CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

W
A
R
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
NI (Do not fill up. For
Print
N legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No.
CSC use only)
G:
I.
A
P
ny
mi
E
2. SURNAME Odin
sr
R
ep FIRST NAME Krizlove Yasser NAME EXTENSION (JR., SR)
re
S
se MIDDLE NAME
O Mantawil
nt
N DATE OF BIRTH
ati 3.
o (mm/dd/yyyy) 06/24/1982 16. CITIZENSHIP
✘ Filipino Dual Citizenship
A
n
L
m by birth by naturalization
Iad
e
4. PLACE OF BIRTH Tamontaka,DOS, Maguindanao If holder of dual citizenship, Pls. indicate country:
N
in
please indicate the details.
Fth5. SEX ✘ Male Female
e
O
P
R6 CIVIL STATUS
er Single ✘ Married 17. RESIDENTIAL ADDRESS #27 Rosales Street
so House/Block/Lot No. Street
M Widowed Separated Purok Pinnen Brgy.RH 6
na
A
l Other/s:
Subdivision/Village Barangay
D
TI
at7. HEIGHT (m) 1.64cm Cotabato City Maguindanao
O
a City/Municipality Province
N
S
he8. WEIGHT (kg) 68kg ZIP CODE 9600
et
an
9. BLOOD TYPE "B" 18. PERMANENT ADDRESS #27 Rosales Street
d
House/Block/Lot No. Street
th
10. GSIS ID NO.
e N/A Purok Pinnen Brgy.RH 6
W Subdivision/Village Barangay
or
11. PAG-IBIG ID NO.
k Cotabato City Maguindanao
E City/Municipality Province
xp
er
12. PHILHEALTH NO. 17-000059861-8 ZIP CODE 9600
ie
nc 557-49-
13. SSS NO.
e N/A 19. TELEPHONE NO.
S 30
he 09061870
14.
et TIN NO. 400-992-750 20. MOBILE NO.
sh
847
Krisshear
all
15. AGENCY EMPLOYEE NO.
ca
20100600251 21. E-MAIL ADDRESS (if any) t@yahoo.
us com
II. FAMILY BACKGROUND
e
23. NAME of
th
CHILDREN
e
22. SPOUSE'S SURNAME Odin DATE OF BIRTH (mm/dd/yyyy)
fili Salindatu
(Write full name
n NAME and list all)
g
FIRST NAME Angelie EXTENSION Kazhimie
Krizmerni 06/29/2002
of MIDDLE NAME
Alo
(JR., SR) relah
R.Odin F. 12/2/2007
ad Aaqil
mi
OCCUPATION Housewife Odin
Ressan 12/11/2013
ni
Aafiyah
st A. Odin
ra EMPLOYER/BUSINESS NAME N/A Rihanna 08/22/2018
tiv
A. Odin
e/ BUSINESS ADDRESS
cr
N/A
im
in
TELEPHONE NO. 557-49-30
al
24.
ca FATHER'S SURNAME Odin
se
NAME
/s FIRST NAME
ag
Nasser EXTENSION
(JR., SR)
ai MIDDLE NAME
ns Ayupan
t
25. MOTHER'S MAIDEN NAME
th
e
pe SURNAME Mantawil
rs
o FIRST NAME Miriam
n
co MIDDLE NAME
nc Sinsuat (Continue on separate sheet if necessary)
er
III.
ne EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/
YEAR
SCHOLARSHIP/
d. BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
26. LEVEL (Write in PERIOD OF ATTENDANCE
EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED

From To

ELEMENTARY Sero Central Elementary School Primary Education 1984 1990 N/A 1990 N/A

VOCATIONAL
SECONDARY /
Notre Dame of Cotabato Boys
High School 1990 1994 N/A 1994 N/A
Dept
N/A N/A N/A N/A N/A N/A N/A
TRADE Bachelor of Science in
COURSE COLLEGE A.R Pacheco College,INC 1994 2001 N/A 2001 N/A
Electrical Engineering
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 09/07/2018 CS FORM 212 (Revised 2017), Page 1 of 4

