CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the fi ling of
administrative/criminal ca se/s a gainst the person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOM PLISHING THE PDS FORM .
1. CS ID No.
Print legibly. Tick appropriate box es ( ) and use separate sheet if necessary . Indicate N/A if not applicable. DO NOT ABBREVIATE. (Do not fill up. For CSC use only )

I. PERSONAL INFORMATION
2. SURNAME AB ON
NAM E EXTENS ION (J R ., S R )
FIRST NAME DONAL YN

MIDDLE NAME VERUEL A

3. DATE OF BIRTH
JANUARY 8,1991 16. CITIZENSHIP
Filipino Dual Citizenship
(mm/dd/y y y y )
by birth by naturalization
4. PLACE OF BIRTH CUYAPO, NUEVA ECIJA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PUROK 5

6 CIVIL STATUS
Widowed House/Block/Lot No. Street
Separated
N/A SALAGUSOG
Other/s:
Subdivision/Village Barangay
CUYAPO NUEVA ECIJA
7. HEIGHT (m) 1.52
City/Municipality Province
8. WEIGHT (kg) 54 ZIP CODE 3117
18. PERMANENT ADDRESS PUROK 5
9. BLOOD TYPE AB
House/Block/Lot No. Street
N/A SALAGUSOG
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CUYAPO NUEVA ECIJA
11. PAG-IBIG ID NO. 121029882578
City/Municipality Province
12. PHILHEALTH NO. 21-050048348-7 ZIP CODE 3117

13. SSS NO. 34-1455371-3 19. TELEPHONE NO. N/A

14. TIN NO. 736 826 134 000 20. MOBILE NO. 09272354010

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any ) DonalynJeff.0806vi@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME ABON 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/y y y y )
FIRST NAME
NAM E EXTENS ION (J R ., S R ) N/A 06/06/1990
GIL BERT N/A

MIDDLE NAME I MUS

OCCUPATION VENDOR

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS CUYAPO, NUEVA ECIJA

TELEPHONE NO. 9957865304

24. FATHER'S SURNAME VERUELA 18/12/1959

NAM E EXTENS ION (J R .,
FIRST NAME DOMINADOR S R )S R

MIDDLE NAME MINOR

25. MOTHER'S MAIDEN NAME CASIDSI D 05/08/1969

SURNAME VERUELA

FIRST NAME LIDA

MIDDLE NAME REBOSTE (Continue on separ ate sh eet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHES T S C HOLAR S
BASIC
26. NAME OF SCHOOL P ER IOD OF ATTENDANC E LEVEL/ YEAR HIP /
LEVEL EDUCATION/DEGREE/COURSE UNITS GR ADU AC ADEM IC
(Write in full) EAR NED ATED HONOR S
(Write in full)
(if no t R EC EIVED

GRADUATE STUDIES
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF LICENSE (if applicable)
RATING
UNDER SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE EXAMINATION FOR TEACHERS 77.4 30/09/2018 ROSALES NATIONAL HIGH SCHOOL 1739281 08/01/2022

(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.
SALARY/
28. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / J OB/ PAY

(mm/dd/y y y y ) POSITION TITLE M ONTHLY

GRADE (if
STATUS OF GOV'T S ERVIC E
COMPANY ap p licab le)&
(Write in full/Do not abbrev iate) S ALAR Y
STEP
AP P OINTM ENT (Y/ N)
From (Write in full/Do not abbrev iate)
To (Fo rmat "0 0 -
0 ")/
15 / 0 1/ 2 0 19 P R ES EN T MLSB-TEACHER VILLAFLORES INTEGRATED SCHOOL 4000.00 N/A PROBATIONARY N/A

19 / 0 4 / 2 0 12 12 / 0 5 / 2 0 15 AREA SALES COORDINATOR RICKIMEL MARKETING COMPANY 16000.00 N/A CONTRACTUAL N/A

2011 2012 CASHIER BAKERS FAIR INC. 12000.00 N/A CONTRACTUAL N/A

2011 2011 FACTORY WORKER VKC INC. 10000.00 N/A CONTRACTUAL N/A

DATE FEBRUARY 11,2020

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. NUM B ER OF
(Write in full) (mm/dd/y y y y ) POSITION / NATURE OF WORK
HOURS
From To

