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 SAYAT
NAME EXTENSION (JR, SR)
FIRST NAME ANGELITA
MIDDLE NAME MORALES
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
AUGUST 27, 1975 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH PARAÑAQUE CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS BLK 19 Road 20 ORCHIDS
Widowed House/Block/Lot No. Street
✘ Separate
d WEST FLOODWAY SAN ANDRES
Other/s:
Subdivision/Village Barangay
CAINTA RIZAL
7. HEIGHT (m) 5m
City/Municipality Province
8. WEIGHT (kg) 70kg ZIP CODE 1900
18. PERMANENT ADDRESS BLK 19 Road 20 ORCHIDS
9. BLOOD TYPE "B+"
House/Block/Lot No. street
WEST FLOODWAY SAN ANDRES
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CAINTA RIZAL
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 03-027045122-1 ZIP CODE 1900
13. SSS NO. 3377960692 19. TELEPHONE NO. N/A
14. TIN NO. 249-417-896-000 20. MOBILE NO. 09679985475
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) MIREO JJIERHEN DEPAZ@GMAIL.COM
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SAYAT 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH
FIRST NAME MARLON
NAME EXTENSION (JR, SR)
MARY JOY M. SAYAT 04/15/1996
MIDDLE NAME ALA MARK ANGELO 07/21/2000
OCCUPATION N/A MARLON M. SAYAT 12/24/2009
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME MORALES
NAME EXTENSION (JR, SR)
FIRST NAME PATERNO
MIDDLE NAME MAESTRAL
25. MOTHER'S MAIDEN NAME
SURNAME LAZARO
FIRST NAME TESSIE
MIDDLE NAME LIZA
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
From To
ELEMENTARY MINA PUTUTAN ELEM SCHOOL ELEMENTARY N/A N/A N/A N/A N/A
SECONDARY
VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
N/A N/A N/A N/A N/A N/A N/A
TRADE
COURSE
COLLEGE N/A N/A N/A N/A N/A N/A 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. 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
(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 abbreviate) (Write in SALARY
applicable)& STEP
APPOINTMENT
full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)
JAN. 2025 PRESENT TASK FORCE ROAD CLEARING OFFICE 5000.00 N/A JOB ORDER Y
JAN. 2024 DEC.2024 HAULER ROAD CLEARING OFFICE 5000.00 N/A JOB ORDER Y
(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
(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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS ( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
Cainta Elementary School Auditorium/ Road
Seminar 2024 8/26/24 8/27/24 24.0 N/A clearing
TEAM BUILDING 4/26/24 4/27/24 24.0 N/A ROAD CLEARING OFFICE
(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)
(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
by any court or tribunal? YES ✘ NO
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 YES ✘ NO
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)? YES ✘ NO
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
EMMANUEL B. CORPUZ CAINTA RIZAL 9185386036 3.5 cm. X 4.5 cm
(passport size)
MARY ANN V. CASTRO CAINTA RIZAL 9602482656 With full and handwritten
name tag and signature over
printed name
CRISOLOGO PILOTON CAINTA RIZAL 9477052199
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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: TIN ID
ID/License/Passport No.: 249-417-896-00 Signature (Sign inside the box)
Date/Place of Issuance: CAINTA RIZAL 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
