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CS Form No. 212 Personal Data Sheet PDS
CS Form No. 212 Personal Data Sheet PDS
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME Dudo
NAME EXTENSION (JR., SR)
FIRST NAME Arjay
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) trojan4avast2@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
COLLEGE Sultan Kudarat State University Bachelor of Science in Information Technology 2021
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
CAREER SERVICE PROFESSIONAL ELIBILITY 83.0 3/12/2017 BATAAN NATIONAL HIGH SCHOOL - BALANGA, BATAAN N/A
DRIVER'S LICENSE N/A 1/24/2017 LAND TRANSPORTATION OFFICE - PILAR, BATAAN C02-17-001499 9/14/2021
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
MADARIS VOLUNTEER PROGRAM - CEAP, NABEI & BARMM - Ateneo De Davao
05/14/2019 6/4/2020 7920.0 Volunteer Teacher
University, Davao City, Mindanao
LIGAYA SA PASKO: A BEDAN CHRISTMAS GIFT GIVING (2018) San Beda Law Student
12/21/2019 12/22/2019 16.0 Volunteer Teacher
Government (LSG) - Mendiola, Manila
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 by any court or
tribunal? YES ✘ NO
If YES, give details:
________________________________
________________________________
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 out (abolition) in the public or private sector? YES NO
If YES, give details:
________________________________
(1) Resignation in Office of the Vice-Governor ;
________________________________
(2) Finished Contract in Philippines Army
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)? YES ✘ NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last election to YES ✘ NO
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:
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.) DIANA M. VELASCO
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID:
ID/License/Passport No.:
Signature (Sign inside the box)
Date/Place of Issuance:
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.