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 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. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME RIVERA

FIRST NAME CHRISTINE

MIDDLE NAME VILLEGAS

3. DATE OF BIRTH
(mm/dd/yyyy) 12/25/2003 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH MATI, DAVAO ORIENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS
Widowed Separated House/Block/Lot No. Street
TAGUIBO
Other/s:
Subdivision/Village Barangay
CITY OF MATI DAVAO ORIENTAL
7. HEIGHT (m) 1.55
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 8200
18. PERMANENT ADDRESS
9. BLOOD TYPE O
House/Block/Lot No. Street
TAGUIBO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CITY OF MATI DAVAO ORIENTAL
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 8200

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09094819028

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) 09094819028
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)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME RIVERA

FIRST NAME REY

MIDDLE NAME VILLIANCIO

25. MOTHER'S MAIDEN NAME VILLEGAS
SURNAME RIVERA

FIRST NAME JENNY

MIDDLE NAME VILLEGAS (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

MARCH WITH HIGH

ELEMENTARY TAGUIBO ELEMENTARY SCHOOL ELEMENTARY JUNE 2010
2016
GRADUATED 2015
HONORS
VOCATIONAL APRIL WITH
SECONDARY / CITY OF MATI NATIONAL HIGH SCHOOL SECONDARY JUNE 2016 GRADUATED 2019
2O20 HONORS
N/A N/A N/A N/A N/A N/A N/A
TRADE
COLLEGE
COURSE
PHILIPPINE MILITARY ACADEMY BACHELOR OF MILITARY IN FORCE JUNE 2020 APRIL 2030 GRADUATED 2025 N/A

GRADUATE STUDIES N/A N/A N/A (ongoing) N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 01, 2030

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 applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

MILITARY EXAMINATION DAVAO CITY 1271109 9/27/2030

(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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

10/27/2020 2/27/2027 SERGEANT MAJOR 701st BRIGADE 50, 000 11-1 PERMANENT Yes

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 01, 2030

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

VOCALIST 4/1/2020 PRESENT A VOCALIST

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
### From To

DIVISION ROLL-OUT ON THE PHILIPPINE PROFESSIONAL STANDARDS FOR TEACHERS 2/26/2020 2/27/2027 N/A GOVERNMENT

(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 in
(Write in full)
full)

DANCER SCHOOL ONLY N/A

SINGER REGIONAL RE-THROW

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 01, 2030

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,
IR a. within the third degree? YES ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

ARM If YES, give details:

ED
________________________________
FOR
35. a. Have you ever been found guilty of any administrative offense? CES YES ✘ NO
of
If YES, give details:
the
________________________________
PHIL 80
________________________________
IPPI ,1
### b. Have you been criminally charged before any court? NES YES 49✘ NO
ARMED FORCES of the PHILIPPINES
Date Filed:

YES ✘ NO

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
ARCHIE HEIGHTS, MATIAO, CITY OF the last 6 months
RIZZA O. PADILLA MATI
9125135969 3.5 cm. X 4.5 cm
(passport size)

CHARLES YVES MILLAN MATIAO CITY OF MATI 9154748237 With full and handwritten
name tag and signature over
printed name
ALBERT B. RESPECIA CITY OF MATI 9183750008
Computer generated
42. or photocopied picture
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: PRC ID

ID/License/Passport No.: 1271109

Signature (Sign inside the box)
APRIL 01, 2030
Date/Place of Issuance: 01/09/20
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