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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 case/s ag
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. (Do

I. PERSONAL INFORMATION
2. SURNAME BUÑI
NAME EXTENSION (JR., SR
FIRST NAME CAREN JOI

MIDDLE NAME

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) January 26, 1997

4. PLACE OF BIRTH PUERTO PRINCESA CITY, PALAWAN If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX FEMALE

6 CIVIL STATUS SINGLE


17. RESIDENTIAL ADDRESS 21-B MEND
House/Block/Lot No. S
KA
Subdivision/Village Ba
7. HEIGHT (m) 150 MTRS. PUERTO PRINCESA CITY PAL
City/Municipality Pr
8. WEIGHT (kg) 48 KG. ZIP CODE 5300

9. BLOOD TYPE B
18. PERMANENT ADDRESS 21-B MEND
House/Block/Lot No. S

10. GSIS ID NO. N/A KA


Subdivision/Village Ba

11. PAG-IBIG ID NO. N/A PUERTO PRINCESA CITY PAL


City/Municipality Pr

12. PHILHEALTH NO. N/A ZIP CODE 5300

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

14. TIN NO. 350-074-105 20. MOBILE NO. 0956 993 4308

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) carenjoi1997@gmail.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 ALVARICO


NAME EXTENSION (JR., SR)
FIRST NAME JOSEPH

MIDDLE NAME ENDIAPE

25. MOTHER'S MAIDEN NAME

SURNAME BUÑI

FIRST NAME JEAN

MIDDLE NAME BURATA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND


NAME OF SCHOOL HIGHEST LEVEL/
26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS
LEVEL (Write in EARNED
(Write in full)
full) (if not graduated)
From To
PUERTO PRINCESA PILOT ELEMENTARY
ELEMENTARY PRIMARY EDUCATION 2004 2010 GRADUATED
SCHOOL
SECONDARY PALAWAN NATIONAL SCHOOL SECONDARY 2010 2014 GRADUATED
VOCATIONAL /

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


TRADE
BS IN BUSINESS ADMINISTRATION
COLLEGE
COURSE PALAWAN STATE UNIVERSITY MAJOR IN MARKETING 2014 2018 GRADUATED
MANAGEMENT
GRADUATE STUDIES N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 08-3


CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Pls. indicate country:

MENDOZA ST.
Street
KALIPAY
Barangay
PALAWAN
Province
5300
MENDOZA ST.
Street
KALIPAY
Barangay
PALAWAN
Province

N/A

0956 993 4308

carenjoi1997@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2010 N/A

2014 N/A
N/A N/A

2018 N/A

N/A N/A
parate sheet if necessary)

08-30-2018
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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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

(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 STATUS OF
(Write in full/Do not SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To

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

(Continue on separate sheet if necessary)


SIGNATURE DATE 08-30-2018
CS FORM 212 (Revised 20
LICENSE (if applicable)

Date of
Validity

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N/A

arate sheet if necessary)


08-30-2018
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

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

(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) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

BUSINESS SUMMIT 09/2017 8

GOOGLE DEVELOPER GROUP PHILIPPINES 6/30/2016 5 PAL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

PATIENT

INITIATIVE
HARDWORKING

TRUSTWORTHY
FAST LEARNER WITH GOOD INTERPERSONAL
AND ORGANIZATIONAL SKILLS
GOOD COMMINICATION

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)


ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

MANILA

PALAWAN STATE UNIVERSITY

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
eparate sheet if necessary)

08-30-2018
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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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
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,
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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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 within


the last 6 months
3.5 cm. X 4.5 cm
ELSIE C. CASAÑAS BGY. STA. MONICA, PPC 0910 828 1774 (passport size)

GAMELBA BLANCO NAVARRO BGY. STA. MONICA, PPC 0920 240 2568 With full and handwritten
name tag and signature over
MYLENE D. BALLARES BGY. KALIPAY, PPC 0917 600 2182 printed name

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
or photocopied picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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: COMMUNITY TAX CERTIFICATE

ID/License/Passport No.: 12228392


Signature (Sign inside the box)
08-30-2018
Date/Place of Issuance: 03-27-2018/PPC
Date Accomplished Right Thumbmark

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

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 o


If YES, give details (country):

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

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