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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET


Print legibly. Mark appropriate boxes

with "

1. CS ID No.

" and use separate sheet if necessary.

(to be filled up by CSC)

I. PERSONAL INFORMATION
C |O |S |C |O |S |

2. SURNAME

FIRST NAME

R |A |N |U |L |F |O |

MIDDLE NAME

M |O |N |G |H |I |T |

5. PLACE OF BIRTH

Male

7. CIVIL STATUS

Female

Single

Widowed

Married

Separated

17. TELEPHONE NO.

Annulled

Others, specify ___________

18. PERMANENT ADDRESS

8. CITIZENSHIP

FILIPINO

9. HEIGHT (m)

5'6

|
|

|
|

|
|

JR.

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

PHASE 4 B-5 L-5 BROOKFIELD SUBD., BASAK, LAPU LAPU


CITY, CEBU

LILO-AN, SOUTHERN, LEYTE

6. SEX

16. RESIDENTIAL ADDRESS

MAY / 04 /1988

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

ZIP CODE

6012
N/A
PHASE 4 B-5 L-5 BROOKFIELD SUBD., BASAK, LAPU LAPU
CITY, CEBU
6012

10. WEIGHT (kg)

200 lbs

11. BLOOD TYPE

type "O"

19. TELEPHONE NO.

N/A

12. GSIS ID NO.

CM 432571

20. E-MAIL ADDRESS (if any)

ranulfocoscos@yahoo.com

13. PAG-IBIG ID NO.

21. CELLPHONE NO. (if any)

09157665459 / 09177787657 / 253-2163

14. PHILHEALTH NO.

22. AGENCY EMPLOYEE NO.

15. SSS NO.

23. TIN

ZIP CODE

431-867-628-000

II. FAMILY BACKGROUND


24. SPOUSE'S SURNAME

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

DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

COSCOS

FIRST NAME

RANULFO, SR.

MIDDLE NAME

GULLE

26. FATHER'S SURNAME

27. MOTHER'S MAIDEN NAME


SURNAME

MONGHIT

FIRST NAME

MERCILITA

MIDDLE NAME

MAGRELOS

(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)

full)

INCLUSIVE DATES OF
ATTENDANCE
From

To

ELEMENTARY

HALI-AN ELEM. SCHOOL, DEL CARMEN


SURIGAO DEL NORTE

2001

1995

2001

SECONDARY

LAWANG BATO NATIONAL HIGH SCHOOL,


LAWANG BATO, VALENZUELA CITY, NCR,
PHILIPPINES

2005

2001

2005

2 MONTHS

FEB. 2014

Apr-15

2010-2012

2010

2012

VOCATIONAL /

TESDA, BINANGUNAN, RIZAL


COLLEGE
COURSE

(if graduated)

NC1 WELDER

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

TRADE

VALENZUELA CITY POLYTECHNIC


2YRS COURSE
COLLEGE, PASO DE BLAS, VALENZUELA COMPUTER
CITY, NCR, PHILIPPINES
TECHNOLOGY

GRADUATE STUDIES

(Continue on separate sheet if necessary)


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

LICENSE (if applicable)


PLACE OF EXAMINATION / CONFERMENT

NUMBER

DATE OF
RELEASE

(Continue on separate sheet if necessary)

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

INCLUSIVE DATES
(mm/dd/yyyy)
From

POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY


(Write in full)

To

07/01/2015

UP TO
PRESENT
NOW

07/01/2014

07/01/2015

05/08/2013

07/15/2013

02/04/2013

04/25/2013

10/04/2012

02/02/2013

01/15/2007

10/28/2009

(Write in full)

GOV'T
SERVICE
MONTHLY
SALARY

COMMISSION ON ELECTION, OFFICE


OF THE PROVINCIAL ELECTION
9,478.00
SUPERVISOR
COMMISSION ON ELECTION, CEBU
7,980/ 380
JO / OFFICE STAFF/ ENCODER
CITY ,1ST DIST.(NORTH), CEBU
PER DAY
COMMISSION ON ELECTION,
VERIFFICATION COMMITTEE AT PHIL.
ELECTION CASUAL
POST.,
INTRAMUROS,
MANILAITD
ELECTION CASUAL / PCOS
COMMISSION
ON ELECTION,
MACHINE OPERATOR OR
DEPARTMENT/ PCOS MACHINE DEPT.
VERIFIER
AT NATIONAL PRINTING OFFICE
COMMISSION ON ELECTION, MAKATI
(OJT) ON THE JOB TRAINING
CITY, 2ND DIST. MANILA
CREDO CASUAL

MERCHANDISER

PAGODA PHILS. AT STA. MESA,


MANILA, MAIN CORP.

7,848.00

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

STATUS OF
APPOINTMENT

CONTRACT
UL OR
RENUEWAL
CONTRACT
UL

(Yes / No)

CONTRACT
UAL

(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)

NUMBER OF
HOURS

(mm/dd/yyyy)
From

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)

ORIENTATION ON R.A. 9485 AND BASIC CUSTOMER SERVICE


SKILLS

LEADERSHIP TRAINING SIMINAR

(mm/dd/yyyy)

NUMBER OF
HOURS

From

To

08/25/2016

08/25/2016

08/15/2012

08/15/2012

07/12/2011

07/12/2011

09/19/2010

09/19/2010

CONDUCTED/ SPONSORED BY
(Write in full)

MS. PROLAINE DELA CALZADADACLAN

VALPOLIANS / MR. LLOYD NALO

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


33.

SPECIAL SKILLS / HOBBIES:

34.

NON-ACADEMIC DISTINCTIONS / RECOGNITION:


(Write in full)

35.

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)

COMPUTER LITERATE
DRIVING

N/A
CHOIR: ST. JOSEPH AQUASHI
PARISH, PUNTURIN, VALENZUELA
CITY, MANILA

SPORTMANSHIP
DANCING AND SINGING

(Continue on separate sheet if necessary)


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?

YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

b.

Within the fourth degree (for Local Government Employees):


appointing authority or recommending authority where you will be appointed?

YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37

a. Have you ever been formally charged?

YES

NO

If YES, give details:


________________________________
________________________________
YES

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

NO

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?

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?

40.

YES
NO
If YES, give details:
________________________________
________________________________
YES

NO

If YES, give details:


________________________________
________________________________

Have you ever been a candidate in a national or local election (except Barangay election)?

YES

NO

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?

c.

Are you a solo parent?

YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________

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


NAME

ADDRESS

TEL. NO.

DIR. RAFAEL B. OLAO

RED VII

255-0418

ATTY. LIONEL MARCO R. CASTILLANO

PES-CEBU

253-2163

ATTY. MARCHEL C. SARNO

OEO-CEBU CITY

412-9741

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.

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

COMMUNITY TAX CERTIFICATE NO.

RANULFO M. COSCOS JR.


ISSUED AT

SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy)

12/28/2016
DATE ACCOMPLISHED

RIGHT THUMBMARK

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