL ADDRESS 97 N/A
6 CIVIL STATUS ✘ Single
Married House/Block/Lot No. Street
Widowed Separa N/A CAL-LITANG
Other/s: ted Subdivision/Village Barangay
STA. MARIA PANGASINAN
7. HEIGHT (m) 1.75
City/Municipality Province
8. WEIGHT (kg) 70 ZIP CODE 2441

18. PERMANENT ADDRESS 97 N/A

9. BLOOD TYPE AB
House/Block/Lot No. Street
N/A CAL-LITANG
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A STA. MARIA PANGASINAN

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 2440

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

14. TIN NO. N/A 20. MOBILE NO. 09053080090

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
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) N/A N/A
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME TADENA

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

MIDDLE NAME FORTEZ

25. MOTHER'S MAIDEN NAME

SURNAME CAMACHO

FIRST NAME MARLENE

MIDDLE NAME CABOSAS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LIVING STONE CHRISTIAN ACADEMY ELEMENTARY 1999 2005 GRADUATED 2005 N/A

SECONDARY DIVINE GRACE MONTESSORI AND HIGH SCHOOL HIGH SCHOOL 2005 2009 GRADUATED 2009 N/A
VOCATIONAL /

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

TRADE
COURSE BACHELOR OF HOSPITALITY TOURISM
COLLEGE SAINT LOUIS UNIVERSITY MANAGEMENT MAJOR IN HOTEL,RESORT AND 2009 2013 GRADUATED 2013 N/A
RESTAURANT MANAGEMENT

MASTER IN EDUCATION MAJOR IN SPECIAL

GRADUATE STUDIES UNIVERSIDAD DE DAGUPAN EDUCATION 7/16/1905 PRESENT 24 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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 77.4 9/1/2023 BAGUIO CITY 2140542 04/15/2027

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

07/17/2023 PRESENT VOLUNTEER TEACHER TOMANA ELEMENTARY SCHOOL SPED CENTER N/A N/A VOLUNTEER Y

(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

CAL-LITANG BETHEL CHURCH 5/1/2020 PRESENT 576.0 YOUNG PEOPLE ADVISER

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

DIVISION ORIENTATION ON THE DEVELOPMENT OF INDIVIDUALIZED

01/20/2025 01/22/2025 24.0 DEPED
EDUCATION PLAN (IEP) FOR LEARNERS WITH DISABILITY
EQUITY AND ACCESS IN EDUCATION: STRATEGIES FOR INCLUSIVE
3/12/2024 3/12/2024 3.0 CARL INSTITUTE
TEACHING
2-DAY NATIONAL TRAINING IN RANKING 101: EFFECTIVE DEMO AND TRF
11/182024 11/19/2024 6.0
STRATEGIES FOR DEPED ASPIRANT EDUCATORS CARL INSTITUTE
NAVIGATING THE EARLY YEARS: UNDERSTANDING DEVELOPMENTAL
10/26/2024 10/26/2024 3.0
MILESTONE AND DELAYS LEARNING CIRCLE INC.
LITERACY REIMAGINED: INNOVATIVE WAYS TO TEACH READING AND
10/23/2024 10/23/2024 3.0
WRITING CARL INSTITUTE

ONE-DAY ORIENTATION ON PARAGAMES COACHING 10/22/2024 10/22/2024 8.0

DEPED
THE POWER OF TWO: IMPLEMENING EFFECTIVE CO-TEACHING
10/16/2024 10/16/2024 3.0
PRACTICES CARL INSTITUTE
INCLUSIVE EDUCATION FOR SCHOOL ADMINISTRATORS TEACHERS
AND NON-TEACHING PERSONNEL: AN ADVANCED LEADERSHIP 11/10/2024 10/13/2024 24.0
TRAINING-SEMINAR
LAYESE-CORTES TUTORIAL AND REVIEW CENTER PTR-2022-397-5700
PLANNING CONFERENCE FOR COACHES AND TECHNICAL WORKING
7/10/2024 7/10/2024 8.0 DEDEP
GROUP OF PARAGAMES

INCLUSIVE EDUCATION TRAINING ON SPECIAL EDUCATION-SPED 1/10/2024 10/10/2024 80.0 CPDCFT TRAINING CENTER PTR-2019-354

UPSKILLING AND RESKILLING TEACHING AND SUPERVISION SKILLS

09/15/2024 09/24/2024 80.0 CPDCFT TRAINING CENTER PTR-2019-354
TRAINING
COMPUTER SKILLS DEVELOPMENT TRAINING: IMPROVING CLASSROOM
1/9/2024 10/9/2024 80.0
LEARNING THRU ICT CPDCFT TRAINING CENTER PTR-2019-354
ORIENTATION ON THE SPECIAL NEED EDUCATION PROGRAM FOR SPED
07/19/2024 07/19/2024 8.0
CENTER IMPLEMENTERS TOMANA ELEMENTARY SCHOOL SPED CENTER

NATIONAL DISABILITY RIGHTS WEEK (R.A 11650 SEMINAR) 07/16/2024 07/16/2024 2.0
PHILIPPINE NORMAL SCHOOL
SPECIAL EDUCATION 101 FOR TEACHERS: A COMPREHENSIVE
11/7/2024 11/7/2024 3.0
OVERVIEW ON SPECIAL EDUCATION NEEDS (SEN) MST CONNECT OCE-2022-062

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
in full)
(Write

READING

EATING

(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
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,
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:
________________________________
FINISHED CONTRACT
________________________________
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.

ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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/License/Passport No.: 2140542

Signature (Sign inside the box)

Date/Place of Issuance: 02/15/2024

Right Thumbmark

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

Person Administering Oath

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