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 SOLAIMAN
NAME EXTENSION (JR, SR) N/A
FIRST NAME SHAILAH-SHALYMAR

MIDDLE NAME BALAYMAN

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 10/18/1997 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH COTABATO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS # 020 Prk. Tulungan II

6 CIVIL STATUS
House/Block/Lot No. Street
Widowed Separated
Dorotheo Compound Rosary Heights 4
Other/s:
Subdivision/Village Barangay
Cotabato City Maguindanao
7. HEIGHT (m) 1.60 m
City/Municipality Province
8. WEIGHT (kg) 60 kg ZIP CODE 9600
18. PERMANENT ADDRESS # 020 Prk. Tulungan II
9. BLOOD TYPE O
House/Block/Lot No. Street
Dorotheo Compound Rosary Heights 4
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Cotabato City Maguindanao
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 20-251396193-8 ZIP CODE 9600

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09365711950

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) shailahsolaiman1018@gmail.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) N/A N/A
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME SOLAIMAN

NAME EXTENSION (JR., SR) N/A
FIRST NAME OMARKHALIF

MIDDLE NAME PIANG

25. MOTHER'S MAIDEN NAME

SURNAME BALAYMAN

FIRST NAME WAHJANABIA

MIDDLE NAME KAMENZA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SERO CENTRAL SCHOOL ELEMENTARY 2009 2010 GRADUATED 2010 N/A

SECONDARY /
VOCATIONAL NOTRE DAME OF COTABATO HIGHSCHOOL 2013 2014 GRADUATED 2014 N/A

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

TRADE
COURSE
COLLEGE NOTRE DAME OF TACURONG COLLEGE BACHELOR OF SCIENCE IN SOCIAL WORK 2018 2019 GRADUATED 2019 N/A

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

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

BOARD OF SOCIAL WORKER AUG. 24,25,26, 2021 NDMU-KORONADAL CITY 0034847 10/22/2021

(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. SALARY/ JOB/ PAY SERVICE
INCLUSIVE DATES (mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
POSITION TITLE MONTHLY STATUS OF
(Write in full/Do not SALARY
applicable)& STEP
APPOINTMENT
(Write in full/Do not abbreviate) (Format "00-0")/
abbreviate) INCREMENT
From To
(Y/ N)

7/1/2020 up to present ADMINISTRATIVE AIDE 1 OFFICE OF PROVINCIAL ADMINISTRATOR 9900.00 N/A Y

5/30/2020 9/30/2020 VOLUNTEER OFFICE OF PROVINCIAL ADMINISTRATOR 5000.00 N/A N/A Y

2/10/2020 5/22/2020 OFFICE CLERK KAWAGIB MANPOWER INC. 5000.00 N/A N/A N

DEPARTMENT OF SOCIAL WELFARE AND

12/2/2019 2/3/2020 N/A N/A N/A Y
ENUMERATOR OF LISTAHANAN 3 DEVELOPMENT
4/4/2018 5/11/2018 ON JOB TRAINEE TOMBOC-SALAYOG HOSPITAL N/A N/A N/A N/A
OFFICE OF THE SOCIAL WELFARE AND
6/6/2018 10/10/2018 ON JOB TRAINEE N/A N/A N/A N/A
DEVELOPMENT
BARANGGAY HALL OF SAN PABLO,
11/23/2018 03/12/2019 ON JOB TRAINEE N/A N/A N/A N/A
TACURONG CITY, SULTAN KUDARAT

(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
(mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
(Write in full)
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
(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

Seminar on Disaster Risk Reduction Management Orientation 10/6/2018 10/6/2018 8 HOURS TECHNICAL NOTRE DAME OF TACURONG COLLEGE

Seminar on Premarital Sex and Teenage Pregnancy 10/7/2018 10/7/2018 8 HOURS TECHNICAL NOTRE DAME OF TACURONG COLLEGE

Seminar on Sexual Orientation and Gender Identity 09/23/2018 09/23/2018 8 HOURS TECHNICAL NOTRE DAME OF TACURONG COLLEGE

Seminar on Anti-Bullying Act of 2013 known as R.A 10627 09/23/2018 09/23/2018 8 HOURS TECHNICAL NOTRE DAME OF TACURONG COLLEGE

Symposium on the Effects of Pre-Marital Sex 07/26/2017 07/26/2017 8 HOURS TECHNICAL NOTRE DAME OF TACURONG COLLEGE

TRAINING OF ENUMERATORS FOR THE 3RD ROUND NATIONWIDE HOUSEHOLD DEPARTMENT OF SOCIAL WELFARE AND
4/11/2019 8/11/2019 40 HOURS TECHNICAL
ASSESSMENT DEVELOPMENT FIELD OFFICE XII

(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)
JUNIOR OF SOCIAL WORK ASSOCIATION OF THE
COMPUTER LITERATE N/A PHILIPPINES(JSWAP)

KNOWLEDGEABLE IN WRITING
LETTERS,PROPOSALS PAPERS
N/A MUSLIM STUDENT ORGANIZATION(MSO)

CAN RELATE TO DIFFERENT TYPES OF COMMUNITY

WORKS
N/A N/A

ENCODING 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? YES ✘ NO

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
If YES, give details:
________________________________
YES ✘ NO

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
YES ✘ NO

b. Have you been criminally charged before any court?

If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
YES ✘ NO

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:
________________________________
YES NO
________________________________
✘

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? ________________________________
YES ✘ NO
________________________________

38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES If YES, give details:
✘ NO

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? YES If YES, give details:
✘ NO

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 ✘ YES ✘ NO
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?
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
Ms. Eufemia L. Robles, DSD CITY SOCIAL WELFARE AND DEVELOPMENT OFFICE
9106701938 3.5 cm. X 4.5 cm
(passport size)
Mrs. Kathy Mae R. Catalan, RSW CITY SOCIAL WELFARE AND DEVELOPMENT OFFICE
9265058161
With full and handwritten
Mr. Sinforiano L. Pelongo Jr., RSW NOTRE DAME OF TACURONG COLLEGE
9171108769 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 Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. is not acceptable
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: Philhealth ID

ID/License/Passport No.: 20-251396193-8

Signature (Sign inside the box)

Date/Place of Issuance: 06/27/2019- PRO-ARMM LHIO-BULUAN

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