CS Form No. 212
Revised 2017

PERSONAL DATA SHEET

W
A
R
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
NI (Do not fill up. For
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.
N 1. CS ID No.
CSC use only)
G:
I.A
P
ny
mi
E
2. SURNAME Odin
sr
R
ep FIRST NAME Krizlove Yasser NAME EXTENSION (JR., SR)
re
S
se MIDDLE NAME
O Mantawil
nt
N
ati 3. DATE OF BIRTH
o (mm/dd/yyyy) 06/24/1982 16. CITIZENSHIP
✘ Filipino Dual Citizenship
A
n
L
m by birth by naturalization
ad
Ie4. PLACE OF BIRTH Tamontaka,DOS, Maguindanao If holder of dual citizenship, Pls. indicate country:
N
in
please indicate the details.
F5. SEX
th ✘ Male Female
e
O
P
er6 CIVIL STATUS
R Single ✘ Married 17. RESIDENTIAL ADDRESS #27 Rosales Street
so House/Block/Lot No. Street
M Widowed Separated Purok Pinnen Brgy.RH 6
na
lA Other/s:
Subdivision/Village Barangay
D
TI
at7. HEIGHT (m) 1.64cm Cotabato City Maguindanao
O
a City/Municipality Province
N
S
he8. WEIGHT (kg) 68kg ZIP CODE 9600
et
an
9. BLOOD TYPE "B" 18. PERMANENT ADDRESS #27 Rosales Street
d
House/Block/Lot No. Street
th
e10. GSIS ID NO. N/A Purok Pinnen Brgy.RH 6
W Subdivision/Village Barangay
or
k11. PAG-IBIG ID NO. Cotabato City Maguindanao
E City/Municipality Province
xp
12. PHILHEALTH NO.
er 17-000059861-8 ZIP CODE 9600
ie
nc 557-49-
e13. SSS NO. N/A 19. TELEPHONE NO.
S 30
he 09061870
14.
et TIN NO. 400-992-750 20. MOBILE NO.
sh
847
Krisshear
all
15. AGENCY EMPLOYEE NO.
ca
20100600251 21. E-MAIL ADDRESS (if any) t@yahoo.
us com
II. FAMILY BACKGROUND
e
23. NAME of
th
CHILDREN
e
22. SPOUSE'S SURNAME Odin DATE OF BIRTH (mm/dd/yyyy)
fili Salindatu
(Write full name
n NAME and list all)
g
FIRST NAME Angelie EXTENSION Kazhimie
Krizmerni 06/29/2002
of MIDDLE NAME
Alo
(JR., SR) r R.Odin
elah
ad AaqilF. 12/2/2007
mi
OCCUPATION Housewife Odin
Ressan 12/11/2013
ni
Aafiyah
st A. Odin
ra EMPLOYER/BUSINESS NAME N/A Rihanna 08/22/2018
tiv
A. Odin
e/ BUSINESS ADDRESS
cr
N/A
im
in
TELEPHONE NO. 557-49-30
al
24. FATHER'S SURNAME
ca Odin
se
NAME
/s FIRST NAME
ag
Nasser EXTENSION
(JR., SR)
ai
ns
MIDDLE NAME Ayupan
t
25. MOTHER'S MAIDEN NAME
th
e
pe SURNAME Mantawil
rs
o FIRST NAME Miriam
n
co MIDDLE NAME
nc Sinsuat (Continue on separate sheet if necessary)
er
ne
d.
CS Form No. 212
Revised 2017

