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 PISINGAN
NAME EXTENSION (JR., SR)
FIRST NAME ALLAN
MIDDLE NAME JADJI
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) SEPTEMBER 25, 1981 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS # 207 SAMPAGUITA DRIVE
Widowed Separated House/Block/Lot No. Street
AGUADA
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5'8" ISABELA CITY BASILAN
City/Municipality Province
8. WEIGHT (kg) 80 kg ZIP CODE 7300

18. PERMANENT ADDRESS # 207 SAMPAGUITA DRIVE

9. BLOOD TYPE "O"
House/Block/Lot No. Street
AGUADA
10. GSIS ID NO. 2004820270
Subdivision/Village Barangay
ISABELA CITY BASILAN
11. PAG-IBIG ID NO. 7815572
City/Municipality Province

12. PHILHEALTH NO. 17-000079795-5 ZIP CODE 7300

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 479-903-462 20. MOBILE NO. 09260980519

15. AGENCY EMPLOYEE NO. MBHTE 011403-9067 21. E-MAIL ADDRESS (if any) ajpisingan@tesda.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PISINGAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME SITTI HAIFA MALIA ZAHR N. PISINGAN 05-05-2007
MIDDLE NAME GUIWAN MUH'D ALI GIBREEN G. PISINGAN 12-05-2010
OCCUPATION NURSE II ALLYZZA HYFA G. PISINGAN 07-20-2012
EMPLOYER/BUSINESS NAME DepED-BARMM, BASILAN DIVISION YUSUF ALI UMAR G. PISINGAN 10-01-2021
BUSINESS ADDRESS PEO COMPOUND, ISABELA CITY
TELEPHONE NO. N/A
24. FATHER'S SURNAME PISINGAN
NAME EXTENSION (JR., SR)
FIRST NAME NASSER
MIDDLE NAME AMINUDIN
25. MOTHER'S MAIDEN NAME

SURNAME JADJI
FIRST NAME NURMINA
MIDDLE NAME KHAN (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY MALUSO CENTRAL ELEMENTARY SCHOOL ELEMENTARY 1988 1994 Graduated 1994 Diploma

SECONDARY /
VOCATIONAL MALUSO NATIONAL HIGH SCHOOL HIGH SCHOOL 1995 1996 Graduated 1998 Diploma

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

TRADE
COURSE
COLLEGE BASILAN STATE COLLEGE BACHELOR OF ARTS IN POLITICAL SCIENCE 1998 2007 Graduated 2007 Diploma

COLLEGE NOTRE DAME UNIVERSITY BACHELOR OF LAWS 2007 2009 Under Graduate N/A N/A

MINDANAO AUTONOMOUS COLLEGE MASTER IN PUBLIC ADMINISTRATION -

GRADUATE STUDIES
FOUNDAITON INCORPORATED PLAN B 2009 2011 Graduated 2011 Diploma
(Continue on separate sheet if necessary)

SIGNATURE DATE January 20, 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
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

CAREER SERVICE ELIGIBILITY - PROFESSIONAL 81.08 % 10-15-2005 NOTRE DAME UNIVERSITY - COTABATO CITY

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in full/Do not SALARY
applicable)& STEP
APPOINTMENT
abbreviate) abbreviate) (Format "00-0")/
INCREMENT
From To

CHIEF TRANSPORTIAON REGULATION

02-12-2018 10-30-2019 LTO-BARMM 83,406.00 24 PERMANENT
OFFICER
CONTRACT OF
11-16-2017 01-12-2018 CONSULTANT REGIONAL PORTS MANAGEMENT AUTHORITY 30,000.00
SERVICE
ASSISTANT GENERAL MANAGER FOR
01-01-2017 11-15-2017 REGIONAL PORTS MANAGEMENT AUTHORITY 78,950.00 26 COTERMINOUS
OPERATIONS
ASSISTANT GENERAL MANAGER FOR
08-01-2016 12-31-2016 REGIONAL PORTS MANAGEMENT AUTHORITY 78,960.00 26 COTERMINOUS
OPERATIONS
01-01-2015 06-30-2015 EXECUTIVE ASSISTANT III OFFICE OF THE REGIONAL GOVERNOR 39,768.00 21 COTERMINOUS

