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 REYES
NAME EXTENSION (JR., SR) JR
FIRST NAME LEO

MIDDLE NAME CELESPARA

3. DATE OF BIRTH
16. CITIZENSHIP FILIPINO
(mm/dd/yyyy) 1/12/1986

4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:

RINCON ST., VALENZUELA CITY
please indicate the details.
5. SEX
MALE
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 21 SABINO ALLEY
SINGLE House/Block/Lot No. Street
N/A MAYSAN
Subdivision/Village Barangay
7. HEIGHT (m) VALENZUELA CITY NCR
5'7 City/Municipality Province
8. WEIGHT (kg) ZIP CODE
75 KG 1440
9. BLOOD TYPE
18. PERMANENT ADDRESS 21 SABINO ALLEY
O House/Block/Lot No. Street

10. GSIS ID NO. N/A MAYSAN

N/A Subdivision/Village Barangay

11. PAG-IBIG ID NO. VALENZUELA CITY NCR

N/A City/Municipality Province

12. PHILHEALTH NO. ZIP CODE

02-0506217866 1440
13. SSS NO. 19. TELEPHONE NO.
3416293482 N/A
14. TIN NO. 20. MOBILE NO.
N/A 09455345823
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)
02238 REYES_LEO2523
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
N/A
NAME EXTENSION (JR., SR)
FIRST NAME
N/A N/A N/A
MIDDLE NAME
N/A N/A N/A
OCCUPATION
N/A N/A N/A
EMPLOYER/BUSINESS NAME
N/A N/A N/A
BUSINESS ADDRESS N/A
N/A N/A
TELEPHONE NO. N/A
N/A N/A
24. FATHER'S SURNAME
REYES N/A 03/20/1952
FIRST NAME
NAME EXTENSION (JR., SR) SR N/A
LEO N/A
MIDDLE NAME N/A
LUMUNTAD N/A
25. MOTHER'S MAIDEN NAME N/A
N/A
SURNAME N/A
CELESPARA 12/9/1955
FIRST NAME N/A
LILIA N/A
MIDDLE NAME (Continue on separate sheet if necessary)
CAMPOSANO
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 PRIMARY 1994 2000 GRADUATED 2000 N!/A

MALINTA ELEMENTARY SCHOOL

SECONDARY /
VOCATIONAL MALINTA NATIONAL HIGH SECONDARY 2001 2005 GRADUATED 2005 N/A
SCHOOL

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

N/A N/A
TRADE
COURSE
COLLEGE PHILIPPINE COLLEGE OF BACHELOR OF SCIENCE IN 2005 2011 GRADUATED 2011 N/A
CRIMINOLOGY CRIMINOLOGY

GRADUATE STUDIES N/A N/A N/A N/A N/A

N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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
LA CONSOLATION COLLEGE -
BOARD OF CRIMINOLOGY 79.70% 04/7-9/2013 06708263 05/0613
MENDIOLA

(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)
MANILA INTERNATIONAL ABOVE
12/9/2014 7/13/1905 AIRPORT POLICE SG-11 PERMANENT YES
AUTHORITY MINIMUM
STARFORCE SECURITY SERVICE ABOVE
1/5/2011 1/5/2013 SECURITY GUARD ₱9,000.00 TEMPORARY NO
INCORPORATED MINIMUM

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

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

(Continue on separate sheet if necessary)

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
CASCADING SESSIONS ON PROGRAM TO INSTITUTIONALIZE MERITOCRACY AND
EXCELLENCE IN HUMAN RESOURCE MANAGEMENT (PRIME-HRM) 03/22/2021 N/A 4 CORE HUMAN RESOURCE DEVELOPMENT DIVISION

A SEC REFRESHER COURSE 03/18/2019 03/20/2019 24 TECHNICAL

HUMAN RESOURCE DEVELOPMENT DIVISION
ORIENTATION SEMINAR ON THE PROMOTION OF A DRUG FREE
06/14/2018 N/A 8 CORE
WORKPLACE PROGRAM HUMAN RESOURCE DEVELOPMENT DIVISION

PRE-EMPLOYMENT OF PORTABLE HYBRID DETECTION KIT 03/23/2018 N/A 8 TECHNICAL

HUMAN RESOURCE DEVELOPMENT DIVISION

PORTABLE HYBRID DETECTION KIT TRAINING 03/21/2018 03/22/2018 16 TECHNICAL

HUMAN RESOURCE DEVELOPMENT DIVISION
INTEGRITY, TRANSPARENCY AND ACCOUNTABILITY IN PUBLIC SERVICE (ITAPS)
SEMINAR 09/13/2017 N/A 8 CORE
HUMAN RESOURCE DEVELOPMENT DIVISION

ACTIVE SHOOTER HANDLING AND WEAPONS PROFICIENCY TRAININGS 08/16/2017 08/17/2017 16 TECHNICAL
HUMAN RESOURCE DEVELOPMENT DIVISION

TOURIST SAFETY AND SECURITY SEMINAR 07/26/2017 07/27/2017 16 TECHNICAL

HUMAN RESOURCE DEVELOPMENT DIVISION

LAND TRANSPORTATION OFFICE (LTO) DEPUTATION SEMINAR 03/20/2017 03/25/2017 48 TECHNICAL HUMAN RESOURCE DEVELOPMENT DIVISION

GENDER SENSITIVITY TRAINING 4/10/2016 5/10/2016 16 CORE HUMAN RESOURCE DEVELOPMENT DIVISION

5S ORIENTATION - SEMINAR 08/14/2015 N/A 4 CORE HUMAN RESOURCE DEVELOPMENT DIVISION

ISO - QUALITY MANAGEMENT

08/14/2015 N/A 4 CORE
SYSTEM (QMS) ORIENTATION HUMAN RESOURCE DEVELOPMENT DIVISION
AIRPORT POLICE BASIC COURSE
07/14/2014 12/9/2014 320 TECHNICAL
CLASS NO. 13 - 14 HUMAN RESOURCE DEVELOPMENT DIVISION

(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)

PLAYING BASKETBALL N/A N/A

DRIVING MOTORCYCLE N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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
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,
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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period 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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
4.5 cm. X 3.5 cm
(passport size)

Computer generated
or photocopied picture
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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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