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 ZAMORA
NAME EXTENSION (JR., SR)
FIRST NAME JOVITO

MIDDLE NAME DESOACIDO

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 08/24/1984 ✘

4. PLACE OF BIRTH BACOLOD, NEGROS OCCIDENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘

6 CIVIL STATUS
✘ 17. RESIDENTIAL ADDRESS BLOCK 36 LOT 22
House/Block/Lot No. Street
CUIDAD FELISA BRGY. FELISA
Subdivision/Village Barangay
7. HEIGHT (m) 1.64 BACOLOD NEGROS OCCIDENTAL
City/Municipality Province
8. WEIGHT (kg) 72 ZIP CODE 6100

9. BLOOD TYPE O+
18. PERMANENT ADDRESS BLOCK 36 LOT 22
House/Block/Lot No. Street

10. GSIS ID NO. 2004456043 CUIDAD FELISA BRGY. FELISA

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-1706-8099 BACOLOD NEGROS OCCIDENTAL

City/Municipality Province

12. PHILHEALTH NO. 08-050705496-3 ZIP CODE 6100

13. SSS NO. 07-2615621-2 19. TELEPHONE NO. N/A

14. TIN NO. 243-272-938 20. MOBILE NO. 09235202968

15. AGENCY EMPLOYEE NO. 000-088-079-000 21. E-MAIL ADDRESS (if any) jovitozamora9@gmail.com

II. FAMILY BACKGROUND

DATE OF BIRTH
22. SPOUSE'S SURNAME ZAMORA 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME APRIL RENA JOVENS REUBEN VALENZUELA ZAMORA 12/13/2018
MIDDLE NAME VALENZUELA
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME ZAMORA
NAME EXTENSION (JR., SR)
FIRST NAME HERNANE

MIDDLE NAME LAZANAS

25. MOTHER'S MAIDEN NAME

SURNAME DESOACIDO

FIRST NAME ANECITA

MIDDLE NAME BACULI (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
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY PINAMANTAWAN ELEMENTARY SCHOOL PRIMARY EDUCATON 1991 1997 GRADUATED 1997 N/A
VOCATIONAL /
SECONDARY QUEZON NATIONAL HIGH SCHOOL HIGH SCHOOL 1997 2001 GRADUATED 2001 N/A

N/A
TRADE CARLOS HILADO MEMORIAL STATE
COURSE BS IN INDUSTRIAL TECHNOLOGY 2001 2005 GRADUATED 2005 N/A
COLLEGE
COLLEGE
BACHELOR OF SCIENCE IN
UNIVERSITY OF ILOILO 2014 2015 GRADUATED 2015 N/A
CRIMINOLOGY
GRADUATE STUDIES N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 10, 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

RA 6506 (REGISTERED CRIMINOLOGIST) 80.80% 10/14/2015 ILOILO CITY 0130083 08/24/2024

CAREER SERVICE PROFESSIONAL 80.62% 10/21/2012 BACOLOD CITY N/A N/A

(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 MONTHLY SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) SALARY STATUS OF
(Write in full/Do not (Write in (Effective 3rd
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) Tranche 2011) INCREMENT
From To (Y/ N)

12/13/2021 PRESENT POLICE LIEUTENANT PHILIPPINE NATIONAL POLICE P49,528.00 22-2 TEMPORARY Y

07/31/2018 12/12/2021 POLICE OFFICER 3 PHILIPPINE NATIONAL POLICE P32,114.00 14-2 PERMANENT Y

09/15/2013 07/30/2018 POLICE OFFICER 2 PHILIPPINE NATIONAL POLICE P30,867.00 12-1 PERMANENT Y

1/7/2010 09/14/2013 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P14,834.00 10-0 PERMANENT Y

1/7/2009 06/30/2010 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P10,808.00 10-0 TEMPORARY Y

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 10, 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

N/A

(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

NATIONAL POLICE COLLEGE,

PUBLIC SAFETY OFFICERS BASIC COURSE 12/21/2021 08/16/2022 750 TECHNICAL
SILANG, CAVITE
NATIONAL FORENSIC SCIENCE TRAINING
PUBLIC SAFETY INVESTIGATION AND DETECTION COURSE(PS IDC) 02/26/2015 07/21/2015 720 TECHNICAL
INSTITUTE,CALAMABA CITY,LAGUNA

PUBLIC SAFETY FIELD TRAINING PROGRAM 02/29/2010 06/24/2010 960 TECHNICAL POLICE REGIONAL OFFICE 6

PUBLIC SAFETY BASIC RECRUIT COURSE 07/20/2009 01/28/2010 960 TECHNICAL REGIONAL TRANING SCHOOL 6

(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)

DRIVING MEDALYA NG KASANAYAN - 2 N/A

PLAYING BASKETBALL MEDALYA NG MABUTING ASAL - 2

MEDALYA NG PAPURI - 46

MEDALYA NG PAGLILINGKOD SA VISAYAS - 6

MEDALYA NG PAGTULONG SA NASALANTA - 1

MEDALYA NG KAGALINGAN - 1

MEDALYA NG UGNAYANG PAMPULISYA - 4

MEDALYA NG PAGLILINGOD LABAN SA KRIMINALIDAD - 1

TSAPA NG NATATAGING UNIT - 1

LETTER OF COMMENDATION - 1

MEDALYA NG PANLABAN SA MANLILIGALIG - 1

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 10, 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? ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? ✘

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘

If YES, give details:

________________________________
________________________________
b. Have you been criminally charged before any court? ✘

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?
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 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 ✘
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before 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? ✘

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? ✘

If YES, please specify:

b. Are you a person with disability? ✘

If YES, please specify ID No:

c. Are you a solo parent? ✘

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
MA.LELANIE L. CALUBIRAN BRGY.MANSILINGAN,BACOLOD CITY 09101183410 3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

PLTCOL SHERLOCK C GABANA BRGY.GRANADA,BACOLOD CITY 09997551783 name tag and signature over
printed name

PMAJ RAMEL T SARONA BRGY.ALIJIS,BACOLOD CITY 09082742894 Computer generated

or photocopied picture
42. is not acceptable
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: PNP ID
ID/License/Passport No.: 22A0500259 Signature (Sign inside the box)
NOVEMBER 10, 2022
Date/Place of Issuance: 01/5/2022/QUEZON CITY Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

PMAJ RICHARD N FAJARITO

Person Administering Oath

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