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.

I. PERSONAL INFORMATION
2. SURNAME GILBOR
NAME EXTENSION (JR., SR
FIRST NAME JUDY

MIDDLE NAME CABIGONA

3. DATE OF BIRTH
(mm/dd/yyyy) 7/28/1980 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH CANDONI, NEGROS OCCIDENTAL If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.

Other/s:
Subdivision/Village B
CANDONI NEGRO
7. HEIGHT (m) 1.25
City/Municipality
8. WEIGHT (kg) 55 ZIP CODE 6110

18. PERMANENT ADDRESS PUROK

9. BLOOD TYPE o+
House/Block/Lot No.

10. GSIS ID NO. N/A

Subdivision/Village B
CANDONI NEGRO
11. PAG-IBIG ID NO. 121020495001
City/Municipality

12. PHILHEALTH NO. 11-050287176-5 ZIP CODE 6110

13. SSS NO. 07-3049619-1 19. TELEPHONE NO. N/A

14. TIN NO. 000-921-000-388 20. MOBILE NO. +639463800211

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) gilborjudy@yahoo.com
GILBOR 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) EJIE CABIGONA GILBOR
ERNESTO, JR.

MIDDLE NAME EPALAN TORJ CABIGONA GILBOR

OCCUPATION SURVEYOR JAMES JUER CABIGONA GILBOR

EMPLOYER/BUSINESS NAME CASTRO SURVEYING OFFICE JUDE ERNEST CABIGONA GILBOR

BUSINESS ADDRESS KABANKALAN CITY

TELEPHONE NO. N/A

24. FATHER'S SURNAME CABIGONA

NAME EXTENSION (JR., SR)
FIRST NAME PEDRO

MIDDLE NAME CANAWAY

25. MOTHER'S MAIDEN NAME

SURNAME CASICADAN

FIRST NAME VERONICA

MIDDLE NAME CANDADO (Continue on separate sheet if necessa

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 PAYAUAN ELEMENTARY SCHOOL PRIMARY EDUCATION 6/6/1988 3/25/1994

CANINGAY NATIONAL HIGH SCHOOL CANDONI,

SECONDARY
EXTENSION
SECONDARY EDUCATION 6/5/1995 3/24/1999
VOCATIONAL /

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

TRADE
COURSE
COLLEGE KABANKALAN CATHOLIC COLLEGE 6/8/1999 3/21/2003

CENTRAL STATE PHILIPPINE UNIVERSITY -

GRADUATE STUDIES
CANDONI CAMPUS
BSED-SUPPLEMENTAL 6/11/2010 ###

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS F
L DATA SHEET
ience Sheet shall cause the filing of administrative/criminal case/s against the person

FORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

PUROK NAMONGSOD
Street
EAST
Barangay
NEGROS OCCIDENTAL
Province
6110

PUROK NAMONGSOD
Street

Barangay
NEGROS OCCIDENTAL
Province

6110

N/A

+639463800211

gilborjudy@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

11/12/2005

3/3/2009

9/5/2012

7/9/2014

(Continue on separate sheet if necessary)

YEAR SCHOLARSHIP/
GRADUATED ACADEMIC HONORS
RECEIVED

1994 N/A

1999 SALUTATORIAN
 N/A N/A

2003 N/A

2012 N/A
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 LICENSE (if ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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

OUR LADY OF LOURDES HIGH

8/4/2003 04/31/2019 CLASSROOM TEACHER 13520.56 PROBATIONARY
SCHOOL OF CANDONI, INC.
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
NO
arate 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 /
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) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

COMPUTER SYSTEM SERVICING NC II 392 LASAL TECH

TRAINERS METHODOLOGY I 264 LASAL TECH

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

N/A
 (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)

LASAL TECH, BACOLOD CITY

LASAL TECH, BACOLOD CITY

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
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 ✘ 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? ________________________________
________________________________
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
BRGY. EAST, CANDONI, NEGROS the last 6 months
ALICIA C. DALANANGBAYAN OCCIDENTAL
639153663208 3.5 cm. X 4.5 cm
(passport size)
BRGY. EAST, CANDONI, NEGROS
REV. FR. ROBERT M. SERMONA OCCIDENTAL
639214904406 With full and handwritten
name tag and signature over
BRGY. WEST, CANDONI, NEGROS printed name
MERCY C. GALVAN OCCIDENTAL
639217463817
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: 07-3049619-1

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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