CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes q with "P " and use separate sheet if necessary.

1. CS ID No.

(to be filled up by CSC)

I. PERSONAL INFORMATION
A |G | U | I | L | A | R

FIRST NAME

J | O| Y | C| E |

MIDDLE NAME

A | B | A | D |

2. SURNAME

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16. RESIDENTIAL ADDRESS

6/18/1958

4. DATE OF BIRTH (mm/dd/yyyy)

5. PLACE OF BIRTH

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3. |NAME| EXTENSION
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N/A
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478 7th St. Guigona Subd. Butuan City

CABADBARAN AGUSAN DEL NORTE

6. SEX
7. CIVIL STATUS

q Single
q Married
q Annulled

8. CITIZENSHIP

FILIPINO

9. HEIGHT (m)

5'3

q Widowed
q Separated
q Others, specify ___________

ZIP CODE

8600

17. TELEPHONE NO.

3601748

18. PERMANENT ADDRESS

478 7th St. Guigona Subd. Butuan City

8600

10. WEIGHT (kg)

57 KLS.

11. BLOOD TYPE

"A"

19. TELEPHONE NO.

3601748

12. GSIS ID NO.

58061802906

20. E-MAIL ADDRESS (if any)

jute_18@yahoo.com

13. PAG-IBIG ID NO.

310157599211

21. CELLPHONE NO. (if any)

09158146961

14. PHILHEALTH NO.

18-000024509-5

22. AGENCY EMPLOYEE NO.

4075

15. SSS NO.

0821254200

23. TIN

108-812-406

ZIP CODE

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME

AGUILAR, JR.

25. NAME OF CHILD (Write full name and list all)

(Deceased)

DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MAXIMO

KATHERYN ANNE AGUILAR

5/4/1984

MIDDLE NAME

G.

MC JAY ANDREW AGUILAR

10/30/1985

OCCUPATION

KEEZIAH JOY AGUILAR

3/25/1987

EMPLOYER/BUS. NAME

KEERYN MAXCEY AGUILAR

10/6/1993

BUSINESS ADDRESS
TELEPHONE NO.
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME

ABAD

FIRST NAME

PRUDENCIO

MIDDLE NAME

LANDICHO

27. MOTHER'S MAIDEN NAME

SURNAME

LIBARNES

FIRST NAME

ANAWRITA

MIDDLE NAME

BALATA

(Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

28.

YEAR
GRADUATED

NAME OF SCHOOL
LEVEL

(Write in

HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)

DEGREE COURSE
(Write in full)

From

To

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

1972

1967

1972

None

1976

1972

1976

None

n/a

n/a

None

1976

1981

None

full)
ELEMENTARY

NORCAPES

Elementary

SECONDARY
VOCATIONAL /

NORTHERN MINDANAO
COLLEGES

Secondary

n/a
COLLEGE
COURSE

n/a

INCLUSIVE DATES OF
ATTENDANCE

(if graduated)

n/a

n/a

TRADE

FATHER URIDS UNIVERSITY

BSC major in

1981

Accounting
GRADUATE STUDIES

(Continue on separate sheet if necessary)

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29.

LICENSE (if applicable)

RATING

DATE OF
EXAMINATION /
CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

CS Professional

80.27%

1/15/2002

CSC Caraga, Reg. 13

CS Sub Professional

83.38%

2/15/1998

CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE

NUMBER

DATE OF
RELEASE

220064WE

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.

INCLUSIVE DATES
(mm/dd/yyyy)
From

To

POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)

(Write in full)

GOV'T
SERVICE
MONTHLY
SALARY

SALARY GRADE
& STEP
INCREMENT
(Format "00-0")

STATUS OF
APPOINTMENT
(Yes / No)

pls. see attached service

records

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

31. NAME & ADDRESS OF ORGANIZATION

INCLUSIVE DATES
(Write in full)

(mm/dd/yyyy)
From

N/A

NUMBER OF
HOURS

POSITION / NATURE OF WORK

To

(Continue on separate sheet if necessary)

VII. TRAINING PROGRAMS (Start from the most recent training.)

INCLUSIVE DATES OF ATTENDANCE
32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write
in full)

(mm/dd/yyyy)

NUMBER OF
HOURS

CONDUCTED/ SPONSORED BY
(Write in full)

From

To

9/11/2012

9/12/2012

16 hrs.

CSC HRD, Butuan City

3/8/2012

3/8/2012

4 hrs.

CSC HRD, Butuan City

Seminar Workshop on the Establishment of Agencys

Strategic Performance Management System (SPMS)
Orientation on the use of the Revised Statement of Assets
and Liabilities and Networth

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

33.

SPECIAL SKILLS / HOBBIES:

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

34.
(Write in full)

35.

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)

Bookkeeping/Accounting

n/a

Computer Literate/Typing

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4

36.
a.

b.

37

Are you related by consanguinity or affinity to any of the following :

Within the third degree (for National Government Employees):
appointing authority, recommending authority, chief of office/bureau/department or person who
has immediate supervision over you in the Office, Bureau or Department where you will be
appointed?

Within the fourth degree (for Local Government Employees):

appointing authority or recommending authority where you will be appointed?

If YES, give details:

_____________________________________
_____________________________________
_____________________________________

If YES, give details:

_____________________________________
_____________________________________
_____________________________________

a. Have you ever been formally charged?

If YES, give details:
________________________________
________________________________

b. Have you ever been guilty of any administrative offense?

If YES, give details:

________________________________
38.

39.

40.

Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?

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, AWOL or
phased out, in the public or private sector?

________________________________
If YES, give details:
________________________________
________________________________
If YES, give details: _________
________________________________

Have you ever been a candidate in a national or local election (except Barangay election)?
If YES, give details:
________________________________

41.

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?

b.

Are you differently abled?

________________________________

If YES, please specify: ____________________

If YES, please specify: ____________________
c.

Are you a solo parent?

If YES, please specify: _______widow_________

42. 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)

43.

I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust
that this information shall remain confidential.

Computer generated
or xerox copy of picture
is not acceptable

PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT

SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy)

DATE ACCOMPLISHED

RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4