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 SEDIGO
NAME EXTENSION (JR., SR)
FIRST NAME DAVE

MIDDLE NAME ACEDO N/A

3. DATE OF BIRTH
(mm/dd/yyyy) 10/20/1996 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BRGY. CAMBUILAO, BAIS CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS PROPER N/A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
N/A CAMBUILAO
Other/s:
Subdivision/Village Barangay
BAIS CITY NEGROS ORIENTAL
7. HEIGHT (m) 1.70m
City/Municipality Province
8. WEIGHT (kg) 80kg ZIP CODE 6206
18. PERMANENT ADDRESS PROPER N/A
9. BLOOD TYPE O+
House/Block/Lot No. Street
N/A CAMBUILAO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BAIS CITY NEGROS ORIENTAL
11. PAG-IBIG ID NO. 121288562990
City/Municipality Province
12. PHILHEALTH NO. 12-25995150-5 ZIP CODE 6206
13. SSS NO. 35-1080348-0 19. TELEPHONE NO. 035-541-0507
14. TIN NO. N/A 20. MOBILE NO. 09559329914
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) davesedigo@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 SEDIGO

NAME EXTENSION (JR., SR)
FIRST NAME EXPEDITO

MIDDLE NAME SEDILES

25. MOTHER'S MAIDEN NAME

SURNAME ACEDO

FIRST NAME NENITA

MIDDLE NAME BERGES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BAIS CITY PILOT SCHOOL PRIMARY EDUCATION 2003 2009 GRADE 6 2009

BAIS CITY NATIONAL HIGH

SECONDARY SECONDARY EDUCATION 2009 2013 4TH YEAR 2013
SCHOOL
VOCATIONAL /
N/A N/A
TRADE COURSE DOST 2019 JLSS (Junior
NEGROS ORIENTAL STATE BACHELOR OF SCIENCE IN Level Science Scholarship)
COLLEGE 2017 2021 4TH YEAR 2021
UNIVERSITY INFORMATION TECHNOLOGY

GRADUATE STUDIES N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE February 22, 2022

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Date of
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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To (Y/ N)

Negros Oriental State University Bais P25 per Part Time /

2019 2020 University Encoder
Campus Hour FINISHED

(Continue on separate sheet if necessary)

SIGNATURE DATE February 22, 2022

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (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
(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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

Computer Photoshop Seminar/ Basic

10/25/2019 10/25/2019 4hrs N/A Negros Oriental State University Bais Campus
Computer Photoshopt Concept

Department of Information and Comunications

The Art of Data Storytelling in Tableau 2/26/2021 2/26/2021 4hrs N/A
Technology (Luzon Cluster 3 Cataduanes)

Kamalayan Progressive Webinar Series

with the theme Face - to - Face classes with Commission of Higher Education Regional Office
06/23/2021 06/23/2021 4hrs N/A
COVID - 19 Vaccination: New Normal and VII (Negros Oriental)
Beyond

Department of Interior Local Government

Sangguniang Kabtaan Mandatory Training 10/5/2019 10/5/2019 4hrs N/A
(Bais City)

Department of Science and Technology

Practical Training Program 7/1/2019 8/28/2019 240hrs N/A
(Region VII, Negros Oriental

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in full)

Computer Literacy in MSWord, MSExcel, MS

N/A N/A
Power Point

Computer Encoder N/A N/A

Basic Photoshop Editing N/A N/A

Computer Troubleshooting/Freelance/Home
N/A N/A
Service

(Continue on separate sheet if necessary)

SIGNATURE DATE February 22, 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
YES ✘ NO
regulation 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 If YES, give details:
phased 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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
a.
items:
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
SERGIO A. SILVA BRGY. CAMBUILAO, BAIS CITY 0975 175 6620
3.5 cm. X 4.5 cm
NEGROS ORIENTAL STATE (passport size)
DR. ZENAIDA CALUMPANG UNIVERSITY (BAIS CAMPUS) With full and handwritten
name tag and signature over
NEGROS ORIENTAL STATE
DR. RECTO REYES UNIVERSITY (BAIS CAMPUS)
printed name

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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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 PHOTO
filing of 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: Driver's Licence

ID/License/Passport No.: G08 - 18 - 000201

Signature (Sign inside the box)
10/20/2017 /
Date/Place of Issuance:
Land Transportation Office (Bais 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