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CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misinterpretation 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 REYES

FIRST NAME IGNACIA

MIDDLE NAME ONG


3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 1/4/1989 Filipino Dual Citi

4. PLACE OF BIRTH QUEZON CITY If holder of dual citizenship,

please indicate the details.


5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 13


6 CIVIL STATUS
House/Block/Lot No.
Widowed Separated
ST. DOMINIC SUBDIVISION
Other/s:
Subdivision/Village
QUEZON CITY
7. HEIGHT (m) 1.60 m
City/Municipality
8. WEIGHT (kg) 72 kg ZIP CODE 1124

18. PERMANENT ADDRESS 898


9. BLOOD TYPE O
House/Block/Lot No.
N/A
10. GSIS ID NO. 02004741862
Subdivision/Village
QUEZON CITY
11. PAG-IBIG ID NO.
City/Municipality

12. PHILHEALTH NO. 04-025191995-1 ZIP CODE 1119

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 450-654-336 20. MOBILE NO. +63923166545

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) nancie_reyes@yaho

II. FAMILY BACKGROUND


22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A

MIDDLE NAME N/A N/A

OCCUPATION N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A

BUSINESS ADDRESS N/A N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME REYES N/A


NAME EXTENSION (JR., SR) N/A
FIRST NAME NICANOR
MIDDLE NAME BUSTAMANTE N/A

25. MOTHER'S MAIDEN NAME N/A

SURNAME ONG N/A

FIRST NAME 8CECILIA N/A

MIDDLE NAME FUENTES (Continue on separate sheet i

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE


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

ELEMENTARY DILIMAN PREPARATORY SCHOOL PRIMARY 1994 2001

SECONDARY /
VOCATIONAL DILIMAN PREPARATORY SCHOOL SECONDARY 2001 2005

N/A N/A

TRADE FAR EASTERN UNIVERSITY NICANOR REYES BACHELOR OF SCIENCE IN BUSNIESS


COURSE
COLLEGE EDUCATIONAL FOUNDATION (FEU-FERN) ADMINISTRATION MAJOR IN LEGAL MANAGEMENT 2005 2008

GRADUATE STUDIES NEW ERA UNIVERSITY BACHELOR OF LAWS 2008 2013

(Continue on separate sheet if necessary)

SIGNATURE DATE
AL DATA SHEET
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:

SALVIA
Street
KALIGAYAHAN
Barangay
N/A
Province
1124

COMMONWEALTH AVENUE
Street
MATANDANG BALARA
Barangay
N/A
Province

1119

+639231665458

nancie_reyes@yahoo.com

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

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

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/


YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

2001

2005

DEAN'S LIST
2008 A.Y. 2006-2007

2013

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 LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
CARLOS ALBERT HIGHSCHOOL, BRIXTON HILLS ST.,
CAREER SERVICE PROFESSIONAL ELIGIBILITY 80.4 5/27/2012
BRGY. SANTOL, GALAS, QUEZON CITY
461881

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

8/10/2015 PRESENT CLERK III SANDIGANBAYAN SG 06 PERMANENT Y


DEPARTMENT OF THE INTERIOR AND
4/1/2014 12/31/2014 PROJECT MANAGEMENT OFFICER N/A CONTRACTUAL Y
LOCAL GOVERNMENT (DILG)

(Continue on separate sheet if necessary)

SIGNATURE DATE 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 / N
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/ S
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

GENDER SENSITIVITY TRAINING 10/2/2015 10/2/2015 7.0 TECHNICAL

ORIENTATION-FORUM ON JUSTICE AND HUMAN RIGHTS OF PERSONS WITH NATIONAL C


11/13/2014 11/13/2014 7.0 TECHNICAL
DISABILITIES AND NA
DEPARTME
49th BATCH TRAINING FOR LGOOs II AND III COMPONENT II: CENTER TRAINING 9/28/2014 10/5/2014 19.5 TECHNICAL

POLICY PROGRAM REVIEW AND MAINSTREAMING GENDER AND DEVELOPMENT IN DEPARTME


8/14/2014 8/15/2014 16.0 TECHNICAL
BLGD PPAs 2014
MOVING BEYOND DISABILITY: A FORUM ON THE INCLUSION OF YOUTH WITH NATIONAL C
7/21/2014 7/21/2014 8.0 TECHNICAL NA
DISABILITIES IN COMMUNITY DEVELOPMENT PROGRAMS
COACHES' TRAINING ON THE FINALIZATION OF THE REFERENCE DOCUMENTS ON TB DEPARTMEN
6/24/2014 6/27/2014 32.0 TECHNICAL
DOTS RELATED GOOD PRACTICES
PERFORMANCE INCENTIVE SYSTEM FOR LGUs: A CONSULTATIVE WORKSHOP WITH DEPARTME
4/28/2014 4/28/2014 8.0 TECHNICAL
THE NATIONAL GOVERNMENT AGENCIES (NGAs)
THE PERFORMANCE INCENTIVE SYSTEM: A CONSULTATIVE WORKSHOP WITH THOSE DEPARTME
4/7/2014 4/8/2014 16.0 TECHNICAL
WHO MATTER
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

DILIMAN PREPARATORY SCHOOL GIRLS' BASKETBALL VARSITY GOLD MEDALIST


UPCYCLING
PALARONG PAMBANSA DISTRICT MEET (2003)
DILIMAN PREPARATORY SCHOOL GIRLS' BASKETBALL VARSITY SILVER MEDALIST
DOCUMENTARY BUFF
PALARONG PAMBANSA DISTRICT MEET (2005)
DILIMAN PREPARATORY SCHOOL GIRL'S BASKETBALL VARSITY BRONZE MEDALIST
PALARONG PAMBANSA CITY MEET (2003)

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

rate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

SANDIGANBAYAN

NATIONAL COUNCIL FOR DISABILITY AFFAIRS


AND NATIONAL YOUTH COMMISSION
DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT
DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT
NATIONAL COUNCIL FOR DISABILITY AFFAIRS AND
NATIONAL YOUTH COMMISSION
DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT
DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT
DEPARTMENT OF THE INTERIOR AND LOCAL
GOVERNMENT
rate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

rate 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 NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
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? ________________________________
finished contract
________________________________
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 w
the last 6 mon
FLORECEL M. SEBASTIAN SANDIGANBAYAN 951-46-06 3.5 cm. X 4.5 c
(passport size

LOUIELYN T. PILAR QUEZON CITY 09985344571 With full and hand


name tag and signat
NEW ERA UNIVERSITY printed name
ATTY. CITEDINA U. MAGNO-ZARATE COLLEGE OF LAW
09972413048
Computer gener
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied pi
is not acceptab
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 administrative/criminal case/s PHOTO
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/License/Passport No.:
N02-06-010531 Signature (Sign inside the box)

Date/Place of Issuance:
09JAN2015 / QUEZON CITY Date Accomplished Right Thumbma

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

Person Administering Oath

CS FORM 212 (Revised


If YES, give details:
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
finished contract
________________________________
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