PERSONAL DATA SHEET

W
A
R
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
NI
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.
N 1. CS ID No.
G:
I.A
P
ny
mi
E
2. SURNAME Odin
sr
R
ep FIRST NAME Krizlove Yasser
re
S
se MIDDLE NAME
O Mantawil
nt
N
ati 3. DATE OF BIRTH
o (mm/dd/yyyy) 06/24/1982 16. CITIZENSHIP
✘ Filipino Dual Citizenship
A
n
L
m
ad
Ie4. PLACE OF BIRTH Tamontaka,DOS, Maguindanao If holder of dual citizenship,
N
in
please indicate the details.
F5. SEX
th ✘ Male Female
e
O
P
er6 CIVIL STATUS
R Single ✘ Married 17. RESIDENTIAL ADDRESS #27
so House/Block/Lot No.
M Widowed Separated Purok Pinnen
na
lA Other/s:
Subdivision/Village
D
TI
at7. HEIGHT (m) 1.64cm Cotabato City
O
a City/Municipality
N
S
he8. WEIGHT (kg) 68kg ZIP CODE 9600
et
an
9. BLOOD TYPE "B" 18. PERMANENT ADDRESS #27
d
House/Block/Lot No.
th
10. GSIS ID NO.
e N/A Purok Pinnen
W Subdivision/Village
or
11. PAG-IBIG ID NO.
k Cotabato City
E City/Municipality
xp
12. PHILHEALTH NO.
er 17-000059861-8 ZIP CODE 9600
ie
nc 557-49-
13. SSS NO.
e N/A 19. TELEPHONE NO.
S 30
he 09061870
14.
et TIN NO. 400-992-750 20. MOBILE NO.
sh
847
Krisshear
all
15. AGENCY EMPLOYEE NO.
ca
20100600251 21. E-MAIL ADDRESS (if any) t@yahoo.
us com
II. FAMILY BACKGROUND
e
23. NAME of
th
CHILDREN
e
22. SPOUSE'S SURNAME Odin
fili Salindatu
(Write full name
n NAME and list all)
g
FIRST NAME Angelie EXTENSION Kazhimie
Krizmerni
of MIDDLE NAME
Alo
(JR., SR) relah
R.Odin
ad AaqilF.
mi
OCCUPATION Housewife Odin
Ressan
ni
Aafiyah
st A. Odin
ra EMPLOYER/BUSINESS NAME N/A Rihanna
tiv
A. Odin
e/ BUSINESS ADDRESS
cr
N/A
im
in
TELEPHONE NO. 557-49-30
al
24. FATHER'S SURNAME
ca Odin
se
NAME
/s FIRST NAME
ag
Nasser EXTENSION
(JR., SR)
ai
ns
MIDDLE NAME Ayupan
t
25. MOTHER'S MAIDEN NAME
th
e
pe SURNAME Mantawil
rs
o FIRST NAME Miriam
n
co MIDDLE NAME
nc Sinsuat (Continue on separate sheet if necessary)
er
III.
ne EDUCATIONAL BACKGROUND NAME OF SCHOOL
d. BASIC EDUCATION/DEGREE/COURSE
26. LEVEL (Write in PERIOD OF ATTENDANCE
(Write in full)
full)
IV. CIVIL SERVICE ELIGIBILITY
Po CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER
RATING
DATE OF
27. SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT LICENSE (if applicable)
lic BARANGAY ELIGIBILITY / DRIVER'S LICENSE
(If Applicable)
CONFERMENT
e NUMBER Date of
Validity
Of
fic 76.33% 05/27/2018 Napolcom Central Office, Quezon City 125235 7/9/15
er
Ex
a
m

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE GOV'T
SERVICE
(Include private employment. Start from your recent work) Description
POSITION TITLE
of duties should be indicated in the attached Work Experience
DEPARTMENT / AGENCY / OFFICE / COMPANY
SALARY/ JOB/ PAY sheet.
GRADE (if
INCLUSIVE DATES MONTHLY STATUS OF
28. (Write in full/Do not (Write SALARY
applicable)& STEP
APPOINTMENT
(mm/dd/yyyy) (Format "00-0")/
abbreviate) in full/Do not abbreviate) INCREMENT

