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 Purigay
NAME EXTENSION (JR., SR)
FIRST NAME Ariel

MIDDLE NAME Yacan Afghanistan

3. DATE OF BIRTH
(mm/dd/yyyy) 8/5/1995 16. CITIZENSHIP
✘ Filipino Dual Citizenship Albania
by by
birth naturalization
4. PLACE OF BIRTH Santiago City If holder of dual citizenship, Pls. indicate country: Algeria
please indicate the details.
5. SEX ✘ Male Female Andorra

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS Angola
Separat House/Block/Lot No. Street Antigua and Barbuda
Widowed #26 Roxas Avenue
Argentina
Other/s: ed Armenia
Subdivision/Village Barangay Aruba
7. HEIGHT (m) 5'5 P-4 Rosario Australia
City/Municipality Province Austria
8. WEIGHT (kg) 65kgs ZIP CODE Santiago City, Isabela Azerbaijan

9. BLOOD TYPE A+
18. PERMANENT ADDRESS Bahamas, The
House/Block/Lot No. Street Bahrain
10. GSIS ID NO.
#26 Roxas Ave. Bangladesh
Subdivision/Village Barangay Barbados
11. PAG-IBIG ID NO.
P-4 Rosario Belarus
City/Municipality Province Belgium
12. PHILHEALTH NO. ZIP CODE 3311 Isabela Belize

13. SSS NO. 19. TELEPHONE NO. Benin

14. TIN NO. 20. MOBILE NO. 09764363275 Bhutan

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) purigayyhel05@gmail.om Bolivia
II. FAMILY BACKGROUND Bosnia and Herzego
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) Botswana
NAME EXTENSION (JR., SR)
FIRST NAME Brazil
MIDDLE NAME Brunei 
OCCUPATION Bulgaria
EMPLOYER/BUSINESS NAME Burkina Faso
BUSINESS ADDRESS Burma
TELEPHONE NO. Burundi
24. FATHER'S SURNAME Purigay Cambodia
NAME EXTENSION (JR., SR)
FIRST NAME Ramon Cameroon
MIDDLE NAME Cisnero Canada
25. MOTHER'S MAIDEN NAME Cape Verde
SURNAME Purigay Central African Repu
FIRST NAME Aida Chad
MIDDLE NAME Yacan (Continue on separate sheet if necessary) Chile
III. EDUCATIONAL BACKGROUND China
HIGHEST LEVEL/ SCHOLARSHIP/ Colombia
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in
(Write in full) EARNED
GRADUATED
HONORS Comoros
full) (if not graduated) RECEIVED
From To Congo, Democratic R
ELEMENTARY Rosario Elementary School 2006 Congo, Republic of t

SECONDARY /
VOCATIONAL Santiago City National High School 2012 Costa Rica

TESDA Bartending NcII and Food and Beverages NCII 2013 Cote d'Ivoire
TRADE
COURSE
COLLEGE Northeastern College Bachelor of Secondary Education Major in Sciences 2023 Croatia

GRADUATE STUDIES Cuba

(Continue on separate sheet if necessary) Curacao
SIGNATURE DATE AUGUST, 09 2023 Cyprus
CS FORM 212 (Revised 2017), Page 1 of 4 Czech Republic
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

(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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

2014 Service Crew (head Dining) Mang Insal

2018
2018 2019 Staff New Life Christian Fellowship

2020 2023 Cook,Sever, Event Coordinator Gravitea's Plate Catering and Services

(Continue on separate sheet if necessary)

SIGNATURE DATE August, 09 2023

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

(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

(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)

(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
YES ✘ NO
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, YES ✘ NO
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
YES ✘ NO
Barangay election)?
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
JONA SALES OIC Divisoria Santiago City 4.5 cm. X 3.5 cm
(passport size)

MELAILANIE F. INGARAN CEO Batal, Santiago City

Computer generated
or photocopied picture
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:

ID/License/Passport No.: P7080145B

Signature (Sign inside the box)
August, 09 2023
Date/Place of Issuance:
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