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 Ondoy
NAME EXTENSION (JR., SR)
FIRST NAME Angielie
MIDDLE NAME Briones
3. DATE OF BIRTH
(mm/dd/yyyy) September 10, 1989 16. CITIZENSHIP
4. PLACE OF BIRTH Los Angeles, Butuan City If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
6 CIVIL STATUS 17. RESIDENTIAL ADDRESS p-11
House/Block/Lot No. Street
Los Angeles
Subdivision/Village Barangay
7. HEIGHT (m) 5'4" Butuan City Agusan del Norte
City/Municipality Province
8. WEIGHT (kg) 58kg ZIP CODE 8600
9. BLOOD TYPE AB+ 18. PERMANENT ADDRESS p-11
House/Block/Lot No. Street
10. GSIS ID NO. N/A Los Angeles
Subdivision/Village Barangay
Butuan City Agusan del Norte
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. N/A ZIP CODE 8600
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 751-928-620-000 20. MOBILE NO. 09925660112
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) angielieondoy89@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Ondoy 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH
(mm/dd/yyyy)
Jr. Mc Lixer B. Ondoy
FIRST NAME Gerson 10/17/2010
Brent B. Ondoy
MIDDLE NAME Galewa 01/22/2012
OCCUPATION Fish Vendor
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME Briones
NAME EXTENSION (JR., SR)
FIRST NAME Catalino
MIDDLE NAME Ardaba
25. MOTHER'S MAIDEN NAME
SURNAME Ramos
FIRST NAME Rosalinda
MIDDLE NAME Diamonon (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHI
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF YEAR
LEVEL (Write in ATTENDANCE UNITS EARNED GRADUATED P/ HONORS
ACADEMIC
(Write in full) full) RECEIVED
(if not graduated)
HIGHEST LEVEL/ SCHOLARSHI
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR
LEVEL (Write in UNITS EARNED GRADUATED P/ HONORS
ACADEMIC
(Write in full) full) RECEIVED
From To (if not graduated)
ELEMENTARY Los Angeles Elementary School Elementary Education 06/17/1995 1/3/2000 2000 N/A
VOCATIONAL
SECONDARY / Los Angeles National High School Secondary Education 1/6/2000 1/3/2005 2005 N/A
N/A N/A N/A N/A N/A N/A
TRADE
COLLEGE
COURSE Northern Mindanao Colleges Inc. Bachelor of Elementary Education 06/19/2017 05/25/2021 2021 N/A
GRADUATE STUDIES 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. 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
N/A N/A N/A N/A 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
(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)
1/4/2022 01/31/2022 Family Income and Expenditure Survey Philippine Statistics Authority 15000.00 N/A Contract of Y
Enumerator Service
(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
(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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
PROGRAMS (Write in full) (mm/dd/yyyy) HOURS Supervisory/ (Write in full)
Technical/etc)
From To
Labor Force Survey and Family Income and Expenditure Survey 4/1/2022 10/1/2022 56.0 Technical Philippine Statistics Authority-Caraga
(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)
Cooking 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
the last 6 months
3.5 cm. X 4.5 cm
Ruth Taotao Los Angeles Butuan City 9206643171 (passport size)
With full and handwritten
Jonel Ondoy Soriano Cabadbaran City 9453545353 name tag and signature over
printed name
Cecille Elegino Sumilihon Butuan City 9485381243 Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not acceptable
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
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:National ID
ID/License/Passport No21E2557098 Signature (Sign inside the box)
Date/Place of IssuanceButuan City
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
