CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 TIRONES
NAME EXTENSION (JR., SR)
FIRST NAME FAITH

MIDDLE NAME AFRICA

3. DATE OF BIRTH
(mm/dd/yyyy)
11/20/1959 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH SAN PABLO 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 280 NARRA ST. PLATON
Widowed Separated
BRGY. III-C
Other/s:
SAN PABLO CITY LAGUNA
7. HEIGHT (m) 163CM

8. WEIGHT (kg) 70KGS. ZIP CODE 4000

9. BLOOD TYPE "O"

18. PERMANENT ADDRESS 280 NARRA ST. PLATON
House/Block/Lot No.

10. GSIS ID NO. B5XLFAT017 BRGY. III-C

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1470-0046-990 SAN PABLO CITY LAGUNA

City/Municipality Province

12. PHILHEALTH NO. 08-00000-9831-4 ZIP CODE 4000

13. SSS NO. 19. TELEPHONE NO. 530 7685

14. TIN NO. 126-023-623 20. MOBILE NO. 09279274121

15. AGENCY EMPLOYEE NO. 0667 21. E-MAIL ADDRESS (if any) africa fat@yahoo.com.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TIRONES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) GERALD A. TIRONES
FIRST NAME EMILIO 4/6/1990

MIDDLE NAME ILAGAN JEFFERSON A. TIRONES 9/2/1991

OCCUPATION GOVERNMENT EMPLOYEE MARIA CRISTINA A. TIRONES 04/27/93

EMPLOYER/BUSINESS NAME CITY MAYOR'S OFFICE

BUSINESS ADDRESS CITY HALL,SAN PABLO CITY

TELEPHONE NO. 5612322

24. FATHER'S SURNAME AFRICA

FIRST NAME AMANDO

MIDDLE NAME MALABANAN

25. MOTHER'S MAIDEN NAME BUISER

SURNAME AFRICA

FIRST NAME ESTELITA

MIDDLE NAME BUISER (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 CANOSSA COLLEGE ELEMENTARY 1967 1972 1972

SECONDARY
VOCATIONAL / CANOSSA COLLEGE SECONDARY 1972 1976 1976

TRADE
COLLEGE OF THE HOLY SPIRIT,MANILAPHILIPPINES WOMEN'S
COURSE
COLLEGE UNIVERSITY MANILA
BACHELOR OF SCIENCE IN FOOD AND NUTRITION 1976 1981 1981

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE September 3, 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

SUB PROFESSIONAL 80.8 1980 BATANGAS CITY

PROFESSIONAL 80.0 10/17/1993 STA.CRUZ,LAGUNA

(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)

1/1/2021 up topresent NUTRTION OFFICER IV CITY POPULATION OFFICE 77801.00 PERMANENT YES

1/1/2020 12/31/2020 NUTRTION OFFICER IV CITY POPULATION OFFICE 75079.00 PERMANENT YES

1/1/2019 12/31/2019 NUTRTION OFFICER IV CITY POPULATION OFFICE 73531.00 PERMANENT YES

12/31/2016 12/31/2019 NUTRTION OFFICER IV CITY POPULATION OFFICE 47747.50 PERMANENT YES

2/11/2014 12/31/2016 NUTRTION OFFICER IV CITY POPULATION OFFICE 47747.50 PERMANENT YES

1/5/2014 1/11/2014 NUTRTION OFFICER IV CITY POPULATION OFFICE 47747.50 PERMANENT YES

1/1/2013 4/30/2014 NUTRTION OFFICER IV CITY POPULATION OFFICE 44560.00 PERMANENT YES

1/1/2012 12/31/2012 NUTRTION OFFICER IV CITY POPULATION OFFICE 39327.00 PERMANENT YES

1/1/2011 12/31/2011 NUTRTION OFFICER IV CITY POPULATION OFFICE 34580.00 PERMANENT YES

1/1/2010 12/31/2010 NUTRTION OFFICER IV CITY POPULATION OFFICE 29832.00 PERMANENT YES

1/7/2008 12/31/2009 NUTRTION OFFICER IV CITY POPULATION OFFICE 24473.00 PERMANENT YES

1/1/2007 6/30/2008 NUTRTION OFFICER IV CITY POPULATION OFFICE 22248.00 PERMANENT YES

1/1/2007 6/30/2007 NUTRTION OFFICER IV CITY POPULATION OFFICE 20225.00 PERMANENT YES

1/1/2004 12/31/2006 NUTRTION OFFICER IV CITY POPULATION OFFICE 19732.00 PERMANENT YES

1/7/2001 2/31/2003 NUTRTION OFFICER IV CITY POPULATION OFFICE 19251.00 PERMANENT YES

1/1/2000 6/30/2001 NUTRTION OFFICER IV CITY POPULATION OFFICE 18334.00 PERMANENT YES

1/11/1997 12/31/2009 NUTRTION OFFICER IV CITY POPULATION OFFICE 16667.00 PERMANENT YES

1/1/1997 10/31/1997 NUTRTION OFFICER IV CITY POPULATION OFFICE 14316.00 PERMANENT YES

1/1/1996 12/31/1996 NUTRTION OFFICER IV CITY POPULATION OFFICE 11965.00 PERMANENT YES

02/021995 12/31/1995 NUTRTION OFFICER IV CITY POPULATION OFFICE 9950.00 PERMANENT YES

2/2/1995 NUTRTION OFFICER IV CITY POPULATION OFFICE 8950.00 PERMANENT YES

1/1/1995 1/2/1995 NUTRITIONIST III CITY POPULATION OFFICE 7370.00 PERMANENT YES

1/1/1994 12/31/1994 NUTRITIONIST III CITY POPULATION OFFICE 6370.00 PERMANENT YES

1/7/1991 12/31/1993 NUTRITIONIST III CITY POPULATION OFFICE 5570.00 PERMANENT YES

1/7/1989 6/30/1991 NUTRITIONIST III CITY POPULATION OFFICE 53887.00 PERMANENT YES

06/16/1989 6/30/1989 SUPVG.NUTRITION OFF.IV CITY MAYOR'S OFFICE 25116.00 PERMANENT YES

1/1/1989 06/15/1989 SUPVG.NUTRITION OFF.IV CITY MAYOR'S OFFICE 25116.00 PERMANENT YES

06/16/88 12/31/1988 SUPVG.NUTRITION OFF.IV CITY MAYOR'S OFFICE 22728.00

ntinue on separate sheet if necessary)

SIGNATURE DATE
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

PHILIPPINES ASSOCIATION OF NUTRTIONIST-DIETITIAN 11/1/2000 PRESENT NUTRITIONIST

CITY NUTRITION ACTION OFFICER Jan-95 PRESENT NUTRITIONIST

(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

(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)

BADMINTON DOUBLE WOMENS DIVISION N/A

DRIVING

(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:
________________________________

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
MRS.ISABEL TICZON SAN PABLO CITY 3.5 cm. X 4.5 cm
(passport size)

DRA.VIOLY PANALIGAN SAN PABLO CITY With full and handwritten

name tag and signature over
printed name
ATTY.RESTITUTO ME4NDOZA SAN PABLO CITY
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
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: GOVERNMENT ID

ID/License/Passport No.: 0667

Signature (Sign inside the box)

Date/Place of Issuance: SAN PABLO CITY

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