Flat 80

Rye rye 120

Nicole 70
Mabini 100
Stc 28.5
Transport 40
438.5

Reynante 300
Mylene 260
560

Salary 560
Deduction 438.5
Allowance 121.5

100 100 200

CS Form No. 212
Revised 2017

PERSONAL DATA SHEET

Print legibly. Tick appropriate boxes ( ) 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 ANSINO
FIRST NAME ALDRIN
MIDDLE NAME BLOR
3. DATE OF BIRTH
(mm/dd/yyyy) 07-19-1990 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH ANILAO, ILOILO

5. SEX MALE
6 CIVIL STATUS SINGLE 17. RESIDENTIAL ADDRESS 2745 ANACLETO
House/Block/Lot No. Street
PALAYPAY
Subdivision/Village Barangay
7. HEIGHT (m) 1.64 ANILAO ILOILO
City/Municipality Province
8. WEIGHT (kg) 74 ZIP CODE 5009

18. PERMANENT ADDRESS

9. BLOOD TYPE B
House/Block/Lot No. Street

10. GSIS ID NO. PALAYPAY

Subdivision/Village Barangay

11. PAG-IBIG ID NO. ANILAO ILOILO

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09072334109

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CORDERO

 FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME LUMANDON
FIRST NAME ROSARIO
MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY N/A 2015 N/A

SECONDARY
VOCATIONAL / MANUEL LUIS QUEZON HIGH SCHOOL N/A 2019 N/A

N/A

TRADE
COURSE
COLLEGE N/A N/A

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE may 10, 2021 CS FORM 212 (Revised 2017), Page 1 of 4

23. NAME of CHILDREN (Write full name and

22. SPOUSE'S SURNAME DATE OF BIRTH (mm/dd/yyyy)
list all)
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

LICENSURE EXAM FOR TEACHERS 82.0 09-29-2019 ILOILO NATIONAL HIGH SCHOOL 1831623 2020-2023

(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
(Write in full/Do not (Write in SALARY
applicable)& STEP STATUS OF APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

01-13-2020 03-31-2021 TEACHER PUTI-AN CHILD LEARNIN G CENTER ₱5,000.00 N/A PROVISIONAL N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 4/08/21 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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
MASTER STEWARDS INFORMATION TECHNOLOGY
CONTACT CENTER SERVICES NC II 11/25/2019 12/13/2019 144.0 TECHNICAL SOLUTIONS IT TRAINING CENTER

Fenex Kyn Solibio

 (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)

SINGING N/A N/A

PLAYING KALIMBA

PHOTOGRAPHY

(Continue on separate sheet if necessary)

SIGNATURE DATE 4/08/21 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? 0 YES 1 NO
b. within the fourth degree (for Local Government Unit - Career Employees)? 0 YES 1 NO
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense? 0 YES 1 NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
0 YES 1 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 0 YES 1 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, 0 YES 1 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 0 YES 1 NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last 0 YES 1 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? 0 YES 1 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: 0 YES 1 NO
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
3.5 cm. X 4.5 cm
(passport size)
 ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
SUZETTE FALCIS BANICA, ROXAS CITY, CAPIZ 9217178147 (passport size)

With full and handwritten

MARY GRACE B. GALAGATE MILIBILI, ROXAS CITY, CAPIZ 9328701895 name tag and signature over
printed name

FREDENIL H. CASTRO QUEZON CITY, METRO MANILA (632) 8931-5001 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 administrative/criminal case/s against me.

PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID: PRC Professional Teacher ID

ID/License/Passport No.: 1831623

Signature (Sign inside the box)

Date/Place of Issuance: 01/06/2020+

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