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 cas
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.

I. PERSONAL INFORMATION
2. SURNAME PAGURAY

FIRST NAME MARK REY

MIDDLE NAME TAGARO

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Cit
(mm/dd/yyyy) 11/30/1989

4. PLACE OF BIRTH UBAY BOHOL If holder of dual citizenship,

please indicate the details.

5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.

Other/s: SUDLON
Subdivision/Village

7. HEIGHT (m) 1.63m MANDAUE

City/Municipality
8. WEIGHT (kg) 60kg ZIP CODE 6014
18. PERMANENT ADDRESS
9. BLOOD TYPE AB+
House/Block/Lot No.

10. GSIS ID NO. 2003490469 PUROK 1

Subdivision/Village

11. PAG-IBIG ID NO. 021100106460 UBAY

City/Municipality

12. PHILHEALTH NO. 120253143393 ZIP CODE 6315

13. SSS NO. 0633482642 19. TELEPHONE NO. N/A

14. TIN NO. 435330395000 20. MOBILE NO. 09432674681

15. AGENCY EMPLOYEE NO. P435-330-395 21. E-MAIL ADDRESS (if any) markreypaguray@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PAGURAY

NAME EXTENSION (JR., SR)
FIRST NAME DIOSDADO

MIDDLE NAME MADULIN

25. MOTHER'S MAIDEN NAME

SURNAME TAGARO

FIRST NAME PRIMITIVA

MIDDLE NAME NAMUAG (Continue on separate sheet

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
 NAME OF SCHOOL
BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY UBAY CENTRAL ELEMENTARY SCHOOL PRIMARY SCHOOL 1996 2002

SECONDARY /
VOCATIONAL HOLY CHILD ACADEMY HIGH SCHOOL 2002 2006

N/A N/A N/A N/A

TRADE
COURSE
COLLEGE UNIVERSITY OF SAN JOSE-RECOLETOS BS ACCOUNTANCY 2006 2010

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
AL DATA SHEET
k Experience Sheet shall cause the filing of administrative/criminal case/s against the person

DS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Filipino Dual Citizenship

by birth by naturalization

Pls. indicate country:

Street
MAGUIKAY
Barangay
CEBU
Province
6014

Street
CALANGGAMAN
Barangay
BOHOL
Province

N/A

09432674681

markreypaguray@yahoo.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

N/A N/A

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/

YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED
 HIGHEST LEVEL/ SCHOLARSHIP/
YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

N/A 2002 N/A

N/A 2016 N/A

N/A N/A N/A

N/A 2010 N/A

ue on separate sheet if necessary)

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

RA 1080 CPA LICENSURE EXAMINATION 79.86% 10/08/2011 South Western University, Urgello, Cebu City

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

5/12/2015 PRESENT ACCOUNTANT I DEPARTMENT OF AGRICULTURE 7 21,387.00 SG 12

7/11/2013 5/11/2015 ACCOUNTING STAFF DEPARTMENT OF AGRICULTURE 7 590/day N/A

ELECTRICITY TRANSMISSION SUPPLIES

2/8/2012 5/15/2013 JUNIOR ACCOUNTING SUPERVISOR 15,000.00 N/A
CORPORATION
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 21
 LICENSE (if applicable)

NUMBER Date of
Validity

0143056 11/30/2017

e on separate sheet if necessary)

duties should be indicated in the attached Work Experience sheet.

GOV'T
SERVICE
STATUS OF
APPOINTMENT

(Y/ N)
REGULAR YES

JOB ORDER YES

REGULAR NO
e on separate sheet if necessary)

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
From To

(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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

MAKING LIFE WORK IN THE DEPARTMENT OF AGRICULTURE: A STRESS MANANGEMENT

2/15/2017 2/16/2017 16 PERSONAL DEPA
WORKSHOP

GENDER SENSITIVITY TRAINING 8/25/2016 8/26/2016 16 PERSONAL DEPA

SEMINAR ON REPUBLIC ACT NO. 9184 AND ITS REVISED IMPLEMENTING RULES AND
8/11/2016 8/12/2016 16 TECHNICAL DEPARTM
REGULATIONS

SEMINAR ON ELECTRONIC NATIONAL GOVERNMENT ACCOUNTING SYSTEM (E.NGAS) 5/23/2016 5/27/2016 32 TECHNICAL C

ORIENTATION/RE-ORIENTATION PROGRAM FOR NEW ENTRANTS (OPEN) 11/5/2015 11/6/2015 16 TECHNICAL C

SEMINAR/WORKSHOP ON THE YEAR-END FINANCIAL EVALUATION AND ASSESSMENT DEPARTM

2/2/2015 2/6/2015 32 TECHNICAL
2015 C

PHILIPPINE PUBLIC SECTOR ACCOUNTING STANDARS (PPSAS) & RCA SEMINAR 6/3/2014 6/5/2014 24 TECHNICAL C

SEMINAR/WORKSHOP ON THE YEAR-END FINANCIAL EVALUATION AND ASSESSMENT DEPARTM

1/27/2014 1/31/2014 32 TECHNICAL
2014 C

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
MEMBER
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

Profound Knowledge of Government Philipp

N/A
Accounting Policies and Procedures
Knowledgeable in bookkeeping, accounting and
Junior P
auditing
Skilled in Microsoft applications University

(Continue on separate sheet if necessary)

SIGNATURE DATE
E / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

parate sheet if necessary)

S ATTENDED
5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF AGRICULTURE RFO7

DEPARTMENT OF AGRICULTURE RFO7

DEPARTMENT OF BUDGET & FINANCE (DBM)

COMMISSION ON AUDIT (COA)

CIVIL SERVICE COMMISSION

DEPARTMENT OF BUDGET & FINANCE (DBM),

COMMISSION ON AUDIT (COA)

COMMISSION ON AUDIT (COA)

DEPARTMENT OF BUDGET & FINANCE (DBM),

COMMISSION ON AUDIT (COA)

parate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in
full)
Philippine Institute of Certified Public
Accountants
Junior Philippine Institute of Accountants

University of San Jose Recoletos-Alumni 2011

parate sheet if necessary)

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? YES

b. within the fourth degree (for Local Government Unit - Career Employees)? YES

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation YES 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, YES 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 YES NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES 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? YES 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? YES NO
If YES, please specify:
b. Are you a person with disability? YES NO
If YES, please specify ID No:
c. Are you a solo parent? YES 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
the last 6 mo
NERILLEN Z. DINOY, CPA Cogon, Cordova, Cebu 0933-053-8877 3.5 cm. X 4.5
(passport si

With full and han

name tag and sign
printed nam

Computer gene
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied p
is not accept
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 PHOTO
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: DRIVER'S LICENSE ID

ID/License/Passport No.: G06-14-004963

Signature (Sign inside the box)

Date/Place of Issuance: 03/28/2014 MANDAUE CITY

Date Accomplished Right Thumbm

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated
Person Administering Oath

CS FORM 212 (Rev

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________
NO

NO

NO
If YES, give details (country):

NO

NO

NO

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4