ANNEX-H-1-CS-Form-No.-212-Revised-2025-Personal-Data-Sheet.xlsx

	A	B	D	G	I	J	K	L	M	N
1
2
3	PERSONAL DATA SHEET
4	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.
5	READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
7	Print legibly if accomplished through own handwriting. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.
8
9	I. PERSONAL INFORMATION
10	1.	SURNAME	BERNABE
11	2.	FIRST NAME	RACHELLE					NAME EXTENSION (JR., SR)
12		MIDDLE NAME	MELEGRITO
13	3.	DATE OF BIRTH (dd/mm/yyyy)	6/6/1985	16. CITIZENSHIP
14
15	4.	PLACE OF BIRTH	VICTORIA, TARLAC	If holder of dual citizenship,				Pls. indicate country:
16	5.	SEX AT BIRTH		please indicate the details.
17	6	CIVIL STATUS		17. RESIDENTIAL ADDRESS	1710			DOMINGA ST.
18	6	CIVIL STATUS			House/Block/Lot No.			Street
19								41
20								41
21					Subdivision/Village			Barangay
22	7.	HEIGHT (m)	1.575 M.		PASAY CITY			METRO MANILA
23	7.	HEIGHT (m)	1.575 M.		City/Municipality			Province
24	8.	WEIGHT (kg)	74 KG	ZIP CODE	1300
25	9.	BLOOD TYPE	TYPE A	18. PERMANENT ADDRESS				SAN SIMON
26	9.	BLOOD TYPE	TYPE A		House/Block/Lot No.			Street
27	10.	UMID ID NO.	2004053986					SAN ANDRES
28	10.	UMID ID NO.	2004053986		Subdivision/Village			Barangay
29	11.	PAG-IBIG ID NO.	4144816606			VICTORIA			TARLAC
30	11.	PAG-IBIG ID NO.	4144816606		City/Municipality			Province
31	12.	PHILHEALTH NO.	02-00236705-0	ZIP CODE	2313
32	13.	PhilSys Number (PSN):	3126-7132-7596-2479	19. TELEPHONE NO.	N/A
33	14. TIN NO.		298470698	20. MOBILE NO.	9606126740
34	15. AGENCY EMPLOYEE NO.		4544331	21. E-MAIL ADDRESS (if any)	rachelle.bernabe@deped.gov.ph
35	II. FAMILY BACKGROUND
36	22.	SPOUSE'S SURNAME	N/A		23. NAME of CHILDREN (Write full name and list all)				DATE OF BIRTH (dd/mm/yyyy)
37		FIRST NAME		NAME EXTENSION (JR., SR)	N/A				N/A
38		MIDDLE NAME
39		OCCUPATION
40		EMPLOYER/BUSINESS NAME
41		BUSINESS ADDRESS
42		TELEPHONE NO.
43	24.	FATHER'S SURNAME	BERNABE
44		FIRST NAME	SOL	NAME EXTENSION (JR., SR)
45		MIDDLE NAME	DE GUZMAN
46	25.	MOTHER'S MAIDEN NAME
47		SURNAME	MELEGRITO
48		FIRST NAME	REBECCA
49		MIDDLE NAME	CABADING		(Continue on separate sheet if necessary)
50	III. EDUCATIONAL BACKGROUND
51	26.	LEVEL	NAME OF SCHOOL (Write in full)	BASIC EDUCATION/DEGREE/COURSE (Write in full)		PERIOD OF ATTENDANCE		HIGHEST LEVEL/ UNITS EARNED (if not graduated)	YEAR GRADUATED	SCHOLARSHIP/ ACADEMIC HONORS RECEIVED
52	26.					PERIOD OF ATTENDANCE
53						From	To
54		ELEMENTARY	SAN ANDRES ELEMENTARY SCHOOL	ELEMENTARY		1992	1998	GRADUATED	1998	VALEDICTORIAN
55		SECONDARY	VICTORIA NATIONAL HIGH SCHOOL	HIGH SCHOOL		1998	2002	GRADUATED	2002	N/A
56		VOCATIONAL / TRADE COURSE	TECHNICAL EDUCATION AND SKILLS DEVELOPMENT AUTHORITY	NC II BARISTA		2016	2016	COMPLETED	2016	N/A
57		COLLEGE	TARLAC STATE UNIVERSITY	BACHELOR IN ELEMENTARY EDUCATION (SCIENCE AND HEALTH)		2002	2006	GRADUATED	2006	N/A
58		GRADUATE STUDIES	EULOGIO AMANG RODRIGUEZ INSTITUTE OF SCIENCE AND TECHNOLOGY	MASTER OF EDUCATION IN ADMINISTRATION AND SUPERVISION		2010	2013	42	N/A	N/A
59	(Continue on separate sheet if necessary)
60	SIGNATURE					DATE		26/9/2025
61	CS FORM 212 (Revised 2025), Page 1 of 4
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93			(e-signature or actual signature or digital certificate)
94
95
96
97
98
99
100
101