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 GARCIA
NAME EXTENSION (JR., SR)
FIRST NAME JOEY
MIDDLE NAME CASTILLO N/A
3. DATE OF BIRTH
(mm/dd/yyyy) 11/27/1980 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH ARAYAT, PAMPANGA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS #260 ACACIA ST.
Widowed Separated House/Block/Lot No. Street

Other/s: N/A DULAG

Subdivision/Village Barangay

7. HEIGHT (m) 1.60 M. LINGAYEN PANGASINAN

City/Municipality Province
8. WEIGHT (kg) 72 KG. ZIP CODE 2401
9. BLOOD TYPE B+ 18. PERMANENT ADDRESS #260 ACACIA ST.
House/Block/Lot No. Street

10. GSIS ID NO. N/A N/A DULAG

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-9053-9188 LINGAYEN PANGASINAN

City/Municipality Province

12. PHILHEALTH NO. 190265695519 ZIP CODE 2401

13. SSS NO. 33-8243726-2 19. TELEPHONE NO. N/A
14. TIN NO. 500-930-359-000 20. MOBILE NO. 09212965173
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) joechelle0128@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME GARCIA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME RICHELLE JOHN ALDRIN BAÑEZ GARCIA 02/20/2018
MIDDLE NAME BAÑEZ
OCCUPATION ADMINISTRATIVE AIDE IV
EMPLOYER/BUSINESS NAME LOCAL GOVERNMENT UNIT-LINGAYEN
BUSINESS ADDRESS POBLACION, LINGAYEN, PANGASINAN
TELEPHONE NO. N/A
24. FATHER'S SURNAME GARCIA
NAME EXTENSION (JR., SR)
FIRST NAME GILBERTO
MIDDLE NAME TOLENTINO
25. MOTHER'S MAIDEN NAME

SURNAME CASTILLO
FIRST NAME TITA
MIDDLE NAME CANILANG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY DULAG ELEMENTARY SCHOOL ELEMENTARY 1987 1993 GRADUATED 1993 N/A

SECONDARY
VOCATIONAL / DULAG NATIONAL HIGH SCHOOL HIGH SCHOOL 2003 2007 GRADUATED 1997 N/A

FIL-TRADE INCORPORATION , MAKATI

CITY, PHILIPPINES TRADE TEST 2005 2005 N/A N/A
TRADE
COURSE
COLLEGE N/A N/A N/A N/A N/A N/A 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 February 8, 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
LAND TRANSPORTATION OFFICE-
PROFESSIONAL DRIVER'S LICENSE N/A N/A A09-16-001666 2023
LINGAYEN, PANGASINAN

(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)
COSTSAVER'S SUPERMARKET
7/3/2017 PRESENT PLUMBER INCORPORATION
P12,000.00 N/A CONTRACTUAL N
PARKWAY CORPORATE CENTER,
6/1/2015 5/31/2017 LEADMAN, SANITARY PLUMBER ALABANG MUNTINLUPA
P 15,000.00 N/A CONTRACTUAL N
PLUMBER AND ELECTRICAL EMSCO GENERAL CONTRACTING ,
6/21/2005 10/23/2014 CONSTRUCTION JEDDAH, SAUDI ARABIA
P 20,000.00 N/A CONTRACTUAL N
RICHARD TAN CONSTRUCTION BUILDING
3/3/2003 4/29/2005 PLUMBER COMPANY, MAKATI CITY
P 10,000.00 N/A CONTRACTUAL N
FM GARCIA ENGINEERING,
1/8/1998 1/31/2003 PLUMBER QUEZON CITY
P 8,000.00 N/A CONTRACTUAL N
 (Continue on separate sheet if necessary)

SIGNATURE DATE February 08, 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

(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
FIL-TRADE INCORPORATION , MAKATI CITY,
TRADE TEST AND TRAINING FIRM 6/7/2005 6/7/2005 8 HOURS TECHNICAL
PHILIPPINES

(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)

TECHNICAL SKILLS N/A N/A

PIPING FOR PLUMBING

WIRING FOR ELECTRICAL AND BUILDING
MAINTENANCE
DRIVING

(Continue on separate sheet if necessary)

SIGNATURE DATE February 08, 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
DULAG, the last 6 months
MR. FERNANDO S. PARAGAS 0995-522-0164 3.5 cm. X 4.5 cm
LINGAYEN, PANGASINAN (passport size)

With full and handwritten

name tag and signature over
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
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: TIN: 500-930-359-000
ID/License/Passport No.: UMID CRN-0111-5615599-2
ID/License/Passport No.: UMID CRN-0111-5615599-2 Signature (Sign inside the box)
September 01, 2022
Date/Place of Issuance: LINGAYEN, PANGASINAN Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 8th day of February, 2022 , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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