CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s
against the person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOM PLISHING 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 not fill up. For CSC use only )

I. PERSONAL INFORMATION
2. SURNAME PABRIGAL
NA M E EXTENSION (JR., SR)
FIRST NAME CRIS JAMES
MIDDLE NAME EUPEÑA
3. DATE OF BIRTH
(mm/dd/y y y y )
7/12/1996 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH SURIGAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS P5

Widowed Separated House/Block/Lot No. Street

Other/s: POBLACION
Subdivision/Village Barangay

7. HEIGHT (m) 157 m SAN JOSE DINAGAT ISLAND

City/Municipality Province
8. WEIGHT (kg) 80 kg ZIP CODE

9. BLOOD TYPE O 18. PERMANENT ADDRESS P6

House/Block/Lot No. Street

10. GSIS ID NO. N/A SAN JUAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 9171-6080-2107 SURIGAO CITY SURIGAO DEL NORTE

City/Municipality Province

12. PHILHEALTH NO. 1825-0786-3672 ZIP CODE 8400

13. SSS NO. 08-2375310-7 19. TELEPHONE NO. N/A
14. TIN NO. 703-119-746-000 20. MOBILE NO. 09300104101

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any ) pabrigalcrisjames@yahoo.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/y y y y )
NA M E EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

NA M E EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLA RSHI
P ERIOD OF
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ YEA R P/
LEVEL A TTENDA NCE UNITS EA RNED GRA DUA TE A CA DEM IC
(Write in full) (Write in full) (if no t graduated) D HONORS
From To RECEIVED

SURIGAO WEST CENTRAL ELEM 2008-

ELEMENTARY ELEMENTARY 2004 2009 N/A N/A
SCHOOL 2009
SURIGAO CITY NATIONAL HIGH 2012-
SECONDARY SECONDARY 2009 2013 N/A N/A
SCHOOL 2013
VOCATIONAL / AUG SEP
SNCAT-MAGPAYANG TRAINERS METHODOLOGY 1 N/A 2019 N/A
TRADE COURSE 2019 2019
SURIGAO STATE COLLEGE OF BACHELOR OF TECHNICAL 2016-
COLLEGE 2013 2017 N/A N/A
TECHNOLOGY TEACHER EDUCATION 2017
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE February 6, 2020

CS FORM 212 (Revised 2017), P age 1o f 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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity
LICENSURE EXAMINATION FOR
77.7 3/24/2019 CAGAYAN DE ORO CITY 1786552 7/12/2022
TEACHERS (LET)

(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.
SALARY/ JOB/
28. INCLUSIVE DATES PAY GRADE (if
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GOV'T
(mm/dd/y y y y ) M ONTHLY applicable)& STA TUS OF
SERVICE
(Write in full/Do not abbrev iate) (Write in full/Do not abbrev iate) SA LA RY STEP (Format A P P OINTM ENT
(Y/ N)
" 00-0" )/
From To INCREM ENT
Surigao Metropolitan Water
3/1/2015 5/1/2015 Helper Electrician (OJT) OJT NO
District
Office of the City Engineer
11/1/2015 3/1/2016 Helper Electrician (OJT) OJT NO
(Surigao City)
CONTRACT
6/1/2017 3/30/2018 Cost Controller/Encoder Ironbase Dev. Company 8000.00 NO
UAL
CONTRACT
4/1/2018 4/1/2019 Maintenance Clerk Nickelbase Incorporated 12000.00 NO
UAL

(Continue on separate sheet if necessary)

SIGNATURE DATE February 6, 2020

CS FORM 212 (Revised 2017), P age 2 o f 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. NUM BER OF
(Write in full) (mm/dd/y y y y ) HOURS
POSITION / NATURE OF WORK
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
Type o f LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE NUM BER OF ( M anagerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/y y y y ) HOURS Superviso ry/ (Write in full)
Technical/etc)
From To

Leadership Training 11/28/2017 11/30/2017 72 HRS IronBase Inc

Inventory Control Seminar 7/15/2018 7/15/2018 8 HRS Nickelbase Inc

Operation Control and Budget Preparation 2/20/2018 2/22/2018 72 HRS Nickelbase Inc
PROVINCIAL TRAINING CENTER-
ELECTRICAL INSTALLATION AND MAINTENANCE NC II 6/18/2019 7/18/2019 196 HRS
SDN
TRAINERS METHODOLOGY LEVEL 1 9/2/2019 10/16/2019 264 HRS SNCAT- MAGPAYANG TESDA

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ASSOCIATION/ORGANIZATION
(Write in full)
(Write in full)

COMPUTER LITERATE: MS OFFICE

LITERATE IN: ADOBE PHOTOSHOP

VIDEO EDITING

(Continue on separate sheet if necessary)

SIGNATURE DATE February 6, 2020

CS FORM 212 (Revised 2017), P age 3 o f 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 YES NO
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,
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 YES NO
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? 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
ROLIE ARELLANO SNCAT-MAGPAYANG 3.5 cm. X 4.5 cm
(passport size)
ST. PAUL UNVERSITY
VINCENT TORAJA With f ull and handwritten
SURIGAO name tag and signature ov er
printed name
MELVIN LINCUNA ASSAT-TESDA
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.P asspo rt, GSIS, SSS, P RC, Driver's

License, etc.) PLEASE INDICATE ID Number
Gov ernment Issued ID: PRC
ID/License/Passport No.: 1786552 Signature (Sign inside the box )
FEBRUARY 6, 2020
Date/Place of Issuance: BUTUAN CITY 6/26/2019 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), P age 4 o f 4