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 GARCIA
NAME EXTENSION (JR., SR)
FIRST NAME ANDEW NICOLE

MIDDLE NAME SAMARETA

3. DATE OF BIRTH
06/27/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH CALOOCAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS BLK.43 LOT 16 ALAKAAK ST.

Widowed House/Block/Lot No. Street

Separate
BRGY. NBBS KAUNLARAN
Other/s: d
Subdivision/Village Barangay
NAVOTAS CITY NCR
7. HEIGHT (m) 1.7272 meters
City/Municipality Province
8. WEIGHT (kg) 80 kg ZIP CODE

18. PERMANENT ADDRESS BLK.43 LOT 16 ALAKAAK ST.

9. BLOOD TYPE O
House/Block/Lot No. Street
BRGY. NBBS KAUNLARAN
10. GSIS ID NO.
Subdivision/Village Barangay
NAVOTAS CITY NCR
11. PAG-IBIG ID NO. 121286619515
City/Municipality Province

12. PHILHEALTH NO. 022502368439 ZIP CODE 1409

13. SSS NO. 34-7621327-9 19. TELEPHONE NO.

14. TIN NO. 381-235-649 20. MOBILE NO. 09163668317

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) ansg08@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME GARCIA

NAME EXTENSION (JR., SR)
FIRST NAME PALERMO

MIDDLE NAME FABRIGAS

25. MOTHER'S MAIDEN NAME

SURNAME SAMARETA

FIRST NAME JOSEFINA

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

ELEMENTARY KAPITBAHAYAN ELEMENTARY SCHOOL 1/6/2001 03/30/2007

SECONDARY /
VOCATIONAL LAKAN DULA HIGH SCHOOL 1/6/2007 03/30/2011

FEATI UNIVERSITY BS IN INFORMATION TECHNOLOGY 1/6/2011 03/30/2014 105 units

TRADE
COURSE LYCEUM OF THE PHILIPPINES UNIVERSITY BS IN INTERNATIONAL TRAVEL AND TOURISM
COLLEGE
MANILA. MANAGEMENT
1/6/2014 06/24/2019 July,2019

GRADUATE STUDIES

(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

(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)

10/8/2021 11/26/2021 Customer Service Representative Teleperformance Philippines Contractual N

3/1/2021 07/30/2021 Freelance Computer/Laptop Technician Self-Employed N

Department of Interior and Local Government-
1/10/2020 12/31/2021 DILG Contact tracer SG 9 Contractual Y
NCR
2/7/2018 12/2/2020 Brgy. Computer Programmer DILG Barangay NBBS Kaunlaran Contractual Y

2/3/2019 06/15/2019 Reservation Officer / IT Support RMLC Travel & Tours OJT N

01/14/2019 02/27/2019 Food and Beverage Waiter Barbarras Heritage Restaurant, Intramuros OJT N

3/4/2015 12/30/2019 Gym Instructor Jun's Fitness Gym Part Time N

07/15/2013 12/14/2013 Computer shop Attendant Nikki's Internet Café Part Time N

1/7/2011 02/30/2013 Service Crew Rita's Native Food Restaurant Part Time N

(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

(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

Digital and Photography Workshop 09/06/2011 09/06/2011 Philippine Society of I.T. Educators (PSITE)

FEATI UNIVERSITY COLLEGE OF ARTS

Katibayan ng Pakikilahok 08/16/2012 08/16/2012
,SCIENCE AND EDUCATION

Shangri-la Makati Hotel Familiarization Tour and Seminar. 09/06/2014 09/06/2014 Edsa Shangri-la, Manila

Amadeus e-Learning - Reservation Essentials 09/24/2015 09/25/2015 LPU Manila

Amadeus e-Learning - Ticketing Essentials 03/03/2017 03/03/2017 LPU Manila

American Hospitality Academy Professional Development Certificate 03/27/2017 03/27/2017 LPU Manila

TESDA NC II Tourism Promotions 12/01/2017 12/01/2017 LPU Manila TESDA Center

TESDA NC III Events Management 04/03/2017 04/03/2017 LPU Manila TESDA Center

TESDA NC II Food and Beverage Services 04/03/2017 08/07/2019 LPU Manila TESDA Center

Drinking Notes : The Art of Coffe and Cocktail Seminar 03/18/2017 03/18/2017 LPU Manila

SHAPING THE STUDENTS' FUTURE BEYOND THE 4TH INDUSTRIAL 04/10/2019 04/10/2019 LPU Manila

Basic Life Support & Standard First Aid Training for Joint Rescue Team (JRT)
09/16/2018 09/17/2018 NAVOTAS CITY DRRMO
Volunteers

Capacity Buiding of GFPS and Setting the GAD Agenda 11/17/2018 11/19/2018 DILG City Government of Navotas

Orientation / Seminar on Anti-Drug Abuse (R.A. 9165) Comprehensive Act of

2002 and BCPC Training & Symposium
12/07/2018 12/07/2018 DILG City Government of Navotas

GENDER SENSITIVITY TRAINING 07/18/2019 07/19/2019 DILG City Government of Navotas

GENDER AND DEVELOPMENT BUDGETING AND PLANNING SEMINAR 07/19/2019 07/20/2019 DILG City Government of Navotas

PWD LEADERSHIP AND BASIC SIGN LANGUAGE TRAINING 09/11/2019 09/13/2019 Person with Disability Affairs Office Navotas

Doulos for Christ World Harvest Ministry

Certificate of Completion in the Christian "Encounter Weekend" 01/24/2020 01/26/2020
Navotas

(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)

Computer / Laptop Technician Member/ Contributor Computer Technicians in the Philippines

Computer / Laptop Technician Member/ Contributor Philippine Technicians Group

Powerlifiting Member/ Conpetitor Powerlifting Association of the Philippines

(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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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
YES ✘ 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, 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? ________________________________
________________________________
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
Cristel G. Ygoña San Roque, Navotas City 9084595440 4.5 cm. X 3.5 cm
(passport size)

Ahllan Christoffer Caragdag Brgy. NBBS Kaunlaran, Navotas City 9776215889

Computer generated
or photocopied picture
Jun Rogelio Aniban Brgy. NBBS Kaunlaran, Navotas City 9277101186 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: Passport
ID/License/Passport No.: P4810405B
Signature (Sign inside the box)

Date/Place of Issuance: FEB 14, 2020 - DFA NCR WEST

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