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 Caballero
NAME EXTENSION (JR., SR)
FIRST NAME Richmondemil

MIDDLE NAME Novicio

3. DATE OF BIRTH
(mm/dd/yyyy) 10/12/1990 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH Quezon 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 #05 Quezon Sreet
Widowed Separated House/Block/Lot No. Street
Barangay 07 Poblascion
Other/s:
Subdivision/Village Barangay
Casiguran Aurora
7. HEIGHT (m) 5'7
City/Municipality Province
8. WEIGHT (kg) 153 pounds ZIP CODE 3204
18. PERMANENT ADDRESS #05 Quezon Sreet
9. BLOOD TYPE type O
House/Block/Lot No. Street
Barangay 07 Poblascion
10. GSIS ID NO. None
Subdivision/Village Barangay
Casiguran Aurora
11. PAG-IBIG ID NO. 121073480669
City/Municipality Province
12. PHILHEALTH NO. 020258675836 ZIP CODE 3204

13. SSS NO. 0237403810 19. TELEPHONE NO. None

14. TIN NO. 491105128 20. MOBILE NO. 09555781588 / 09123950816

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
None 21. E-MAIL ADDRESS (if any) caballerorichmond@gmail.com
23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) Carlos Joaquin S. Caballero
3/16/2019

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Caballero

NAME EXTENSION (JR., SR)
FIRST NAME Oscar

MIDDLE NAME Salamera

25. MOTHER'S MAIDEN NAME

SURNAME Novicio

FIRST NAME Harley

MIDDLE NAME Licu (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From To
graduated)
ELEMENTARY Casiguran Central School 6/3/1997 3/3/2003
VOCATIONAL /
SECONDARY Lual National High School 6/5/2003 4/11/2007

Lorraine Technical School Building Wirring Installation/EIM 1/10/2010 2/25/2011

COLLEGE TRADE Dual Tech Center Electro-Mechanics Technology 6/11/2007 12/16/2009

COURSE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE November 22,2019

CS FORM 212 (Revised 2017), Page 1 of 4

on Sreet

rora
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

None

(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/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
12/2/2007 6/26/2008 On-the-job Training as Machine Operator Moriroku Phillippines Incorporated 6k OJT

7/5/2008 10/29/2009 On-the-job Training as Machine Operator Honda Cars Philippines 6k OJT

12/11//2011 11/6/2013 Technician/Installer Seng Hoe Huat Car Audio and Accessories 28k OFW

12/3/2013 12/29/2015 Maintenance Technician Universal Robina Corp. 10k Regular

1/19/2016 12/20/2017 Maintenance Technician Colorsteel System Corp. 10k Regular

12/26/2017 3/3/2019 Maintenance Technician Kodec Precision Inc. 14k Regular

(Continue on separate sheet if necessary)

SIGNATURE DATE November 22,2019

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

None

(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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

None

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Wiring Installation

Machine Operator

Computer Literate

Technician

(Continue on separate sheet if necessary)

SIGNATURE DATE November 22,2019

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
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 If YES, give details:
phased 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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the 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
a.
items:
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
Jerimias Esteves Casiguran Aurora None 3.5 cm. X 4.5 cm
(passport size)

Ronen C. Galang URC Pampanga Plant None With full and handwritten
name tag and signature over
printed name
Bernie Ozaeta KPI Pampanga Plant None
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 PHOTO
filing of 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: UMID 0111-8847965-9

ID/License/Passport No.: EB4339330

Signature (Sign inside the box)

Date/Place of Issuance: December 27,2011

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