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 Nanol
NAME EXTENSION (JR., SR)
FIRST NAME Hans Louie
MIDDLE NAME Abero
3. DATE OF BIRTH
(mm/dd/yyyy) 9/13/1995 16. CITIZENSHIP
✘
4. PLACE OF BIRTH Cagayan De Oro City If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘
✘ 17. RESIDENTIAL ADDRESS Sta. Delapaz Street
6 CIVIL STATUS
House/Block/Lot No. Street
Kauswagan
Subdivision/Village Barangay
Cagayan De Oro City Misamis Oriental
7. HEIGHT (m) 1.67
City/Municipality Province
8. WEIGHT (kg) 65.2 ZIP CODE 9000
18. PERMANENT ADDRESS Sta. Delapaz Street
9. BLOOD TYPE O+
House/Block/Lot No. Street
Kauswagan
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Cagayan De Oro City Misamis Oriental
11. PAG-IBIG ID NO. 1212 4719 9378
City/Municipality Province
12. PHILHEALTH NO. 150501207405 ZIP CODE 9000
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 447-002-126 20. MOBILE NO. 09168443736
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) louie.nanol@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 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 N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME Nanol
NAME EXTENSION (JR., SR)
FIRST NAME Erlindo
MIDDLE NAME Llave
25. MOTHER'S MAIDEN NAME
SURNAME Abero
FIRST NAME Susan
MIDDLE NAME Aguiñot (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To
ELEMENTARY City Central School N/A 2002 2008 N/A 2008 N/A
SECONDARY /
VOCATIONAL St. Mary's Academy of Carmen N/A 2008 2012 N/A 2012 N/A
N/A N/A N/A N/A N/A N/A N/A
TRADE
University of Science and Technology of Southern
COURSE
COLLEGE
Philippines
Bachelors of Science in Information Technology 2012 2018 N/A 2018 N/A
GRADUATE STUDIES N/A N/A N/A N/A N/A 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. 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
CS - Professional 80.32% 6/19/2022 Cagayan De Oro City N/A N/A
(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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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)
City Disaster Risk Reduction Management
3/20/2019 Present Admin Assistant I 13889.92 N/A Job Order 3
Department
(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
N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
Basic Life Support 7/15/2019 7/19/2019 40 N/A City Disaster Risk Reduction and Management
Water Safety and Rescue 9/16/2020 9/20/2020 40 N/A City Disaster Risk Reduction and Management
(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 in
(Write in full)
full)
Computer Programming N/A N/A
Computer Hardware N/A N/A
(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? ✘
b. within the fourth degree (for Local Government Unit - Career Employees)? ✘
If YES, give details:
________________________________
35. a. Have you ever been found guilty of any administrative offense? ✘
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? ✘
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?
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 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 ✘
Barangay election)?
If YES, give 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? If YES, give 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
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? ✘
If YES, please specify:
b. Are you a person with disability? ✘
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
#129 Tomas Saco - 6th Streets, Nazareth, the last 6 months
Julce Sam Maverick G. Claret CDOC
0917-1639-712 4.5 cm. X 3.5 cm
(passport size)
Monette Sagrado Zone 4, Upper Bulua, CDOC 0916-8487-706
Computer generated
Blk. 39 Lot 7, Bloomingdale Subd., Phase II, or photocopied picture
Jayson J. Maagad Iponan, CDOC
0905-3776-371 is not acceptable
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: Drivers Lisence
ID/License/Passport No.: K02-14-001401
Signature (Sign inside the box)
Date/Place of Issuance: 2022/11/10
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
