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 LLEMIT
NAME EXTENSION (JR., SR) N/A
FIRST NAME PETER PATRICK

MIDDLE NAME ABAO

3. DATE OF BIRTH
(mm/dd/yyyy) 12/7/1993 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
4. PLACE OF BIRTH CONCEPCION, ASUNCION, DAVAO DEL NORTE If holder of dual citizenship, Pls. indicate country:
✘

by birth ✘ naturalizatio
5. SEX
please indicate the details. n

6 CIVIL STATUS Marrie 17. RESIDENTIAL ADDRESS PUROK 4

Male d House/Block/Lot No. Street

Single
✘
✘
Widowed Female
Separa CONCEPCION
Other/s: Subdivision/Village Barangay
ted ASUNCION DAVAO DEL NORTE
7. HEIGHT (m) 1.63 METERS
City/Municipality Province
8. WEIGHT (kg) 64 KILOGRAMS ZIP CODE 8102

18. PERMANENT ADDRESS PUROK 4

9. BLOOD TYPE A+
House/Block/Lot No. Street
CONCEPCION
10. GSIS ID NO. 2005058623
Subdivision/Village Barangay
ASUNCION DAVAO DEL NORTE
11. PAG-IBIG ID NO. 1211-8392-5011
City/Municipality Province

12. PHILHEALTH NO. 16-250016825-0 ZIP CODE 8102

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

14. TIN NO. 486-849-843 20. MOBILE NO. 09625406982

15. AGENCY EMPLOYEE NO. 7114650 21. E-MAIL ADDRESS (if any) peterllemit@gmail.com/peterpatrick.llemit@deped.gov.ph
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
FIRST NAME N/A N/A N/A N/A

MIDDLE NAME N/A N/A N/A N/A

OCCUPATION N/A N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A N/A

TELEPHONE NO. N/A N/A N/A N/A

24. FATHER'S SURNAME LLEMIT N/A N/A N/A

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

MIDDLE NAME REYES N/A N/A N/A

25. MOTHER'S MAIDEN NAME MARILOU VILLADORES ABAO N/A N/A N/A

SURNAME LLEMIT N/A N/A N/A

FIRST NAME MARILOU N/A N/A N/A

MIDDLE NAME ABAO (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 CONCEPCION ELEMENTARY SCHOOL ELEMENTARY 6/7/2000 3/30/2006 GRADUATED 2006 VALEDICTORIAN

SECONDARY SAGAYEN NATIONAL HIGH SCHOOL SECONDARY 6/72006 3/30/2010 GRADUATED 2010 N/A
VOCATIONAL /

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

TRADE
COURSE UNIVERSITY OF SOUTHEASTERN PHILIPPINES-
COLLEGE TAGUM CAMPUS BACHELOR IN ELEMENTARY EDUCATION 6/7/2010 4/13/2015 GRADUATED 2015 N/A

MASTER OF ARTS IN EDUCATION MAJOR IN

GRADUATE STUDIES BUKIDNON STATE UNIVERSITY EDUCATIONAL ADMINISTRATION ( CAR ) 6/13/2015 Present 33 units N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE February 7, 2024

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
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(LET) 82.0 9/28/2015 UNIVERSITY OF MINDANAO DAVAO CITY 1440724 12/7/2019

…………..NOTHING FOLLOWS……………

(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
INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
(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)

