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 against the person
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. T15374668
I. PERSONAL INFORMATION
2. SURNAME BILLONES
NAME EXTENSION (JR., SR)
FIRST NAME REYNALDO

MIDDLE NAME AUQUICO

3. DATE OF BIRTH
(mm/dd/yyyy) 10/11/1996 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH E.B MAGALONA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS HDA. LUMBIA 1

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
Other/s: BRGY. ALICANTE
Subdivision/Village Barangay
E. B MAGALONA NEGROS OCCIDENTAL
7. HEIGHT (m) 1.70688 METERS
City/Municipality Province
8. WEIGHT (kg) 60 KILOGRAMS ZIP CODE 6118

18. PERMANENT ADDRESS HDA. LUMBIA 1

9. BLOOD TYPE N/A
House/Block/Lot No. Street
BRGY. ALICANTE
10. GSIS ID NO. N/A
Subdivision/Village Barangay
E. B MAGALONA NEGROS OCCIDENTAL
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 11-254181844-0 ZIP CODE 6118

13. SSS NO. 07-3673009-7 19. TELEPHONE NO. N/A

14. TIN NO. 338-297-364-0000 20. MOBILE NO. 0961 323 6705

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) renzbillones011@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
N
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A
/
MIDDLE NAME N/A A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME BILLONES

NAME EXTENSION (JR., SR)
FIRST NAME RONILO

MIDDLE NAME ELIZALDE

25. MOTHER'S MAIDEN NAME

SURNAME AUQUICO

FIRST NAME EVELYN

MIDDLE NAME GOLEZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

1ST HON.
ELEMENTARY ALICANTE ELEMENTAR SCHOOL GRADUATED 6/2/2003 3/20/2009 2009
MENTION

SECONDARY /
VOCATIONAL E.B MAGALONA NATIONAL HIGH SCHOOL GRADUATED 6/8/2009 3/20/2013 2013 N/A

NFSP SUGAR WORKERS FOUNDATION INC.

TECHNICAL SKILLS TRAINING CENTER
PASSED 9/2/2019 ### 2019 N/A
TRADE
BACHELOR'S OF SCIENCE IN INFORMATION
COURSE
COLLEGE BACOLOD CITY COLLEGE
SYSTEM
6/10/2013 3/31/2017 2017 N/A

GRADUATE STUDIES TEACHER CERTIFICATE PROGRAM (TCP) PASSED ### ### 2018 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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

LICENSED PROFESSIONAL TEACHER 79.6 3/24/2019 BACOLOD CITY, NEGROS OCCIDENTAL

(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

PHILIPPINE SPRING WATER PHP

6/5/2017 9/11/2019 PRODUCT MERCHANDISER 9,000.00
RESOURCES INCORPORATION
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (R
 LICENSE (if applicable)

NUMBER Date of
Validity

1779597 10/11/2022

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)
REGULAR
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 / NATURE OF WORK
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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A N/A

Install and Configure Computer Sytem

Organization Skills

Leadership Skills

Writing Poems

Singing

Dancing
(Continue on separate sheet if necessary)

SIGNATURE DATE
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? TO APPLY AS A TEACHER
________________________________
________________________________
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
RASDY D. BIACO BACOLOD CITY 0938 796 4423 3.5 cm. X 4.5 cm
(passport size)

MIA P. CAMAGAN TALISAY CITY 0995 896 1499 With full and handwritten
name tag and signature over
printed name
ANTHONY PATRATA E. B MAGALONA 0999 806 9865
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: 1779597 (07-21-2019)

ID/License/Passport No.: 1779597 (07-21-2019)

Signature (Sign inside the box)

Date/Place of Issuance: 07-21-2019 / ILO-ILO 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