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 NATANAWAN
NAME EXTENSION (JR., SR)
FIRST NAME MARLISSA N/A
MIDDLE NAME MENDOZA
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) MAY 01, 1980 ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH HERMOSA, BATAAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS PUROK I
Widowed Separated House/Block/Lot No. Street
PAG-ASA
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 156 DINALUPIHAN BATAAN
City/Municipality Province
8. WEIGHT (kg) 75 ZIP CODE 2100
18. PERMANENT ADDRESS PUROK I
9. BLOOD TYPE "O"
House/Block/Lot No. Street
PAG-ASA
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-4177-7978

DINALUPIHAN BATAAN
City/Municipality Province

12. PHILHEALTH NO. 070502965679 ZIP CODE 2100

13. SSS NO. 02-2004110-8 19. TELEPHONE NO. N/A

14. TIN NO. 223-328-079 20. MOBILE NO. 09176398534

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) ineng678@yahoo.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)
NAME EXTENSION (JR., SR)
FIRST NAME JOSE MARION NATANAWAN PELOBELLO SEPTEMBER 08, 2008

MIDDLE NAME MARCELO JEL NATANAWAN PELOBELLO NOVEMBER 06, 2010

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME NATANAWAN

NAME EXTENSION (JR., SR)
FIRST NAME MARCELO
SR
MIDDLE NAME BAYBAY

25. MOTHER'S MAIDEN NAME

SURNAME MENDOZA

FIRST NAME ELISA

MIDDLE NAME BABADILLA (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 EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY COLO ELEMENTARY SCHOOL ELEMENTARY 1987 1993 GRADUATED 1993 DIPLOMA

SECONDARY NORTHERN BATAAN INSTITUTE HIGH SCHOOL 1993 1997 GRADUATED 1997 DIPLOMA
VOCATIONAL /

N/A

TRADE
COLLEGE
COURSE VIRGEN DELOS REMEDIOS COLLEGE BACHELOR OF SCIENCE IN CRIMINOLOGY 1997 2001 GRADUATED 2001 DIPLOMA

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 17, 2021 CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER LICENSE (if applicable)
RATING DATE OF EXAMINATION /
SPECIAL LAWS/ CES/ CSEE PLACE OF EXAMINATION / CONFERMENT
(If Applicable) CONFERMENT NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
Validity
MANUEL L QUEZON UNIVERSITY QUIAPO,
CRIMINOLOGISTS 75.00% SEPTEMBER 16, 2001 11575 MAY 01, 2022
MANILA PHILIPPINES

(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 SERVICE
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 full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) not abbreviate) INCREMENT
From To (Y/ N)
MARCH 28, ADMINISTATIVE ASSISTANT II (HRM PNP-NON UNIFORMED PERSONNEL PARMU,
TO PRESENT 16,758.00 SG-8 PERMANENT YES
2019 ASSISTANT) BATAAN PPO, PRO3
JULY 28, 2012 MAY 11, 2018 CUSTOMER CARE EXCUTIVE NMC SPECIALITY HOSPITAL,DUBAI,UAE 62,300.00 N/A PERMANENT NO
SEPTEMBER
JULY 1, 2009
1, 2009
QUALITY SUPERVISOR HOKEI SUBIC CORPORATION, PHILIPPINES 15,000.00 N/A TEMPORARY NO

MAY 20, 2009 JULY 1, 2009 SALES EXECUTIVE HOKEI SUBIC CORPORATION, PHILIPPINES 15,000.00 N/A TEMPORARY NO
DECEMBER PHILIPPINE OCEAN BUSSINESS
MAY 2, 2007
30, 2007
RESEARCHER 15,000.00 N/A PERMANENT NO
CORPORATION, PHILIPPINES
NOVEMBER PHILIPPINE OCEAN BUSSINESS
2,2006
MAY 1,2007 ADMINISTATIVE SUPERVISOR 15,000.00 N/A PERMANENT NO
CORPORATION, PHILIPPINES
OCTOBER 3, NOVEMBER 2,
2006 2006
HUMAN RESOURCE OFFICER HOKEI SUBIC CORPORATION, PHILIPPINES 15,000.00 N/A TEMPORARY NO
SEPTEMBER PERSONNEL AND GENERAL AFFAIRS SANYO DENKI PHILIPPINES, CORPORATION,
JULY 24, 2002
4, 2004
13,000.00 N/A PERMANENT NO
SECURITY COORDINATOR PHILIPPINES
NOVEMBER 1,
2001
APRIL 1, 2003 COLLEGE INSTRUCTRESS VIRGEN DELOS REMEDIOS COLLEGE 5,000.00 N/A PART TIME NO
NOVEMBER 1,
2001
APRIL 1, 2003 COLLEGE INSTRUCTRESS HOLY INFANT COLLEGE 5,000.00 N/A PART TIME NO

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 17, 2021 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
FEBRUARY MARCH 01,
INTELLIGENCE & INVESTIGATION OFFICE, SUBIC BAY FRREPORT ZONE 180 HRS ADMINISTRATIVE ASSISTANT
01, 2001 2002

(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

DECEMBER 29,
2020 & JANUARY 18, CAMP CAPT JULIAN OLIVAS, CITY OF SAN
TEN-DAY READ SEMINAR PROGRAM FOR NUP JANUARY 5, 2021
80HRS TECHNICAL
FERNANDO, PAMPANGA
2021

OCTOBER 21, OCTOBER 25, BATAAN PPO, CAMP PFC CIRILO S

BASIC HUMAN RESOURCE MANAGEMENT SEMINAR 2019 2019
40 HRS TECHNICAL
TOLENTINO, BALANGA CITY, BATAAN

MARCH 31, MARCH 31, SANYO DENKI PHILIPPINES, CORPORATION,

TRAIN THE TRAINOR 2004 2004
8 HRS MANAGERIAL
SUBIC BAY FREEFORT ZONE

FEBRUARY 09, MARCH 06, INTELLIGENCE & INVESTIGATION OFFICE,

ON THE JOB TRAINING 2001 2001
180 HRS TECHNICAL
SUBIC BAY FREEFORT ZONE

(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 WITH MICROSOFT

N/A N/A
OFFICE
WELL CUSTOMER ORIENTED N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 17, 2021 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 NO
YES ✘
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? ________________________________
RESIGNED IN ALL EMPLOYMENT
________________________________
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
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete
Computer generated
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I or photocopied picture
authorize the agency head / authorized representative to verify/validate the contents stated herein. I agree that any is not acceptable
misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s PHOTO
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: PNP IDENTIFICATION CARD

ID/License/Passport No.: 0000000000

Signature (Sign inside the box)
FEBRUARY 17, 2021
Date/Place of Issuance: CAMP CRAME QUEZON CITY
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

PLTCOL DENNIS R ORBISTA

C, PARMU
Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of 4