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 CATRAL
NAME EXTENSION (JR., SR
FIRST NAME KING SOLOMON

MIDDLE NAME FIELDAD

3. DATE OF BIRTH
(mm/dd/yyyy) 12/2/1981 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH SAN MATEO, ISABELA If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS #24 CITY

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
PUROK 1 CALA
Other/s:
Subdivision/Village Ba
SANTIAGO CITY ISA
7. HEIGHT (m) 165.10 cm
City/Municipality Pr
8. WEIGHT (kg) 80 kg ZIP CODE 3311

9. BLOOD TYPE B
18. PERMANENT ADDRESS #24 CITY
House/Block/Lot No. S
10. GSIS ID NO. PUROK 1 CALA
Subdivision/Village Bar
SANTIAGO CITY
11. PAG-IBIG ID NO. 0019-6587-7708
City/Municipality Pro
12. PHILHEALTH NO. 06-025054493-9 ZIP CODE 3311

13. SSS NO. 01-1731393-6 19. TELEPHONE NO.

14. TIN NO. 289-927-959 20. MOBILE NO. 09262740296 or 0948601793

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) Kcatral@yahoo.com
CATRAL 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) FRANCHESKA MEL ATHENA O. CATRAL
SALVACION

MIDDLE NAME OCAMPO

OCCUPATION Assistant Librarian

EMPLOYER/BUSINESS NAME Metropolitan College of Science & Technology

BUSINESS ADDRESS Victory Norte, Santiago City

TELEPHONE NO.

24. FATHER'S SURNAME CATRAL

NAME EXTENSION (JR., SR)
FIRST NAME FRANCISCO JR.

MIDDLE NAME FERNANDO

25. MOTHER'S MAIDEN NAME FIELDAD

SURNAME CATRAL

FIRST NAME IMELDA

MIDDLE NAME FORNEAS (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

ELEMENTARY La Salette of San Mateo 6/13/1991 3/28/1995

SECONDARY La Salette of San Mateo 6/13/1995 3/24/199

VOCATIONAL /

TESDA -TAGUIG CITY 7/31/2007 8/3/2007

TRADE
COURSE
COLLEGE UNIVERSITY OF LA SALETTE 7/18/1999 3/24/2004

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE Januar

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)

Dual Citizenship

by naturalization

Pls. indicate country:

CITY ROAD
Street
CALAO WEST
Barangay
ISABELA
Province
3311

CITY ROAD
Street
CALAO WEST
Barangay
ISABELA
Province
3311

09262740296 or 09486017935

Kcatral@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

Deceased

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1995

1999
 2007

2004

parate sheet if necessary)

January 19, 2019

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

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

2/17/2017 PRESENT Teaching Staff Firestrike Taekwondo Club P 2,500.00 Part-time

Southern Isabela College of Arts &
4/13/2013 7/18/2013 Instructor P 15.000.00 Contractual
Trades -TESDA
6/18/2012 10/20/2012 Assistant Instructor AMA College, Santiago City P 3,500.00 Part-time

6/12/2011 2/15/2012 Computer Technician & Cashier Kenzon Computer Shop P 3,500.00 Part-time
Southern Isabela College of Arts &
7/12/2010 2/16/2011 Instructor P 15.000.00 Contractual
Trades -TESDA
4/23/2010 7/9/2010 Call Center Agent NCO - RMH Teleservices Asia Pacific Inc. P 18,000.00 Contractual

3/4/2010 4/9/2010 Call Center Agent Teleperformance Telephilippines Inc. P 10,000.00 Contractual
Southern Isabela College of Arts &
4/15/2009 11/25/2009 Instructor P 20,000.00 Contractual
Trades -TESDA
Southern Isabela College of Arts &
2/1/2009 4/12/2009 Instructor P 15,000.00 Contractual
Trades -TESDA
 (Continue on separate sheet if necessary)

SIGNATURE DATE January 19, 2019

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N

N
arate sheet if necessary)

January 19, 2019

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

(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

N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Can fix fix and reprogrammed desktop

Out-Standing Teaching Staff of Nueva Vizcaya Taekwondo Chapter of the Philippines Philippine
computers
Can teach Self-defense

(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)

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

Philippine Taekwondo Association Member

eparate 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 within
the last 6 months
Mr. Frederick Samiling Santiago City, Isabela 9558427223 3.5 cm. X 4.5 cm
(passport size)

Mr. Alaine Gallarde Santiago City, Isabela 90658760010 With full and handwritten
name tag and signature over
printed name
Mr. Amads Elias Santiago City, Isabela 9359263393
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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: UMID CARD

ID/License/Passport No.: 0111-2667051-7

Signature (Sign inside the box)

Date/Place of Issuance: Solano, Nueva Vizcaya

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