07/19/2024 PRESENT TEACHER II DEPARTMENT OF EDUCATION 30,705.00

SG 12 STEP REGULAR/ YES
1 PERMANENT

1/1/2024 07/18/2024 TEACHER I DEPARTMENT OF EDUCATION 29,085.00

SG STEP 3/ REGULAR/ YES
NBC 594 PERMANENT

1/1/2023 12/31/2023 TEACHER I DEPARTMENT OF EDUCATION 27,773.00

SG STEP REGULAR/ YES
3 /NBC 591 PERMANENT

09/19/2022 12/31/2022 TEACHER I DEPARTMENT OF EDUCATION 26,012.00

SG 11 STEP REGULAR/ YES
3 PERMANENT

1/1/2022 09/18/2022 TEACHER I DEPARTMENT OF EDUCATION 25,273.00

SG 11 STEP REGULAR/ YES
2 PERMANENT

1/1/2021 12/31/2021 TEACHER I DEPARTMENT OF EDUCATION 20,754.00

SG 11 STEP REGULAR/ YES
2 PERMANENT

1/1/2020 13/31/2020 TEACHER I DEPARTMENT OF EDUCATION 20,754.00

SG 11 STEP REGULAR/ YES
2 PERMANENT

09/19/19 12/31/2019 TEACHER I DEPARTMENT OF EDUCATION 20,754.00

SG 11 STEP REGULAR/ YES
2 PERMANENT

1/1/2018 9/18/2018 TEACHER I DEPARTMENT OF EDUCATION 20,120.00

SG 11 STEP REGULAR/ YES
1/NBC 572 PERMANENT

1/1/2017 12/13/2017 TEACHER I DEPARTMENT OF EDUCATION 19,620.00

SG 11 STEP REGULAR/ YES
1/NBC 568 PERMANENT

9/19/2016 12/31/2016 TEACHER I DEPARTMENT OF EDUCATION 19,077.00

SG 11 STEP REGULAR/ YES
1 PERMANENT
 (Continue on separate sheet if necessary)

SIGNATURE DATE February 7, 2024

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
NA NA NA NA NA

(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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

District Refresher Course 2023 cum Physical Fitness Test 11/18/2023 11/19/2023 16 HOURS Technical DEPED District

PAGDASIG: The Madz Inspires thru Music Chorale Workshop 12/1/2022 12/1/2022 8 HOURS Technical CULTURAL CENTER OF THE PHILIPPINES

UPSKILLING OF MUSIC TEACHERS 11/26/2022 11/27/2022 16 HOURS Technical DEPED DAVNOR DIVISION

UPSKILLING OF MUSIC TEACHERS 11/19/2022 11/20/2022 16 HOURS Technical DEPED DAVNOR DIVISION

SEMINAR-WORKSHOP ON CONTEXTUALIZATION ASSESSMEMNT IN ALL LEARNING 12/13/2021 12/15/2021 24 HOURS Technical DEPED DAVNOR DIVISION
AREAS

SINING SA ESKWELA-CULTURAL CENTER OF THE PHILIPPINES 8/9/2021 8/13/2021 40 HOURS Technical CULTURAL CENTER OF THE PHILIPPINES

VIRTUAL ENHANCEMENT TRAINING FOR THE DIVISION POOL OF SELF LEARNING MODULE WRITERS ACROSS ALL
LEARNING AREAS AND GRADE LEVEL 5/19/2021 5/19/2021 8 HOURS TECHNICAL DEPED DAVNOR DIVISION

TECHNOLOGY INTEGRATION AND INSTRUCTIONAL MATERIALS DEVELOPMENT/ 3/19/2021 3/19/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL
PREPARATION IN ENGLISH LANGUAGE

HOUR OF CODE (PROGRAMMING FOR WOMEN) 3/19/2021 3/19/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

INTERACTIVE INSTRUCTIONAL MATERIALS 3/18/2021 3/18/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

GOOGLE WORKSPACE FOR EDUCATION FUNDAMENTALS 3/17/2021 3/17/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

POSTER DESIGN IN ADOBE PHOTOSHOP 3/17/2021 3/17/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

SOLVING PEOPLE PUZZLE 3/17/2021 3/17/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

OVERVIEW OF RA 10173, THE DATA PRIVACY ACT OF 2012 3/17/2021 3/17/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

EFFECTIVE UTILIZATION OF MULTIMEDIA MATERIALS: DEPED TV 3/16/2021 3/16/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

OER READINESS REVIEW CRITERIA 3/16/2021 3/16/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

VIDEO EDITING TECHNIQUES IN PRODUCING QUALITY VIDEO LESSON 3/16/2021 3/16/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

A NEW NORMAL: THE CRITICAL ROLE OF ASSESSMENT IN ONLINE LEARNING 3/16/2021 3/16/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

EFFECTIVE DELIVERY OF SYNCHRONOUS/ASYNCHRONOUS TEACHING 3/15/2021 3/15/2021 1 HR & 30 MIN TECHNICAL ICTS- DEPED NATIONAL

REGIONAL TRAINING ON LITERACY 7/31/2020 7/31/2020 8 HRS TECHNICAL DEPED DAVAO REGION

ROLL-OUT WEBINAR ON THE DEVELOPMENT OF SELF-LEARNING ACTIVITY SHEETS IN 6/15/2020 6/16/2020 16 HRS TECHNICAL DEPED DAVAO REGION
MAPEH, SPA AND SPS.

