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 JAYONA
NAME EXTENSION (JR., SR)
FIRST NAME JAMES

MIDDLE NAME DE LOS SANTOS

3. DATE OF BIRTH
3/13/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship by
by
naturalizatio
birth
4. PLACE OF BIRTH MURCIA, NEGROS OCCIDENTAL If holder of dual citizenship, Pls. indicate country:n
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS Single ✘ 17. RESIDENTIAL ADDRESS
Married House/Block/Lot No. Street
Separat
Widowed MAGSAYSAY VILLAGE
Other/s: ed Subdivision/Village Barangay
ILOILO CITY
7. HEIGHT (m) 1.6256
City/Municipality Province
8. WEIGHT (kg) 62 ZIP CODE 5000
18. PERMANENT ADDRESS
9. BLOOD TYPE AB+
House/Block/Lot No. Street
MAGSAYSAY VILLAGE
10. GSIS ID NO.
Subdivision/Village Barangay
ILOILO CITY
11. PAG-IBIG ID NO. 121169470994
City/Municipality Province
12. PHILHEALTH NO. 112511003248 ZIP CODE 5000

13. SSS NO. 0735289581 19. TELEPHONE NO.

14. TIN NO. 703187617 20. MOBILE NO. 09489849932

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) jdjayona13@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CAPOSPOS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) SHERLOCKE JAMES C. JAYONA
FIRST NAME MA. ROSE 3/29/2018

MIDDLE NAME JARA EURUS MARIE C. JAYONA 6/12/2020

OCCUPATION SELF EMPLOYED

EMPLOYER/BUSINESS NAME POMECCO

BUSINESS ADDRESS POTOTAN, ILOILO

TELEPHONE NO.

24. FATHER'S SURNAME JAYONA

NAME EXTENSION (JR., SR)
FIRST NAME EDUARDO

MIDDLE NAME PATINGO

25. MOTHER'S MAIDEN NAME

SURNAME DE LOS SANTOS

FIRST NAME LUDELYN

MIDDLE NAME LISO-AN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY NABITASAN ELEMENTARY SCHOOL ELEMENTARY 6/2/2001 3/31/2007 GRADUATED 2007 N/A
VOCATIONAL /
SECONDARY ILOILO NATIONAL HIGH SCHOOL HIGH SCHOOL 6/6/2007 3/31/2011 GRADUATED 2011 N/A

COLLEGE TRADE WEST VISAYAS STATE UNIVERSITY BSED MATHEMATICS 6/4/2011 3/31/2015 GRADUATED 2015 N/A
COURSE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE January 6, 2023

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

LICENSURE EXAMINATIONS FOR TEACHER 78.4 SEPT. 2015 JARO NATIONAL HIGH SCHOOL 1431719 3/13/2022

(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/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if 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)
PROBATIONA
6/1/2019 7/31/2021 TEACHER ASSUMPTION SCHOOL PASSI CITY 15000.00 004 N
RY
PROBATIONA
6/11/2018 4/5/2019 TEACHER ASIAN COLLEGE OF AERONAUTICS 9000.00 N
RY
PROBATIONA
6/1/2017 10/1/2017 TEACHER PHINMA-UNIVERSITY OF ILOILO 17990.00 007 N
RY
PROBATIONA
6/1/2016 3/1/2017 TEACHER BETHANY LIFE CENTER ACADEMY 7000.00 N
RY

(Continue on separate sheet if necessary)

SIGNATURE DATE January 6, 2023

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

ASIAN MATHSCI LEAGUE INC. 6/1/2017 PRESENT MATH MENTOR

(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 FUNDAMENTAL COURSE 11/12/2017 12/22/2017 30.0 TECHNICAL OWWA REGIONAL OFFICE 6

HEALING INVISIBLE WOUNDS 9/28/2016 10/6/2016 24.0 MANAGERIAL KALIPAY NEGRENSE FOUNDATION

SAFETY MANAGEMENT SYSTEM 5/21/2018 5/25/2018 30.0 MANAGERIAL ASIAN COLLEGE OF AERONATUTICS

QUALITY MANAGEMENT SYSTEM 6/4/2018 6/8/2018 30.0 MANAGERIAL ASIAN COLLEGE OF AERONATUTICS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
ASIAN MATH-SCIENCE LEAGUE ILOILO
DRIVING
CHAPTER
COOKING

PLAYING/COACHING TEAM SPORTS

(Continue on separate sheet if necessary)

SIGNATURE DATE January 6, 2023

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? ✘ NO
YES
b. within the fourth degree (for Local Government Unit - Career Employees)? ✘ NO
YES
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? ✘ NO
YES
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? ✘ NO
YESgive details:
If YES,
________________________________
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?
✘ NO
YESgive details:
If YES,
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or YESgive details:
If YES,
phased out (abolition) in the public or private sector? PRIVATE SECTOR/ END OF TERM
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year
(except Barangay election)?
✘ NO
YESgive details:
If YES,
b. Have you resigned from the government service during the three (3)-month period before ✘ NO
the last election to promote/actively campaign for a national or local candidate? YES
If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
✘ NO
YESgive details (country):
If YES,

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? ✘ NO
If YES,YES
please specify:
b. Are you a person with disability? ✘ NO
If YES,YES
please specify ID No:
c. Are you a solo parent? ✘ NO
If YES,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
DAGSAAN, BUENAVISTA the last 6 months
GENESIS G. CAMARISTA GUIMARAS
9451459449 3.5 cm. X 4.5 cm
(passport size)

LENNON JOHN RENDON DINGLE, ILOILO 9271803948 With full and handwritten
name tag and signature over
printed name
JUNALD PACLIBAR PASSI CITY, ILOILO 9096424660
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 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: PRC ID

ID/License/Passport No.: 1431719

Signature (Sign inside the box)
01/06/2023
Date/Place of Issuance: 1/13/2016
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