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 ROTANO
NAME EXTENSION (JR., SR)
FIRST NAME JENNY ANN
N/A
MIDDLE NAME MARCELO
3. DATE OF BIRTH
1/24/1998 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH TAYUMAN, BINANGONAN RIZAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS BLK5H LOT16 CASTER
Widowed Separated House/Block/Lot No. Street
JADE HEIGHTS VICTORIA HOMES TUNASAN
Other/s:
Subdivision/Village Barangay
MUNTINLUPA NATIONAL CAPITAL REGION
7. HEIGHT (m) 157.48m
City/Municipality Province
8. WEIGHT (kg) 54 ZIP CODE 1773

18. PERMANENT ADDRESS BLK5H LOT16 CASTER

9. BLOOD TYPE O+
House/Block/Lot No. Street
JADE HEIGHTS VICTORIA HOMES TUNASAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MUNTINLUPA NATIONAL CAPITAL REGION
11. PAG-IBIG ID NO. 121266569450
City/Municipality Province

12. PHILHEALTH NO. 01-026574604-2 ZIP CODE 1773

13. SSS NO. 34-9165459-6 19. TELEPHONE NO. N/A
14. TIN NO. 362-965-321-0000 20. MOBILE NO. 09357655436
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) rotanojeane@yahoo.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)
FIRST NAME N/A N/A 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 ROTANO
NAME EXTENSION (JR., SR)
FIRST NAME NARCISO N/A

MIDDLE NAME RENOY

25. MOTHER'S MAIDEN NAME

SURNAME MARCELO

FIRST NAME MYRNA

MIDDLE NAME DE LEON (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY VICTORIA HOMES ELEMENTARY SCHOOL ELEMENTARY 6/5/2004 4/7/2010 N/A 2010 N/A

SECONDARY /
VOCATIONAL MUNTINLUPA NATIONAL HIGH SCHOOL HIGH SCHOOL 6/12/2011 4/7/2015 N/A 2015 RANK 2

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

TRADE
COURSE PAMANTASAN NG LUNGSOD NG BACHELOR OF SCIENCE IN ISKOLAR NG
COLLEGE 8/12/2015 6/21/2019 N/A 2019
MUNTINLUPA CRIMINOLOGY BAYAN

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
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
NOV. 29,30 -
RA 6506 78.95 PERPETUAL HELP DALTA LAS PIÑAS 0201668 1/24/2023
DEC. 1 2019

** NOTHING FOLLOWS **

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

11/22/2021 PRESENT CORRECTIONS OFFICER 1 BUREAU OF CORRECTIONS ₱29,668.00 11 PERMANENT Y

2/19/2020 1/5/2021 SAFETY OFFICER FAST SERVICES CORPORATION ₱18,000.00 N/A REGULAR N

CONTRACTU
7/4/2020 12/27/2019 FIELD ENUMERATOR DOLE MTPL FIELD OFFICE ₱12,000.00 N/A Y
AL

** NOTHING FOLLOWS **
 (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

N/A

** NOTHING FOLLOWS **

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

BASIC OCCUPATIONAL SAFETY AND HEALTH 3/10/2020 03/13/2020 40 HRS. N/A FAST SERVICES CORPORATION

ON-THE JOB TRAINING MUNTINLUPA TRAFFIC MANAGEMENT BUREAU FEB. 2019 APRIL 2019 270 HRS. N/A PAMANTASAN NG LUNGSOD NG
MUTINLUPA
ON-THE JOB TRAINING BUREAU OF JAIL MANAGEMENT AND PAMANTASAN NG LUNGSOD NG
OCT. 2018 DEC. 2018 270 HRS. N/A
PENOLOGY MUTINLUPA

** NOTHING FOLLOWS **

(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)
PROFESSIONAL CRIMINOLOGIST ASSOCIATION OF THE
BASIC COMPUTER LITERACY N/A PHILIPPINES

VOLLEY BALL

DRIVING

SINGING

(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? Y
Y
✘

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

If YES,ESgive details:
________________________________
N/A
SY
________________________________
a. Have you ever been found guilty of any administrative offense?
35. ✘ N
If YES,Egive details:
O
________________________________
N/A
S
________________________________
b. Have you been criminally charged before any court?
Y ✘ N
If YES,Egive details:
N/AO
________________________________
Date Filed:
S
________________________________
Status of Case/s: N/A

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation Y ✘ N
by any court or tribunal?
If YES,Egive details:
O
________________________________
N/A
S
________________________________
Have you ever been separated from the service in any of the following modes: resignation, Y
37.
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased
✘
If YES,Egive details:
N
out (abolition) in the public or private sector? FINISHED CONTRACT,
________________________________ORESIGNED
a. Have you ever been a candidate in a national or local election held within the last year (except SY
________________________________
38.
Barangay election)?
✘ N
E give details: N/A
If YES,
Y O
b. Have you resigned from the government service during the three (3)-month period before the last S ✘ N
election to promote/actively campaign for a national or local candidate? Egive details: N/A
If YES,
Y O
39. Have you acquired the status of an immigrant or permanent resident of another country? S ✘ N
If YES,E give details (country):
N/A O
S
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? Y ✘ N N/A
E
If YES, please specify:
Y
b. Are you a person with disability? O
N
S ✘
E specify ID No:
If YES, please N/A
c. Are you a solo parent? Y O
S specify ID No:✘ N N/A
E
If YES, please
O
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) S
NAME ADDRESS TEL. NO. ID picture taken within
the last 6 months
4.5 cm. X 3.5 cm
CO1 DAN JAYDEN RAGAY POBLACION MUNTINLUPA CITY 9168471623 (passport size)

JO1 ABBEY JACOBE BICUTAN TAGUIG CITY 9958257928 Computer generated

or photocopied picture
is not acceptable
MNGR. KEVIN MANIKAN SAN PEDRO CITY 9277968329
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.

42.

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

ID/License/Passport No.: 0201668

Signature (Sign inside the box)
02/16/20222
Date/Place of Issuance: PRC (PICC PASAY)
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