Personal Data Sheet Form 212

CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes q with "" and use separate sheet if necessary.
1. CS ID No.
(to be filled up by CSC)
I. PERSONAL INFORMATION
ABANTE
2. SURNAME
FIRST NAME
FEBES
MIDDLE NAME
BRUCAL
3. NAME EXTENSION (e.g. Jr., Sr.)
4. DATE OF BIRTH (mm/dd/yyyy)

5. PLACE OF BIRTH
16. RESIDENTIAL ADDRESS
09/03/1969
N/A
BRGY.CASTILLO PADRE GARCIA BATANGAS
TABUK,KALINGA APAYAO
6. SEX
q Male
q Female
7. CIVIL STATUS
q Single
q Married
qAnnulled
q Widowed
q Separated
q Others, specify ___________
8. CITIZENSHIP
FILIPINO
9. HEIGHT (m)
1.4kg.
10. WEIGHT (kg)
56 kg.
11. BLOOD TYPE
"O"
ZIP CODE
4224
300 5489
17. TELEPHONE NO.

18. PERMANENT ADDRESS
BRGY.CASTILLO PADRE GARCIA BATANGAS
ZIP CODE
4224
19. TELEPHONE NO.
300 5489
12. GSIS ID NO.
006 0043 9796 2
20. E-MAIL ADDRESS (if any)
N/A
13. PAG-IBIG ID NO.
912005001129
21. CELLPHONE NO. (if any)
0910 6078 408
14. PHILHEALTH NO.
09 200006215 6
22. AGENCY EMPLOYEE NO.
N/A
15. SSS NO.
N/A
23. TIN
925 695 139
II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME
25. NAME OF CHILD (Write full name and list all)
ABANTE
FIRST NAME
APOLINARIO
MIDDLE NAME
OCCUPATION
ESPIRITU
LABORER
EMPLOYER/BUS. NAME
N/A
BUSINESS ADDRESS
TELEPHONE NO.
DATE OF BIRTH (mm/dd/yyyy)
MERFE ANNE B. ABANTE
11/26/1990
MERLENE B. ABANTE
12/03/1991
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
FIRST NAME
BRUCAL
ANACITO
N/A
N/A
N/A
MIDDLE NAME
CABRAL
N/A
N/A
N/A
N/A
(Continue on separate sheet if necessary)

26. FATHER'S SURNAME
27. MOTHER'S MAIDEN NAME

SURNAME
SALVA ( DECEASED)
N/A
N/A
FIRST NAME
AURORA
N/A
N/A
MIDDLE NAME
SAPATERO
III. EDUCATIONAL BACKGROUND

28.
LEVEL
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE STUDIES
NAME OF SCHOOL
(Write in full)
DEGREE COURSE
(Write in full)
TABUK CENTRAL ELEM.SCHOOL

QUIRINO GEN.HIGHSCHOOL
N/A
LIPA CITY COLLEGES
YEAR
GRADUATED
(if graduated)
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
PRIMARY
1983
N/A
Secondary
1987
N/A
N/A
N/A
INCLUSIVE DATES OF
ATTENDANCE
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
From
To
1977
1983
1983
1987
N/A
N/A
1987
1988
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
JUNIOR
SECRETARIAL
COURSE
1988
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
N/A

Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY

29.
CAREER SERVICE/ RA 1080 (BOARD/ BAR)

UNDER SPECIAL LAWS/ CES/ CSEE
LICENSE (if applicable)
RATING
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
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N/A
N/A
N/A
N/A
N/A
N/A
NUMBER
DATE OF
RELEASE
N/A
N/A
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.
INCLUSIVE DATES
(mm/dd/yyyy)
From
POSITION TITLE
(Write in full)
DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)
MONTHLY
SALARY
SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
STATUS OF
APPOINTMENT
GOV'T
SERVICE
(Yes / No)
To
01/01/2014
06/30/2014
ADMINISTRATIVE AIDE IV
SANGGUNIANG PANLALAWIGAN
296.45/DAY
CASUAL
YES
07/01/2013
12/31/2013
296.45/DAY
CASUAL
YES
01/02/2013
06/30/2013
296.45/DAY
CASUAL
YES
07/01/2012
12/31/2012
296.45/DAY
CASUAL
YES
01/01/2012
06/30/2012
296.45/DAY
CASUAL
YES
07/01/2011
12/31/2011
296.45/DAY
CASUAL
YES
01/01/2011
06/30/2011
296.45/DAY
CASUAL
YES
07/01/2010
12/30/2010
296.45/DAY
CASUAL
YES
01/04/2009
06/30/2009
296.45/DAY
CASUAL
YES
07/02/2009
12/31/2009
296.45/DAY
CASUAL
YES
01/02/2008
06/30/2008
296.45/DAY
CASUAL
YES
07/31/2008
12/31/2008
296.45/DAY
CASUAL
YES
296.45/DAY
CASUAL
YES
07/02/2007
12/31/2007
ADMINISTRATIVE AIDE III
OPG
274.50/DAY
CASUAL
YES
02/02/2004
06/30/1998
MESSENGER
SP
218.00/DAY
CASUAL
YES
07/01/2003
03/30/1982
UTILITY WORKER II
PPDO
237.63
CASUAL
YES
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
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N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A

CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATIONS

31.
INCLUSIVE DATES
(mm/dd/yyyy)
NAME & ADDRESS OF ORGANIZATION

(Write in full)
N/A
N/A
N/A
N/A
N/A
From
To
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
NUMBER OF
HOURS
POSITION / NATURE OF WORK
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
VII. TRAINING PROGRAMS (Start from the most recent training.)

32.
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

(Write in full)
INCLUSIVE DATES OF ATTENDANCE

(mm/dd/yyyy)
NUMBER OF
HOURS
From
To
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
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N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
CONDUCTED/ SPONSORED BY
(Write in full)
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
N/A
VIII. OTHER INFORMATION

33.
SPECIAL SKILLS / HOBBIES:
34.
NON-ACADEMIC DISTINCTIONS / RECOGNITION:

(Write in full)
N/A
35.
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
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
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?
YES NO
Within the fourth degree (for Local Government Employees):

appointing authority or recommending authority where you will be appointed?
YES NO
a. Have you ever been formally charged?
YES NO
If YES, give details:

_____________________________________
_____________________________________
_____________________________________

_____________________________________
_____________________________________
_____________________________________
________________________________
________________________________
YES NO
b. Have you ever been guilty of any administrative offense?

________________________________
________________________________
38.
Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
YES NO
________________________________
________________________________
39.
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?
YES NO
40.
Have you ever been a candidate in a national or local election (except Barangay election)?
YES NO
________________________________
________________________________
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:

________________________________
________________________________
YES NO
a.
Are you a member of any indigenous group?
b.
Are you differently abled?
YES NO
c.
Are you a solo parent?
YES NO
If YES, please specify: ____________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME
TEL. NO.
ADDRESS
LIANDA
LIANDAB.B.BOLILIA
BOLILIA OFFICE OF THE PROVINCIAL GOVERNOR
FIDEL M. LOPEZ
BM.AMADO CARLOS BOLILIA IV

43.
300 5489
IBAAN BATANGAS
425 4288
425 4288
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.
ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)
Computer generated
or xerox copy of picture
is not acceptable
PHOTO
14338076
COMMUNITY TAX CERTIFICATE NO.
PADRE GARCIA BATANGAS
ISSUED AT
SIGNATURE (Sign inside the box)
01/02/2014
1-06-2014
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
RIGHT THUMBMARK

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Personal Data Sheet Form 212

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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

(to be filled up by CSC)

3. NAME EXTENSION (e.g. Jr., Sr.)

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

16. RESIDENTIAL ADDRESS

BRGY.CASTILLO PADRE GARCIA BATANGAS

10. WEIGHT (kg)

11. BLOOD TYPE

17. TELEPHONE NO.

BRGY.CASTILLO PADRE GARCIA BATANGAS

19. TELEPHONE NO.

12. GSIS ID NO.

006 0043 9796 2

20. E-MAIL ADDRESS (if any)

13. PAG-IBIG ID NO.

21. CELLPHONE NO. (if any)

0910 6078 408

14. PHILHEALTH NO.

22. AGENCY EMPLOYEE NO.

15. SSS NO.

925 695 139

II. FAMILY BACKGROUND

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

DATE OF BIRTH (mm/dd/yyyy)

MERFE ANNE B. ABANTE

(Continue on separate sheet if necessary)

27. MOTHER'S MAIDEN NAME

(Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

TABUK CENTRAL ELEM.SCHOOL

(Continue on separate sheet if necessary)

IV. CIVIL SERVICE ELIGIBILITY

CAREER SERVICE/ RA 1080 (BOARD/ BAR)

LICENSE (if applicable)

PLACE OF EXAMINATION / CONFERMENT

(Continue on separate sheet if necessary)

DEPARTMENT / AGENCY / OFFICE / COMPANY

ADMINISTRATIVE AIDE III

(Continue on separate sheet if necessary)

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

NAME & ADDRESS OF ORGANIZATION

POSITION / NATURE OF WORK

(Continue on separate sheet if necessary)

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

TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES

INCLUSIVE DATES OF ATTENDANCE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

SPECIAL SKILLS / HOBBIES:

NON-ACADEMIC DISTINCTIONS / RECOGNITION:

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

Within the fourth degree (for Local Government Employees):

a. Have you ever been formally charged?

If YES, give details:

If YES, give details:

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

If YES, give details:

If YES, give details:

Are you a member of any indigenous group?

Are you differently abled?

Are you a solo parent?

If YES, please specify: ____________________