11-03-2015 12-31-2015 EXECUTIVE ASSISTANT III OFFICE OF THE REGIONAL GOVERNOR 39,768.00 21 COTERMINOUS

08-01-2012 10-30-2015 DEPUTY SECRETARY GENERAL MINDANAO PEOPLE'S CAUCUS-MCSOPP 45,000.00 CONTRACTUAL

02-01-2012 07-30-2012 GENERAL MANAGER REGIONAL PROTS MANAGEMENT AUTHORITY 58,028.00 27 COTERMINOUS

CONTRACT OF
01-01-2011 03-30-2011 CONSULTANT OFFICE OF THE REGIONAL GOVERNOR 40,000.00
SERVICE

01-01-2008 01-30-2010 EXECUTIVE ASSISTANT REGIONAL LEGISLATIVE ASSEMBLY 36,000.00 20 CONTRACTUAL

CONTRACT OF
01-01-2007 12-31-2007 PART TIME INSTRUCTOR BASILAN STATE COLLEGE 17,000.00
SERVICE

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
 LICENSE (if applicable)

Date of
Validity

nue on separate sheet if necessary)

GOV'T
SERVICE

(Y/ N)

nue on separate sheet if necessary)

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

BANTAY CEASEFIRE-BASILAN 08-02-2002 PRESENT PROVINCIAL CHAIRMAN

KAPATUTAN-BAHRAIN 02-10-2010 PRESENT SECRETARY GENERAL

(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
13th LEADERSHIP AND MANAGEMENT OF CHANGE FOR DEVELOPMENT
MANAGERS 08-14-2017 08-18-2017 50 MANAGERIAL ASIAN INSTITUTE MANAGEMENT

SUPERVISORY DEVELOPMENT COURSE - TRACK III 09-19-2016 09-23-2016 40 SUPERVISORY CSC-BARMM

SUPERVISORY DEVELOPMENT COURSE - TRACK II 11-21-2016 12-25-2016 40 SUPERVISORY CSC-BARMM

SUPERVISORY DEVELOPMENT COURSE - TRACK I 08-15-2016 08-19-2016 40 SUPERVISORY

CSC-BARMM
CAPACITY BUILDING FROM EVIDENCE TO ACTION
PROTECTING THE HUMAN RIGHTS DEFENDERS & FIGHTER 05-25-2014 05-28-2014 48 TECHINCAL TFDF & MAC
UMINITY
WORKSHOP CUM CONSULTATION ON THE RIGHT-BASED APPROACH FOR THE
FORMULATION OF THE NATIONAL HUMAN RIGHTS ACTION PLAN 03-25-2009 03-28-2009 48 TECHINCAL NATIONAL HUMAN RIGHTS COMMISSION

(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 full)
(Write in full)

COMPUTER LITERATE N/A MINDANAO PEOPLE'S CAUCUS

TRANSCRIBING MINDANAO PEOPLE'S MOVEMENT

BANTAY CEASEFIRE

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 20, 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 by any court or
YES ✘ NO
tribunal?
If YES, give details:
________________________________
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from ✘ YES NO
the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private sector? If YES, give details:
________________________________
Phased out (Abolition)
________________________________
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:
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
ATTY. MARY ANN R. ARNARDO Matina, Davao city 3.5 cm. X 4.5 cm
(passport size)

ALVARO SENTURIAS Midsayap, North Cotabato With full and handwritten

name tag and signature over
printed name
MUJIV S. HATAMAN Sumisip, Basilan
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement or photocopied picture
is not acceptable
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. 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: NON-PROFESSIONAL DRIVER'S LICENSE

ID/License/Passport No.: M01-07-001913 Signature (Sign inside the box)

Date/Place of Issuance: Cotabato 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