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
NAME EXTENSION (JR., SR) N/A
FIRST NAME
MIDDLE NAME
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS
Widowed House/Block/Lot No. Street
Separate
Other/s: d
Subdivision/Village Barangay
7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) ZIP CODE
18. PERMANENT ADDRESS
9. BLOOD TYPE
House/Block/Lot No. Street
10. GSIS ID NO.
VETALLEA SUBD. MANGA
Subdivision/Village Barangay
11. PAG-IBIG ID NO.
City/Municipality Province
12. PHILHEALTH NO. ZIP CODE
13. SSS NO. 19. TELEPHONE NO.
14. TIN NO. 20. MOBILE NO.
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) psjlc202302.239327@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME
NAME EXTENSION (JR., SR) SR
FIRST NAME
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
UNITS
YEAR SCHOLARSHIP/
LEVEL (Write in (Write in full) GRADUATE ACADEMIC HONORS
full) EARNED RECEIVED
D
(if not graduated)
From To
ELEMENTARY NAGA CENTRAL ELEMENTARY SCHOOL ELEMENTARY 1992 1998 GRADUATED 1998 N/A
SECONDARY NAGA NATIONAL HIGH SCHOOL HIGH SCHOOL 1998 2002 GRADUATED 2002 LEADERSHIP
AWARD
VOCATIONAL /
TESDA SCHOLAR, LEADERSHIP
KABASALAN INSTITUTE OF TECHNOLOGY VOCATIONAL 2004 2006 GRADUATED 2006 AWARD
TRADE COURSE
PHILIPPINE CAMBRIDGE SCHOOL OF LAW COLLEGE 2007 2011 GRADUATED 2011 CUM LAUDE
COLLEGE SOUTHERN MINDANAO COLLEGES COLLEGE 2017 2021 GRADUATED 2021 LEADERSHIP AWARD
GRADUATE STUDIES N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE
;
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
CRIMINOLOGIST DECEMBER 2021 DON PABLO, ZAMBOANGA CITY 6/15/2025
NAPOLCOM SPO EXAM 10/16/2016 PAGADIAN CITY N/A
NAPOLCOM PO EXAM 11/9/2014 PAGADIAN CITY N/A
CS PROF PD 907 March 18, 2011 R4A, QUEZON CITY N/A
LET EXAM (PRC) R4A, QUEZON CITY
(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 GOV'T SERVICE
(mm/dd/yyyy) SALARY/ JOB/
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do not SALARY
applicable)& STEP
APPOINTMENT
abbreviate) (Write in full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)
12/31/2021 PRESENT POLICE STAFF SERGEANT PHILIPPINE NATIONAL POLICE 32,114.00 14 PERMANENT YES
02/13/2014 03/12/2019 POLICE CORPORAL PHILIPPINE NATIONAL POLICE 30,867.00 12 PERMANENT YES
2/8/2014 2/13/2014 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE 14,834.00 10 PERMANENT YES
1/7/2014 2/8/2014 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE 14,834.00 10 PERMANENT YES
(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
(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
PUBLIC SAFETY JUNIOR LEADERSHIP COURSE (PSJLC) 12/15/2023 5/28/2024 720 Technical RTC9, PASONANCA, ZAMBOANGA CITY
POST BLAST INVESTIGATION COURSE 3/5/2018 3/16/2018 88 Technical PBDC DI AND THE BRITISH EMBASSY MANILA
EXPLOSIVE ORDNANCE RECONNAISSANCE AGENT 4/4/2016 4/25/2016 168 Technical 1ST ID TABAK PHILIPPINE ARMY PULACAN
CRIMINAL INVESTIGATION COURSE 12/18/2014 3/30/2015 240 Technical ZSPPO
SCIENTIFIC METHOD OF PROCESSING FINGERPRINTS FOR POLICE INVESTIGATORS 9/23/2014 9/26/2014 24 Technical MERCEDES, ZAMBOANGA CITY
SEMINAR-WORKSHOP
MODIFIED PNP SPECIAL COUNTER-INSURGENCY OPERATIONS UNIT TRAINING (SCOUT) 8/22/2013 1/7/2014 360 Technical MERCEDES, ZAMBOANGA CITY
II CLASS 01-2013
ANTI-VIOLENCE AGAINST WOMEN AND CHILDREN 10/27/2012 10/27/2012 8 Technical ATENEO DE ZAMBOANGA UNIVERSITY
PS BASIC RECRUIT COURSE 7/2/2012 7/31/2013 1920 Technical RTS9, PASONANCA, ZAMBOANGA CITY
(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)
Computer Literate N/A
Medalya ng Papuri (3)
Commendation (1)
Medalya ng Paglaban sa Manliligalig (2)
Medalya ng Paglilingkod Laban sa Kriminalidad (1)
Medalya ng Paglilingkod sa Mindanao (1)
(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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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
3.5 cm. X 4.5 cm
(passport size)
With full and handwritten
name tag and signature over
printed name
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:
ID/License/Passport No.:
Signature (Sign inside the box)
Date/Place of Issuance: 6/15/25 CAMP CRAME, QUEZON 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
