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 JARAULA
NAME EXTENSION (JR., SR)
FIRST NAME RACHELLE ANN
MIDDLE NAME SUAN
3. DATE OF BIRTH
(mm/dd/yyyy) 3/12/2000 16. CITIZENSHIP
4. PLACE OF BIRTH
SAN MIGUEL, MANOLO FORTICH, If holder of dual citizenship, Pls. indicate country:
BUKIDNON
please indicate the details.
5. SEX
17. RESIDENTIAL ADDRESS ZONE-2A
6 CIVIL STATUS
House/Block/Lot No. Street
CAWAYANON SAN MIGUEL
Subdivision/Village Barangay
MANOLO FORTICH BUKIDNON
7. HEIGHT (m) 154
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 8703
18. PERMANENT ADDRESS ZONE-2A
9. BLOOD TYPE O
House/Block/Lot No. Street
CAWAYANON SAN MIGUEL
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MANOLO FORTICH BUKIDNON
11. PAG-IBIG ID NO. 121347957748
City/Municipality Province
12. PHILHEALTH NO. 15-025673875-0 ZIP CODE 8703
13. SSS NO. 08-3378824-3 19. TELEPHONE NO. N/A
14. TIN NO. 673-223-765 20. MOBILE NO. 09614597533 / 09166697258
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) jaraularachelleann@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME N/A
NAME EXTENSION (JR., SR) N/A N/A
MIDDLE NAME N/A N/A
OCCUPATION N/A N/A
EMPLOYER/BUSINESS NAME N/A N/A
BUSINESS ADDRESS N/A N/A
TELEPHONE NO. N/A N/A
24. FATHER'S SURNAME JARAULA N/A
FIRST NAME ROMEO
NAME EXTENSION (JR., SR)
N/A
MIDDLE NAME CURAN N/A
25. MOTHER'S MAIDEN NAME N/A
SURNAME SUAN N/A
FIRST NAME VIRGINIA N/A
MIDDLE NAME SALE (Continue on separate sheet if necessary)
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
HIGHEST LEVEL/ SCHOLARSHIP/
NAME OF SCHOOL YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
From To
SAN MIGUEL ELEMENTARY MANOLO FORTICH,
ELEMENTARY BUKIDNON
N/A 2011 2012 2012
SECONDARY MANOLO FORTICH NATIONAL HIGH SCHOOL N/A 2017 2018 2018
VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE
COURSE BACHELOR OF SCIENCE IN BUSINESS
COLLEGE NORTHERN BUKIDNON STATE COLLEGE ADMINISTRATION MAJOR IN MARKETING 2023 2024 2024 N/A
MANAGEMENT
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE June 4, 2025
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)
11/5/2024 12/31/2024 Administrative Assistant Green Acres Renewable Energy 11986.00 N
Corporation
Waitress Pinutos sa Kanto Food Hauz 6500.00 N
6/20/2018 5/21/2020
N/A N/A N/A N/A N/A N/A N /A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE JUNE 4, 2025
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
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
ON THE JOB TRAINING 5/3/2024 8/6/2024 580.0 N/A BUKIDNON SECOND ELECTRIC COOPERATIVE
CASH FOR WORK 06/13/2024 09/30/2024 90 DAYS N/A
NORTHERN BUKIDNON STATE COLLEGE
N/A N/A N/A N/A N/A
N/A
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
Singing & Dancing N/A N/A
Drawing N/A N/A
N/A N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE JUNE 4, 2025
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: ________NO________
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:
________________________________
NO
________________________________
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? ________________________________
NO
________________________________
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: NO
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. ID picture taken within
the last 6 months
4.5 cm. X 3.5 cm
Jefrey A. Doring San Miguel, Manolo Fortich, Bukidnon 9678642884 (passport size)
Hilrose A. Ongi Philips, Manolo Fortich, Bukidnon 9976223642 Computer generated
or photocopied picture
is not acceptable
Grant Harold Baconguis Sankanan, Manolo Fortich, Bukidnon 09164100577
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
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/License/Passport No.: 673-223-765
Signature (Sign inside the box)
Date/Place of Issuance: April 12, 2025
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