(Y/ N)
From To
Police
### To-date Philippine National Police P29,668.00 10-0 Permanent Yes
officer I
Police
01/06/2016 01/01/2018 Philippine National Police P14,834.00 10-0 Permanent Yes
officer I
Police
01/06/2015 05/31/2015 Philippine National Police P14,834.00 10-0 Permanent Yes
officer I
Police
01/06/2013 05/31/2015 Philippine National Police P14,834.00 10-0 Permanent Yes
officer I
Police
### 05/31/2013 Philippine National Police P14,834.00 10-0 Permanent Yes
officer I
Police
### 05/31/2012 Philippine National Police P13,492.00 10-0 Permanent Yes
officer I
Police
06/24/2010 05/31/2011 Philippine National Police P12,150.00 10-0 Permanent Yes
officer I
Police
### 06/23/2010 Philippine National Police P10,808.00 10-0 Permanent Yes
officer I
Police
### 06/30/2009 Philippine National Police P9,466.00 10-0 Permanent Yes
officer I
Police
### 6/30/2008 Philippine National Police P8,605.00 10-0 Permanent Yes
officer I
Police
### 7/11/2007 Philippine National Police P8,605.00 10-0 Temporary Yes
Trainee

(Continue on separate sheet if necessary)

SIGNATURE DATE 09/07/2018 CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES POSITION /
29. (Write in full) NUMBER OF HOURS NATURE OF
(mm/dd/yyyy) WORK

From To
N/
VII. N/A N/A N/A N/A
A
LE
AR
(Star
tNI
from
NG
the
AN
most
rece
D
nt
DE
L&D/
VE
traini A
ng
LO
prog ut
PM
ram on CO
and
EN
inclu oND
Tde UC
m TE
(L&
only
ou D/
the
D) (Continue on separate sheet if necessary) SP
relev sON
INT
ant
ER
RSO
Pu
L&D/ RE
traini
VE
INCLUSIVE DATES OF Type of LD eg
bli
ng30.
TITLE OF LEARNING AND DEVELOPMENT
ATTENDANCE ( Managerial/
D
NTI INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/ io
ReBY
ctake (Write in full)
ON
n for (mm/dd/yyyy) Technical/etc) ngio
Saf
the nal
S/T in
ety
last Sp
RAI
Mo
five From To M
Ba
(5)
eci
NI
difi us
sic
year 08/28/2006 09/07/2007 1920Hrs Supervisory al
NG
sed for liTr
Re
PR
Divis
PN
05/16/2011 06/18/2011 360hrs m
ain
(Wri
cru
ion
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Technical
ing
te in
Mi
itChie
RA
Sc full)
Un
f/Exe nd
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out it,
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urs
AT
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nage
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ND ,AR
ions) M
Tr
ED M
ai
ni
ng
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ho
ol

M
VIII ed
. M
al
OT ed
HE ya
M (Continue on separate sheet if necessary)
al
ng
ed
R
ya
Pa
al
INF
OR ng
pu
ya MEMBERSHIP IN ASSOCIATION/ORGANIZATION
En31. Pa
Ts
NON-ACADEMIC DISTINCTIONS / RECOGNITION
MA SPECIAL SKILLS and HOBBIES ri32.
ng (Write in full)
33. (Write in
gin ap
gli full)
TIO Pa
eer
N
alin N/
ing gl
ng
Me A
gk
ab
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od
Let
an
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gin
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lig
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15

3
(Continue on separate sheet if necessary)
11
SIGNATURE
1 DATE 09/07/2018 CS FORM 212 (Revised 2017), Page 3 of 4
 34. Are you related by
consanguinity
chief of bureauoror
affinityortoortothe
office
Bureau the
appointing
person
Department who orhas
where
a. within
recommending the third YES ✘ NO
immediate
you will be
degree?
authority,
b. or
apppointed, fourth
within
supervision the to
overthe
degree
you in the (forOffice,
Local YES
If ✘ NO
Government Unit - YES
Career ,
Employees)? give
deta
ils:
___
___
___
___
___
___
___
___
___
___
__
___
___
___
___
___
___
___
___
___
___
__

