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

I. PERSONAL INFORMATION
2. SURNAME DOMINGUEZ
NAME EXTENSION (JR., SR)
FIRST NAME JOHN VALRO

MIDDLE NAME VILLAVICENCIO

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
9/13/1990 by
by naturalization
birth
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS 14 ARMANDO DALISAY

Widowed House/Block/Lot No. Street

Separate
MHFDS BF HOMES
Other/s: d
Subdivision/Village Barangay
PARANAQUE METRO MANILA
7. HEIGHT (m) 1.77
City/Municipality Province
8. WEIGHT (kg) 81.65 ZIP CODE 1700

18. PERMANENT ADDRESS 14 ARMANDO DALISAY

9. BLOOD TYPE O
House/Block/Lot No. Street
MHFDS BF HOMES
10. GSIS ID NO. N/A
Subdivision/Village Barangay
PARANAQUE METRO MANILA
11. PAG-IBIG ID NO. 12-11-53-64-87-71
City/Municipality Province

12. PHILHEALTH NO. 010-5232-084-68 ZIP CODE 1700

13. SSS NO. 34-724-8239-2 19. TELEPHONE NO. 8-825-18-45

14. TIN NO. 501-964-653-000 20. MOBILE NO. 0917-846-53-78

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) johnvalrodominguez@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)

FIRST NAME N/A

NAME EXTENSION (JR., SR) 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 DOMINGUEZ

NAME EXTENSION (JR., SR)
FIRST NAME LAURO

MIDDLE NAME VIVA

25. MOTHER'S MAIDEN NAME

SURNAME VILLAVICENCIO

FIRST NAME ANNETTE

MIDDLE NAME RULLODA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LA SALLE GREENHILLS GRADE SCHOOL 6/1/1997 3/1/2004 N/A 2004 N/A

SECONDARY /
VOCATIONAL SAN BEDA COLLEGE - ALABANG HIGH SCHOOL 6/1/2005 3/1/2008 N/A 2008 N/A

N/A

TRADE
BACHELOR OF ARTS MAJOR IN LEGAL
COURSE
COLLEGE UNIVERSITY OF SANTO TOMAS
MANAGEMENT
6/1/2008 3/1/2012 N/A 2012 N/A

GRADUATE STUDIES SAN BEDA COLLEGE - ALABANG JURIS DOCTOR 6/1/2013 4/1/2017 N/A 2017 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE August 9, 2020

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

BAR EXAMS 2018 75.4 11/1/2018 UNIVERSITY OF SANTO TOMAS 73189 6/26/2021

(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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)

3/1/2020 PRESENT RETAINED COUNSEL USA 88 GROUP OF COMPANIES 15000.00 N/A CONTRACTUAL N/A

3/1/2020 PRESENT RETAINED COUNSEL ARTHUR AP MANAGEMENT INC. 20000.00 N/A CONTRACTUAL N/A

2/1/2020 PRESENT RETAINED COUNSEL FLYING V GROUP OF COMPANIES 30000.00 N/A CONTRACTUAL N/A

5/27/2019 PRESENT ASSOCIATE CAUNAN LAW OFFICE 35000.00 N/A PERMANENT N/A

1/2/2019 PRESENT ASSOCIATE FRIAS&FRIAS and ASSOCIATES 15000.00 N/A PART-TIME N/A

4/1/2017 4/27/2017 COURT DECONGESTION OFFICER REGIONAL TRIAL COURT BR. 29 PQUE. 35000.00 N/A CONTRACTUAL N/A
PAMANTASAN NG LUNGSOD NG
9/1/2015 5/1/2016 INSTRUCTOR 150/HR N/A PART-TIME N/A
MUNTINLUPA
4/1/2013 5/30/2013 INTERN OFFICE OF THE CITY PROSECUTOR PQUE. N/A N/A INTERN N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE August 9, 2020

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

DON GREGORIO AGONCILLO FOUNDATION 12/25/2012 PRESENT N/A LEGAL ADVISER

VOLCORPS - SAN BEDA COLLEGE SCHOOL OF LAW 6/1/2013 5/1/2014 N/A HEAD - OUTREACH

FIRE BEYOND BORDERS CHARISMATIC COMMUNITY - PRESENTATION OF THE

9/1/2007 12/1/2014 N/A HEAD - OUTREACH
CHILD JESUS PARISH

COMMUNITY INVOLVEMENT CENTER - SAN BEDA COLLEGE - ALABANG 6/1/2006 5/1/2008 N/A HEAD - OUTREACH

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

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

Data Privacy Act Awareness Webinar 8/7/2020 8/7/2020 8.0 Garces, Hizon, and Pua Law Office and Associates

(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)

SWIMMING N/A N/A

VOLLEYBALL

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE August 9, 2020

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
the last 6 months
DEP. C.P. EDELYN M. MURILLO OCP- PARANAQUE 0908 820 93 82 4.5 cm. X 3.5 cm
(passport size)

ATTY. KARLA DENISE M. FRIAS LAW PROFESSOR 0917 518 20 83

Computer generated
GENERAL COUNSEL & SVP - GLOBE or photocopied picture
ATTY. VICENTE FROILAN M. CASTELO TELECOMS
02 797 42 64 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: IBP

ID/License/Passport No.: 73189

Signature (Sign inside the box)

Date/Place of Issuance: IBP - MAIN

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