N/A N/A N/A N/A N/A

(Continue o n separate sheet if n ecessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the m o st recent L &D/tr ain ing pro gram and includ e on ly the relevan t L&D/trainin g taken for the l ast fi ve (5) years for Divisi on
Chi ef/Execu ti ve/Man agerial p osi tions)
TITLE OF LEARNING AND DEVELOPMENT INCLUSIVE DATES OF Type o f LD
30. NUM B ER OF ( M a na ge ria l/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE HOURS S upe rvis o ry/ (Write in full)
(Write in full) From To Te c hnic a l/e tc )

HILOT WELLNESS M ASSAGE 11/11/2019 29/11/2019 190.0 TECHNICAL TESDA

COMP UTER LITERACYP ROGRAM 02/08/2019 4/24/2019 191.0 TECHNICAL

TESDA
6TH NATIONAL S EMINAR WORKS HOP ON MANIP ULATIVE LABORATORY
08/05/2019 10/05/2019 30.0 SUPERVISORY
S KILLS FOCUS E D ON EXP ERIMENTAL AND DES CRIP TIVE RES EARCHES ASIAN FISHERIES ACADEMY
S CHOOL BAS ED IN S ERVICE TRAINING OF TEACHERS ON WRITING AND
DEVELOP ING CONTEXTUALIZED S TRATEGIC INTERVENTION( S IM) K TO 5/15/2019 5/17/2019 24.0 SUPERVISORY
12 CURRICULUM SAN LUIS NATIONAL HIGH SCHOOL
MUNICIP AL TRAINING WORKS HOP ON DEVELOP MENT OF QUALITY
CLAS S ROOM BAS ED TES T FOR TEACHERS
7/13/2019 7/27/2019 24.0 SUPERVISORY SA N L UIS NATIONAL HIGH SCHOOL
ORIENTATION S EMINAR ON THE NEW EARLYCHILDHOOD CARE AND PROVINCIA L SOCIAL WELFA RE AND
DEVELOP MENT P ROGRAM ACCREDITATION TOOLS CUM GAME BAS ED 3/17/2019 3/19/2019 30.0 SUPERVISORY
LEARNING DEVEL OPMENT OFFICE
RICKIMEL MARKETING COMP ANYLEADERS HIP CAMP 4/17/2014 4/19/2014 30.0 SUPERVISORY RICKIMEL MA RK ETING COMPANY

EFFECTIVE LEADERS HIP S KILLS 5/19/2012 5/19/2012 8.0 SUPERVISORY RICKIMEL MA RK ETING COMPANY
ENHANCEMENT TRAINING WORKS HOP ON MS EXCEL AND WESL EYAN UNIVERSITY PHILIPPINES-
10/06/2007 10/06/2007 8.0 SUPERVISORY
P OWERP OINT P RES ENTATION MA RIA AURORA A URORA

(Con tinue on separate sheet if necessary)

VIII. OTHER INFORMATION

3 MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 3 ASSOCIATION/ORGANIZATION
(Write in full)
. (Write in full)
MASSAGE THERAPIST N/A N/A

COMPUTER LITERATE

C S FOR M 212 (R e v is e d 2017), P age 3 o f 4

34. Are you related by consanguinity or affinity to the appointing or recommending authority, or
chief of bureau or office or to the person who has immediate supervision over you in the
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 YES NO
before 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
a following
Are you aitems:
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
VILLAFLORES, CUYAPO, the last 6 months
JEANE A FELIX 9162428375 3.5 cm. X 4.5 cm
NUEVA ECIJA (passport size)
SALAGUSOG, CUYAPO,
DIGNA B. PASCUAL 9052756397 With f ull and handwritten
NUEVA ECIJA name tag and signature ov er
printed name
JERICO D. ROBLES CUYAPO, NUEVA ECIJA 9062132142
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
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 PHOTO
filing of administrative/criminal case/s against me.

Gov ernment Issued ID (i.e .P a s s po rt, GS IS , S S S , P R C , Drive r's

Lic e ns e , e tc .) PLEASE INDICATE ID Number
Gov ernment Issued ID: PRC LICENSE

ID/License/Passport No.: 1739281

Signature (Sign inside the box )