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.

I. PERSONAL INFORMATION
2. SURNAME

MAESTRECAMPO

FIRST NAME

NOVEE

MIDDLE NAME

ESTIVA

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

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

5. PLACE OF BIRTH

11/05/1962
Sipalay City, Negros Occidental

16. RESIDENTIAL ADDRESS

Brgy. Gil Montilla, Sipalay City, Negros Occidental

6. SEX

7. CIVIL STATUS

Single
Married
Annulled

8. CITIZENSHIP

Filipino

9. HEIGHT (m)

170

10. WEIGHT (kg)

68

11. BLOOD TYPE

"A''

Widowed
Separated
Others, specify ___________

ZIP CODE
17. TELEPHONE NO.

18. PERMANENT ADDRESS

ZIP CODE

Brgy. Gil Montilla, Sipalay City, N

6113

19. TELEPHONE NO.

12. GSIS ID NO.

20. E-MAIL ADDRESS (if any)

13. PAG-IBIG ID NO.

21. CELLPHONE NO. (if any)

14. PHILHEALTH NO.

6113

11-000087794-8

+63 9993826041

22. AGENCY EMPLOYEE NO.

15. SSS NO.

23. TIN

152-134-018

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME

MAESTRECAMPO

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

FIRST NAME

EVELYN

VEE ELARMO MAESTRECAMPO

MIDDLE NAME

ELARMO

MA.LEE ELARMO MAESTRECAMPO

OCCUPATION

GOVERNMENT EMPLOYEE

NOVEE ELARMO MAESTRECAMPO

EMPLOYER/BUS. NAME

LGU-HINOBA-AN, NEG.OCC.

IAN ELARMO MAESTRECAMPO

BUSINESS ADDRESS

HINOBA-AN, NEG.OCC

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

MAESTRECAMPO

FIRST NAME

ANGELINO

MIDDLE NAME

DAQUIPEL

DECEASED

27. MOTHER'S MAIDEN NAME

SURNAME

ESTIVA

FIRST NAME

ERLINDA

MIDDLE NAME

DELA TORRE

DECEASED

(Continue on separate sheet if neces

III. EDUCATIONAL BACKGROUND

28.
LEVEL

NAME OF SCHOOL
(Write in full)

DEGREE COURSE
(Write in full)

YEAR
GRADUATED

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

INCLUSIVE DATE
ATTENDANCE
From

graduated)

ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE

GENARO P. ALVAREZ ELEMENTARY SCHOOL, SIPALAY CITY,

NEG. OCC.

1974

GRADUATED

1969

HOLY ROSARY ACADEMY, SIPALAY CITY, NEG.OCC

1978

GRADUATED

1974

NEGROS OCCIDENTAL AGRICULTURAL COLLEGE, KABANKALAN

CITY, NEG. OCC.

1983

GRADUATED

1978

GRADUATE STUDIES
(Continue on separate sheet if necessary)

(to be filled up by CSC)

g. Jr., Sr.)

Occidental

palay City, Negros Occidental

DATE OF BIRTH (mm/dd/yyyy)

02/22/1988
12/18/1990
09/10/1993
09/24/1996
/

eet if necessary)

SIVE DATES OF
TENDANCE
To

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

1974
1978

1983

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

29.

CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER

SPECIAL LAWS/ CES/ CSEE

RATING

DATE OF EXAMINATION
/ CONFERMENT

PLACE OF EXAMINATION / CONFERMENT

PNP ENTRANCE EXAMINATION

74.50%

11/05/1990

ILOILO CITY

SENIOR POLICE OFFICER

70.90%

04/26/1993

ILOILO CITY

POLICE OFFICER

72.14%

05/25/2003

ILOILO CITY

(Continue on separate sheet if necessary)

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

INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)

From

(Write in full)

