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 David
FIRST NAME MIDDLE NAME NAME EXTENSION (JR., SR)
Chris
Fernandez
3. DATE OF BIRTH (mm/dd/yyyy)
11/10/1988 16. CITIZENSHIP Filipino
If holder of dual citizenship, please indicate the details. Pls. indicate country:
4. PLACE OF BIRTH Iba, Zambales
5. SEX Male
17. RESIDENTIAL ADDRESS Purok 3
6 CIVIL STATUS Married
House/Block/Lot No. Street
Sto. Rosario
Subdivision/Village Barangay
Iba Zambales
7. HEIGHT (m) 5'5"
City/Municipality Province
ZIP CODE
8. WEIGHT (kg) 72 2201
18. PERMANENT ADDRESS Purok 3
9. BLOOD TYPE B+
House/Block/Lot No. Street
Sto. Rosario
10. GSIS ID NO. n/a
Subdivision/Village Barangay
Iba Zambales
11. PAG-IBIG ID NO. 1211-1816-9394
ZIP CODE City/Municipality Province
12. PHILHEALTH NO. 030511962753 2201
13. SSS NO. 0230000786 19. TELEPHONE NO.
14. TIN NO. 285390167 20. MOBILE NO. 09072637022
15. AGENCY EMPLOYEE NO. n/a 21. E-MAIL ADDRESS (if any)
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME FIRST NAME David 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
MIDDLE NAME NAME EXTENSION (JR., SR) Christa Joice C. David 22/5/2011
Rejoice
Chua Christal Jorge C. David 30/5/2014
OCCUPATION Housewife
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME FIRST NAME David
MIDDLE NAME NAME EXTENSION (JR., SR)
Ariel
Sangalang
25. MOTHER'S MAIDEN NAME SURNAME
FIRST NAME
Fernandez
MIDDLE NAME
Premelinda
Orlino (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
SCHOLARSHIP/ ACADEMIC
26. PERIOD OF ATTENDANCE HE ST LEVEL/ UNITS EARNED
UCATION/DEGREE/COURSE YEAR GRADUATED HONORS RECEIVED
LEVEL (if not graduated)
(Write in full) (Write in full)
From To
ELEMENTARY Sto. Rosario Elementary School 1995 2001 2001
SECONDARY Zambales National High School 2001 2006 2006
VOCATIONAL / TRADE COURSE
2006 2011 2011
COLLEGE Ramon Magsaysay Technological University Bachelor of Science in Industrial Technology
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE September 2, 2022
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/
RATING DATE OF EXAMINATION /
CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) CONFERMENT NUMBER
ELIGIBILITY / DRIVER'S LICENSE Validity
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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(mm/dd/yyyy) GOV'T
E NCY / OFFICE / COMPANY MONTHLY GRADE (if applicable)& STATUS OF
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY STEP (Format "00-0")/ APPOINTMENT
INCREMENT (Y/ N)
From To
2014 2022 Mechanic Supreme Bike Corporation 12700.00) Regular
(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
29. NAME & ADDRESS OF ORGANIZATION (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
n/a
(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)
30. NDANCE Type of LD
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (mm/dd/yyyy) ( Managerial/ ONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
Technical/etc)
From To
Motorcycle / Small Engine Servicing (NCII) 2017 2022 1 Day TESDA
Primary Training Course 17/11/2015 20/11/2015 4 Days
Honda Philippines Inc
Power Product Technical Training Course 22/3/2016 23/3/2016 2 Days
Honda Philippines Inc
Maintenance, Repair and Diagnostic Training 26/3/2016 27/3/2016 2 Days
Honda Philippines Inc
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
-ACADEMIC DISTINCTIONS / RECOGNITION SOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in full)
(Write in full)
Small Engine Mechanic
(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:
NO
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
NO
b. Have you been criminally charged before any court?
If YES, give details:
Date Filed: NO
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:
RESIGNATION
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 out (abolition) in the public or private sector? If YES, give details:
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: NO
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):
NO
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: NO
b
Are you a person with disability?
If YES, please specify ID No: NO
c. Are you a solo parent?
If YES, please specify ID No: NO
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
NAME ADDRESS TEL. NO.
Lelan Cantillo Iba, Zambales 9193874666
Julio Miller Callosa Iba, Zambales 9455509498
Ferdinand V. Mayor Iba, Zambales 9494196095
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement
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: National id
ID/License/Passport No.: C06-09-000-961 Signature (Sign inside the box)
01/19/23
Date/Place of Issuance: 10/12/15 Iba, Zambales
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
