CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 TABERDO
NAME EXTENSION(JR,SR) N/A
FIRST NAME LEONARD PATRICK
MIDDLE NAME REYES
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) JUNE 28 1999
by birth by naturalization
4. PLACE OF BIRTH TARLAC, TARLAC If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 1216 New York Street

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
Villa Aguila Subdivision Maliwalo
Other/s:
Subdivision/Village Barangay
Tarlac City Tarlac
7. HEIGHT (m) 1.68
City/Municipality Province
8. WEIGHT (kg) 68 ZIP CODE 2300

18. PERMANENT ADDRESS 1216 New York Street

9. BLOOD TYPE O+
House/Block/Lot No. Street
Villa Aguila Subdivision Maliwalo
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Tarlac City Tarlac
11. PAG-IBIG ID NO. 121266080001
City/Municipality Province

12. PHILHEALTH NO. 07-2511537228-9 ZIP CODE 2300

13. SSS NO. 02-44697101 19. TELEPHONE NO. N/A

14. TIN NO. 370-920-715-000 20. MOBILE NO. 09061892537

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) lnrdtdo@[Link]
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)

FIRST NAME N/A

NAME EXTENSION(JR,SR) N/A Jeshua Cristoff Leonico A. Taberdo September 15 2020
MIDDLE NAME N/A N/A N/A
OCCUPATION N/A N/A N/A
EMPLOYER/BUSINESS NAME N/A N/A N/A
BUSINESS ADDRESS N/A N/A N/A
TELEPHONE NO. N/A N/A N/A
24. FATHER'S SURNAME TABERDO N/A N/A
FIRST NAME LEONARDO
NAME EXTENSION(JR,SR) N/A N/A N/A
MIDDLE NAME ICALLA N/A N/A
25. MOTHER'S MAIDEN NAME SUSAN ANTONIO REYES N/A N/A
SURNAME TABERDO N/A N/A
FIRST NAME SUSAN N/A N/A
MIDDLE NAME REYES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Maliwalo Central Elementary School ELEMENTARY 2005 2011 GRADUATED 2011 DIPLOMA

SECONDARY Our Lady of Ransom Catholic School HIGH SCHOOL 2011 2015 GRADUATED 2015 DIPLOMA

VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE

COLLEGE Tarlac State University BS - CRIMINOLOGY 2015 2019 GRADUATED 2019 DIPLOMA

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE September 11, 2022 CS FORM 212 (Revised 2017), Page 1 of 4