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 DUMLAO

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

MIDDLE NAME ICBAN

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 09/16/1993 ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH TARLAC CITY, TARLAC If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female Philippines

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS Block 49 Lot 55 N/A
Widowed Separated House/Block/Lot No. Street
N/A CRISTO REY
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.71 m CAPAS TARLAC
City/Municipality Province
8. WEIGHT (kg) 64 kg ZIP CODE 2315

9. BLOOD TYPE "O+"

18. PERMANENT ADDRESS Block 49 Lot 55 N/A
House/Block/Lot No. Street

10. GSIS ID NO. 021-1759-9112-4 N/A CRISTO REY

Subdivision/Village Barangay
CAPAS TARLAC
11. PAG-IBIG ID NO. 121150755819
City/Municipality Province

12. PHILHEALTH NO. 070001509169 ZIP CODE 2315

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

14. TIN NO. 337 975 931 20. MOBILE NO. 0945 726 9956/0961 639 2557

15. AGENCY EMPLOYEE NO. 049 21. E-MAIL ADDRESS (if any) djwenz.dumlao@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)

FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME DUMLAO

NAME EXTENSION (JR., SR)
FIRST NAME JOSELITO
N/A
MIDDLE NAME CASTAÑEDA

25. MOTHER'S MAIDEN NAME

SURNAME ICBAN

FIRST NAME LIEZEL

MIDDLE NAME SANTOS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To
ELEMENTARY LAWY ELEMENTARY SCHOOL ELEMENTARY EDUCATION 2000 2006 N/A 2006 N/A

SECONDARY /
VOCATIONAL CRISTO REY HIGH SCHOOL HIGH SCHOOL 2006 2010 N/A 2010 N/A

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

TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE DOMINICAN COLLEGE OF TARLAC INFORMATION TECHNOLOGY
2011 2015 N/A 2015 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 January 28, 2022

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
SINDALAN HIGH SCHOOL, SINDALAN, CITY
CAREER SERVICE SUBPROFESSIONAL 80.80 10/26/2014 N/A N/A
OF SAN FERNANDO, PAMPANGA

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)
09/01/2021 PRESENT REVENUE COLLECTION CLERK II MUNICIPAL TREASURER'S OFFICE 14,812.00 SG-7 PERMANENT YES

08/01/2017 08/31/2021 REVENUE COLLECTION CLERK I MUNICIPAL TREASURER'S OFFICE 12,606.00 SG-5 PERMANENT YES

01/05/2015 7/31/2017 CLERK MUNICIPAL TREASURER'S OFFICE N/A N/A JOB ORDER YES
 (Continue on separate sheet if necessary)

SIGNATURE DATE January 28, 2022

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
(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

STRATEGIC PERFORMANCE MANAGEMENT SYSTEM WRITESHOP 9/26/2019 9/27/2019 16HRS TECHNICAL CIVIL SERVICE COMMISSION

SEMINAR/WORKSHOP ON TAXATION AND FISCAL ADMINISTRATION IN LOCAL MUNICIPAL TREASURER'S LEAGUE OF TARLAC
GOVERNMENT
9/5/2019 9/9/2019 16HRS TECHNICAL
INC.
ROLL-OUT TRANING ON THE USE OF ELECTRONIC STATEMENT OF RECEIPTS AND BUREAU OF LOCAL GOVERNMENT FINANCE
EXPENDITURES (ESRE) VERSION 3
4/2/2019 4/3/2019 16HRS TECHNICAL
REGION III
TRAINING/WORKSHOP ON EXAMINATION OF BOOKS OF ACCOUNTS FOR BUSINESS MUNICIPAL TREASURER'S LEAGUE OF TARLAC
ESTABLISHMENTS
10/25/2018 10/26/2018 16HRS TECHNICAL
INC.
REFRESHER TRAINING ON BUSINESS PERMIT, LICENSING AND TAX SYSTEM AND
TRAINING ON QUEUING SYSTEM
3/20/2018 3/20/2018 8HRS TECHNICAL TURBEAU SEVEN ENTERPRISES

USER TRAINING ON BUSINESS PERMIT, LICENSING AND TAX SYSTEM TRANSACTION,

REPORT AND SECURITY MODULES
02/02/18 2/2/2018 8HRS TECHNICAL TURBEAU SEVEN ENTERPRISES

USER TRAINING ON BUSINESS PERMIT, LICENSING AND TAX SYSTEM TRANSACTION,

REPORT AND SECURITY MODULES
12/27/17 12/27/2017 8HRS TECHNICAL TURBEAU SEVEN ENTERPRISES

USER TRAINING ON BUSINESS PERMIT, LICENSING AND TAX SYSTEM INSTALLATION,

FILE MAINTENANCE AND POSTING MODULES
12/15/17 12/15/2017 8HRS TECHNICAL TURBEAU SEVEN ENTERPRISES

COACHING AND MENTORING OF LGUS ON BPLS AUTOMATION/COMPUTERIZATION CUM DEPARTMENT OF INTERIOR AND LOCAL
E-EBPLS USERS' TRAINING
12/6/2017 12/8/2017 24HRS TECHNICAL
GOVERNMENT

CUSTOMER RELATIONS MANAGEMENT 8/17/2017 8/18/2017 16HRS TECHNICAL LGU-CAPAS

GENDER AND DEVELOPMENT TRAINING 04/28/2017 N/A 4HRS TECHNICAL LGU-CAPAS, HRMO

SOFTWARE FREEDOM DAY 2013 9/21/2013 N/A 8HRS TECHNICAL SYSTEM PLUS COLLEGE FOUNDATION

(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)

COMPUTER OPERATOR N/A N/A

NETWORKING
COMPUTER PROGRAMMING

(Continue on separate sheet if necessary)

SIGNATURE DATE January 28, 2022

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:

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
CLAIRE JOY SOLIVEN CRISTO REY, CAPAS, TARLAC 9387994431 3.5 cm. X 4.5 cm
(passport size)

EDER N. BASILIO CRISTO REY, CAPAS, TARLAC 09983592919 With full and handwritten
name tag and signature over
printed name

Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and is not acceptable
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: EMPLOYEE ID
ID/License/Passport No.: 049 Signature (Sign inside the box)
 January 28, 2022
Date/Place of Issuance: 10/03/2016 CAPAS, TARLAC Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

HON. REYNALDO L. CATACUTAN, LL.B, DPA.

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4