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 REYES
FIRST NAME ROBERTO JR.
MIDDLE NAME MONARCA
3. DATE OF BIRTH
(mm/dd/yyyy) 11/29/1993 16. CITIZENSHIP FILIPINO
4. PLACE OF BIRTH BINALBAGAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX MALE
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS SINGLE
House/Block/Lot No. Street
SITIO TAP-OK ENCLARO
Subdivision/Village Barangay
7. HEIGHT (m) 1.7 BINALBAGAN NEGROS OCCDENTAL
City/Municipality Province
8. WEIGHT (kg) 75 ZIP CODE 6107
18. PERMANENT ADDRESS
9. BLOOD TYPE 0+
House/Block/Lot No. Street
10. GSIS ID NO. N/A SITIO TAP-OK ENCLARO
Subdivision/Village Barangay
11. PAG-IBIG ID NO. N/A BINALBAGAN NEGROS OCCDEN
City/Municipality Province
12. PHILHEALTH NO. N/A ZIP CODE 6107
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 483-647-247 20. MOBILE NO. 09457256112
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) robreyes6969@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)
NAME EXTENSION (JR., SR)
FIRST NAME N/A NA NA
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUSINESS N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
FATHER'S
24. SURNAME REYES
FIRST NAME ROBERTO SR.
MIDDLE NAME ARANDA
25. MOTHER'S MAIDEN NAM
SURNAME MONARCA
FIRST NAME JUDITH
MIDDLE NAME MANDORIAGA (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
UNITS
YEAR
ACADEMIC
LEVEL (Write in (Write in full) GRADUATED HONORS
EARNED
full) (if not graduated) RECEIVED
NAME OF SCHOOL HIGHEST LEVEL/
YEAR SCHOLARSHIP/
LEVEL BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
(Write in (Write in full) GRADUATED HONORS
EARNED
full) (if not graduated) RECEIVED
From To
ELEMENTAR DON ANGEL Y. LOCSIN MEMORIAL
Y SCHOOL GRADUATED 6/22/2000 3/28/2006 N/A 2006 N/A
VOCATIONA
L/
SECONDARY BNHS(NOSOF EXTENSION) GRADUATED 6/19/2006 3/29/2011 N/A 2011 N/A
GGG REVIEW AND LEARNING
CENTER NCII PASSER 7/24/2023 9/28/2023 N/A 2023 N/A
BINALBAGAN CATHOLIC
COLLEGE
TRADE COLLEGE BEED 6/25/2011 3/26/2015 N/A 2015 N/A
COURSE
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
LICENSURE EXAMINATION FOR TEACHERS 80.4 9/27/2015 BACOLOD CITY 1446211 7/16/1905
(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)
1/3/2023 12/31/2023 MEMORANDOM OF AGREEMENT LGU NONE N/A Contractual Y
4/10/202 3/31/2019 SUBSTITUTE TEACHER DEPED 20754.00 Grade 11 Substitute Y
1/1/2019 3/31/2019 LITERACY TEACHER LGU 4000.00 N/A Contractual Y
1/6/2018 12/31/2018 LITERACY TEACHER LGU 4000.00 N/A Contractual y
1/7/2018 12/31/2018 LITERACY TEACHER LGU 4000.00 N/A Contractual 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 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. ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
ICT TRAINING 12/27/2017 2/18/2018 120.0 TECHNICAL SKEED REVIEW AND LEARNING CENTER
COOKERY NCII 7/27/2023 9/27/2023 316.0 VOCATIONAL TESDA
(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)
SINGING N/A N/A
COOKING
GARDENING
COMPUTER LITERATE
(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?
NO
b. Have you been criminally charged before any court?
Date Filed:
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation No
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, No
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 No
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last 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? 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? No
If YES, please specify:
b. Are you a person with disability? No
If YES, please specify ID No:
c. Are you a solo parent? 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
GEMMA E. MADRID Progreso, BIN. NEG. OCC 9187461744 (passport size)
With full and handwritten
MAYSHEIL G. MISSION CANMOROS, BIN. NEG OCC. 9129773441 name tag and signature over
printed name
MARY CHRISTINE LIRAZAN CANMOROS BIN. NEG. OCC Computer generated
or photocopied picture
is not acceptable
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: National ID
ID/License/Passport No.: 2762317584716536
Signature (Sign inside the box)
Date/Place of Issuance: BINALBAGAN, NEG. OCC.
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