MOOC CONTENT BASED INSTRUCTION COURSE 11/2/2019 02/25/2019 40 HOURS TECHNICAL AMERICAN EMBASSY

SCIENCE AND MATHEMATICS ENHANCEMENT PROGRAM 8/17/2018 2/15/2019 24 HRS TECHNICAL DEPED ASUNCION DISTRICT

SINING SA ESKWELA-CULTURAL CENTER OF THE PHILIPPINES 5/23/2018 5/27/2018 40 HRS TECHNICAL CULTURAL CENTER OF THE PHILIPPINES

District Re-echo for Music Enhancement Training Workshop Tri-M Program (MODERN MUSIC MASTER) 4/23/2018 4/27/2018 40 HOURS TECHNICAL DEPED DAVNOR DIVISION

3-DAY BASIC TRAINING COURSE IN COACHING SPORTS 11/10/2017 11/12/2017 24 HOURS TECHNICAL ICTS- DEPED NATIONAL
UPGRADING OF TEACHERS COACHING GROUP EVENTS, DUAL AND INDIVIDUAL EVENTS 7/15/2017 7/16/2017 16 HOURS TECHNICAL ICTS- DEPED NATIONAL
AND COMBATIVE SPORTS
DIVISION MASS TRAINING ON K-12 ENHANCED BASIC EDUCATION CURICULLUM 5/21/2017 5/27/2017 56 HOURS TECHNICAL DEPED DAVNOR DIVISION

5-Day District Training Workshop on Striker's Material Development 4/24/2017 4/28/2017 32 HOURS TECHNICAL DEPED

(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)
ASSOCIATION OF PUBLIC ELEMENTARY SCHOOLS
SINGING/DANCING NA TEACHERS ASSOCIATION (APESTA)

COMPUTER HARDWARE SERVICING NA GAGMAYNG KRISTOHANONG KATILINGBAN (GKK)

MICROSOFT PROGRAMS NA DAVAO DEL NORTE ATHLETICS SPORTS ASSOCIATION

…...NOTHING FOLLOWS…... NA DAME CHORALE
NA …...NOTHING FOLLOWS…..
NA
(Continue on separate sheet if necessary)
SIGNATURE DATE February 8, 2024
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
✘
If YES, give details:
________________________________
________________________________
YES
b. Have you been criminally charged before any court? ✘

If YES, give details:

________________________________
Date Filed:
________________________________
Status of Case/s:
YES
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation ✘
by any court or tribunal?
If YES, give details:
________________________________
YES________________________________ ✘

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 If YES, give details:
out (abolition) in the public or private sector?
YES________________________________
________________________________
✘ NO
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
YES If YES, give
✘ NO
details:
b. Have you resigned from the government service during the three (3)-month period before the last
election to promote/actively campaign for a national or local candidate?
YES If YES, give NO
✘ details:

39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA YES
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
✘ NO
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?
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
MARLYN T. PERALTA CAMONING, ASUNCION, DAVAO DEL the last 6 months
NORTE 9102683725 3.5 cm. X 4.5 cm
(passport size)
POBLACION,ASUNCION, DAVAO DEL
SHIRLEY S. NERI NORTE 9105647654 With full and handwritten
name tag and signature over
printed name
GRACE M. DESONIA TAGUM CITY, DAVAO DEL NORTE 9456765678
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: PROFESSIONAL REGULATORY COMMISION

ID/License/Passport No.: 1440724

Signature (Sign inside the box)
02/08/24
Date/Place of Issuance: 02/15/2016
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