35. a. Have you ever YES ✘ NO

been found guilty
If
of any
administrative YES
,
offense?
give YES ✘ NO
b. Have you been
deta
criminally charged
ils: If Date
before any court? YES Filed:
___
,___
Status of Case/s:
give
___
36. Have you ever deta
___ YES ✘ NO
been convicted of ils:
___If
any crime or ___
___
YES
___
violation of any ___
,___
law, decree, ___
37. Have you ever
ordinance or give
___ YES ✘ NO
___
deta
been separated
regulation by any ___ If
___
ils:
from
court the service in
or tribunal? ___
YES
__
___
any of the ,___
38. a. Have you ever ___
___
following modes: ___
give YES ✘ NO
been a candidate ___
___
resignation, ___
If YES, give details:
deta
in a national or ___
___
retirement, ___
ils:
local election ___
b. Have
dropped from held
you the ___
__
___ YES ✘ NO
within thefrom
last the ___
___
resigned
rolls, dismissal, If YES, give details:
___
year (exceptend ___
___
government
termination, ___
Barangay
Have you ___
___
39. service
of term, during
finished the ___ YES ✘ NO
election)?
acquired the ___
___
three (3)-month
contract or ___ If
status of an ___
___
period
phasedbefore
out the ___
YES
immigrant ___
last the or
electionin to
(abolition) __
___
,__
40. permanent
promote/actively
public or private
Pursuant to: (a) ___
___
resident of give
campaign
sector?
Indigenous for a ___
___
deta
another
national country?
or local
People's Act (RA ___
___
P a. Are you a member ils
candidate?
8371); (b) Magna ___
___ YES
__ ✘ NO
S of any indigenous (cou
Carta for Disabled ___
If___
__YES, please specify:
P group? ntry)
S b. Persons
Are you a(RAperson ___
___
: YES ✘ NO
IU
P 7277);
with and (c)
disability? ___
___
If YES, please specify ID No:
N Solo Parents ___
P
S c. Are you a solo
___
IS
T Welfare Act of ___ YES
___ ✘ NO
parent? If___
___YES, please specify ID No:
P 2000 (RA 8972),
.
N please answer the __
___
,S
A41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
following items: ___
E
R
P ___
NAME ADDRESS TEL. NO.
D
.I ___ ID picture taken within
M
E
A Force Commander,1st PMFC,Mag __ 9357017870
the last 6 months
3.5 cm. X 4.5 cm
A
L (passport size)

LR Platoon Leader, 2nd FMP, 1st PMFC 9057483002

With full and handwritten
name tag and signature over
F
A Platoon Leader, 1ST FMP, 1st
9176225066
printed name
LN
. PMFC Computer generated
.F or photocopied picture
is not acceptable
A
A
G
 C, With full and handwritten
D name tag and signature over
ri printed name
v
er Computer generated
42.'s I declare under or photocopied picture
Li is not acceptable
c oath that I have
e
n personally
s accomplished this PHOTO
e,
et Personal Data
c. Sheet which is a
)
true, correct and
complete
statement
pursuant to the
Government Issued ID: PNP ID
provisions of
ID/License/Passport laws, 17I150093
No.:
P pertinent
Signature (Sign inside the box)
L rules and
Date/Place of Issuance:
E regulations of the 9/15/2017 DPRM, NHQ PNP 09/07/2018
A Republic of the Date Accomplished Right Thumbmark
S Philippines. I
E authorize theAND SWORN to before me this
I SUBSCRIBED , affiant exhibiting his/her validly issued government ID as indicated above.
N
agenc
D
I
C
A PINSP. EDMAR L. AYCOCHO
T
E Person Administering Oath
I
4
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