MONTHLY
SALARY

To

11/16/1991

12/31/1993

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

1,000.00

01/01/1994

12/31/1994

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

1,800.00

01/01/1995

12/31/1995

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

2,800.00

01/01/1996

12/31/1996

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

3,800.00

01/01/1997

10/31/1997

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

4,600.00

11/01/1997

12/31/1999

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

5,000.00

01/01/2000

12/30/2000

POLICE OFFICER 1

PHILIPPINE NATIONAL POLICE

6,082.00

12/31/2000

06/30/2001

POLICE OFFICER 2

PHILIPPINE NATIONAL POLICE

6,610.00

07/01/2001

06/30/2002

POLICE OFFICER 2

PHILIPPINE NATIONAL POLICE

7,920.00

07/01/2002

01/24/2005

POLICE OFFICER 2

PHILIPPINE NATIONAL POLICE

9,668.00

01/25/2005

06/30/2009

POLICE OFFICER 3

PHILIPPINE NATIONAL POLICE

10,863.00

07/01/2009

06/30/2010

POLICE OFFICER 3

PHILIPPINE NATIONAL POLICE

12,210.00

07/01/2010

05/31/2011

POLICE OFFICER 3

PHILIPPINE NATIONAL POLICE

15,307.00

06/01/2011

05/31/2012

POLICE OFFICER 3

PHILIPPINE NATIONAL POLICE

16,986.00

06/01/2012

TO DATE

POLICE OFFICER 3

PHILIPPINE NATIONAL POLICE

18,665.00

STILL IN THE ACTIVE SERVICE

(Continue on separate sheet if necessary)

SALARY GRADE &

STEP INCREMENT
(Format "00-0")

LICENSE (if applicable)

NUMBER

DATE OF RELEASE

GOV'T SERVICE
STATUS OF
APPOINTMENT
(Yes / No)

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

PERMANENT

YES

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

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

INCLUSIVE DATES
31.

NAME & ADDRESS OF ORGANIZATION

NUMBER OF
HOURS

(mm/dd/yyyy)

(Write in full)
From

POSITION / NATURE OF

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)

NUMBER OF
HOURS

(mm/dd/yyyy)
From

CONDUCTED/ SPONSORED BY

To

(MANDATORY CAREER COURSES)

PUBLIC SAFETY JUNIOR LEADERSHIP COURSE

06/10/2014

10/28/2014

720

RTC6, BACOLOD CITY, NEG.OC

PUBLIC SAFETY BASIC COURSE

11/16/1991

04/30/1992

1,132

VTC7 PNP TRACOM, APAS, CE

(SPECIAL TRAINING)
SPECIAL COUNTER INSURGENCY OPERATION UNIT
TRAINING

11/03/1993

12/20/1993

PRO6, RMFB CAMP HERNAND

ILOILO

(UNIT TRAINING)
CLOSE QUARTER BATTLE (CQB)

01/19/1993

02/15/1993

PRO6, CAMP MARTIN DELGAD

INTELLIGENCE ANALYST SEMINAR

11/20/1995

11/24/1995

PRO6 , R2 CAMP MARTIN DELG

NARCOTICS INTELLIGENCE AND INVESTIGATION

09/20/1999

10/27/1999

PRO6, NOPPO, NEG. OCC.

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION
33.

SPECIAL SKILLS / HOBBIES:

34. NON-ACADEMIC DISTINCTION/RECOGNITION:

(Write in full)

35.
in full)

(Continue on separate sheet if necessary)

CS FORM 212 (Rev

TION/S
POSITION / NATURE OF WORK

CONDUCTED/ SPONSORED BY

(Write in full)

RTC6, BACOLOD CITY, NEG.OCC.

VTC7 PNP TRACOM, APAS, CEBU CITY

PRO6, RMFB CAMP HERNANDEZ, DINGLE,
ILOILO
PRO6, CAMP MARTIN DELGADO, ILOILO
PRO6 , R2 CAMP MARTIN DELGADO, ILOILO
PRO6, NOPPO, NEG. OCC.

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

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

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

a. 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?

If YES, give details:

_________________________________
_________________________________
_________________________________

b. Within the fourth degree (for Local Government Employees):

appointing authority or recommending authority where you will be appointed?

If YES, give details:

_________________________________
_________________________________
_________________________________

37 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. 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:

____________________________
____________________________

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?

If YES, give details:

____________________________
____________________________

40. 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?

If YES, please specify: _______________

b.

Are you differently abled?

If YES, please specify: _______________

c.

Are you a solo parent?

If YES, please specify: _______________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME

ADDRESS

HON. ERNESTO A. ESTRAO

HINOBA-AN, NEG.OCC.

HON. OSCAR C. MONTILLA

SIPALAY CITY, NEG. OCC.

TEL. NO.

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.

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT

SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy)

DATE ACCOMPLISHED

CS FORM 212 (Revis

S, give details:
_________________________________
_________________________________
_________________________________

S, give details:
_________________________________
_________________________________
_________________________________

ES, give details:

____________________________
____________________________

ES, give details:

____________________________
____________________________

ES, give details:

____________________________
____________________________

ES, give details:

____________________________
____________________________

ES, give details:

____________________________
____________________________

S, please specify: ____________________

S, please specify: ____________________

S, please specify: ____________________

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

RIGHT THUMBMARK

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