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 case/s aga
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 TAYLAN
NAME EXTENSION (JR., SR
FIRST NAME JESTONY
MIDDLE NAME GUZMAN
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 9/6/1996 ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH Purok IV, Bagumbayan, Tuao, Cagayan If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS #66 Serva

6 CIVIL STATUS ✘
House/Block/Lot No. S
Widowed Separated
Bagu
Other/s:
Subdivision/Village Ba
Tuao Ca
7. HEIGHT (m) 175.26m
City/Municipality Pr
8. WEIGHT (kg) 69kg ZIP CODE 3528

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. S

10. GSIS ID NO. n/a Purok IV Bagu

Tuao Ca
11. PAG-IBIG ID NO. n/a
City/Municipality Pr

12. PHILHEALTH NO. n/a ZIP CODE 3528

13. SSS NO. n/a 19. TELEPHONE NO. n/a

14. TIN NO. n/a 20. MOBILE NO. 09068395899

15. AGENCY EMPLOYEE NO. n/a 21. E-MAIL ADDRESS (if any) jestonytaylan0019@gmail.co
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 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 TAYLAN

NAME EXTENSION (JR., SR)
FIRST NAME MIGUEL

MIDDLE NAME AGLUGOB

25. MOTHER'S MAIDEN NAME

SURNAME TAYLAN

FIRST NAME ROWENA

MIDDLE NAME GUZMAN (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

BAGUMBAYAN ELEMTARY SCHOOL,

ELEMENTARY 2007 2011 GRADUATED
Bagumbayan, Tuao, Cagayan
Itawes National Agricultural Technical
SECONDARY School (INATS), Bagumbayan, Tuao, 2011 2015 GRADUATED
Cagayan
VOCATIONAL /

TRADE
COURSE CAGAYAN STATE UNIVERSITY,Carig
COLLEGE Bachelor of schience in industrial Technology 2015 2019 GRADUATED
Sur, Tuguegarao City, Cagayan

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Re

L DATA SHEET
rience 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)

Dual Citizenship

by naturalization
Pls. indicate country:

Servando Liban
Street
Bagumbayan
Barangay
Cagayan
Province
3528

Street

Bagumbayan

Cagayan
Province

3528

n/a

09068395899

jestonytaylan0019@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

n/a

n/a

n/a

n/a

n/a

n/a

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2011

2015
 2019

parate 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

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
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
MAYNILAD WATER SERVICES, INC
6/10/2019 8/9/2019 Technical staff Job Order
 (Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised

 LICENSE (if applicable)

NUMBER Date of
Validity

n/a n/a

e on separate sheet if necessary)

of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
N
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 / N
From To

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/ SP
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

NC-II 5/15/2019 5/25/2019

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

PORTRAIT/RENDERING Guhit p

BASKETBALL
 (Continue on separate sheet if necessary)

SIGNATURE DATE
EOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

n/a

te sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

te sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

Guhit pinas TUGUEGARAO CITY

te 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 NO
YES ✘
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
a.
items:
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 within
the last 6 months
Steevengel T. Lagundi TUGUEGARAO CITY 3.5 cm. X 4.5 cm
(passport size)
Sherwin V. Tabago TUGUEGARAO CITY
With full and handwritten
BRYANT T. LACAMBRA TUGUEGARAO CITY name tag and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Computer generated
or photocopied picture
Philippines. I authorize the agency head / authorized representative to verify/validate the contents stated herein. I is not acceptable
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: BIR TIN

ID/License/Passport No.: 497-288-608-000

Signature (Sign inside the box)
01/24/2019
Date/Place of Issuance: TUGUEGARAO CITY
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 of 4