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 DIAZ
NAME EXTENSION (JR., SR) N/A
FIRST NAME MA. ERLIE

MIDDLE NAME GESTA

3. DATE OF BIRTH
(mm/dd/yyyy) 06/23/1998 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH BRGY. STO.NIÑO,MULANAY,QUEZON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS N/A CENTRO III
Widowed House/Block/Lot No. Street
Separated N/A STO.NIÑO
Other/s:
Subdivision/Village Barangay
MULANAY QUEZON
7. HEIGHT (m) 155
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 4312

18. PERMANENT ADDRESS

9. BLOOD TYPE A
House/Block/Lot No. Street
CITY PARK MARAWOY
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LIPA BATANGAS
11. PAG-IBIG ID NO. 121290274696
City/Municipality Province

12. PHILHEALTH NO. 08-252514337-2 ZIP CODE 4217

13. SSS NO. 04-4355996-9 19. TELEPHONE NO. N/A

14. TIN NO. 611-085-586-00000 20. MOBILE NO. 0967-794-2333

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) diazdiazmaerlie@gmail.com
N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME DIAZ

NAME EXTENSION (JR., SR)
FIRST NAME ARIEL SR.

MIDDLE NAME BUENO

25. MOTHER'S MAIDEN NAME

SURNAME GESTA

FIRST NAME ERLA

MIDDLE NAME MAHINAY (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 AJOS ELEMENTARY SCHOOL PRIMARY 2007 2011 N/A 2011

1ST
SECONDARY AJOS NATIONAL HIGH SCHOOL SECONDARY 2011 2015 N/A 2015 HONORABLE
VOCATIONAL / MENTION

NATIONAL CERTIFICATE III- AGRICROP

QUEZON NATIONAL AGRICULTURAL SCHOOL
PRODUCION
2018 2019 N/A 2019
TRADE
POLYTECHNIC UNIVERSITY OF THE PHILIPPINES BACHELOR OF SCIENCE IN AGRIBUSINESS
COURSE
COLLEGE
MULANAY CAMPUS MANAGEMENT
2015 2019 N/A 2019

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Date of
Validity

RA 1080 (AGRICULTURIST) 79.83% NOV.5-7, 2019 MSEUF SHS BUILDING 0033708 06/23/2025

Fire Officer Examination (FOE) 83.80% 10/23/2022 PAGBILAO NATIONAL HIGH SCHOOL 210179 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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy)
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP STATUS OF APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

DEPARTMENT OF AGRICULTURE-
AGRIBUSINESS AND MANAGEMENT CONTRACTUAL OF
09/27/2022 12/31/2022 AGRICULTURIST I 20,754.00 SG11 Y
ASSISTANCE DIVISION REGIONAL FIELD SERVICE
OFFICE IV-A

FARROWING AND NURSERY SWINE

12/7/2022 09/17/2022 WINNERS DIOKO FARM 10,478.00 N/A CASUAL N
TECHNICIAN
DATA ANALYST AND TECHNICAL
06/15/2020 07/15/2021 LIBUTAN ENGINNERING SERVICES N/A N/A PROJECT BASED N
SUPPORT

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

PHILIPPINE ASSOCIATION OF AGRICULTURISTS INC. 0717/2020 PRESENT N/A MEMBER

(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
ARESCOM TRAINING SCHOOL (CAMP REIGO
PROBATIONARY OFFICER TRAINING CORPS 10/30/2021 2/28/2022 N/A SUPERVISORY
DE DIOS TANZA CAVITE)
BUREAU OF AGRICULTURE AND FISHERIES
POULT-RIFIC AND EGG-CELLENT PRACTICES WEBINAR 11/9/2021 11/9/2021 3 TECHNICAL
STANDARDS
"MAYABONG NA KAALAMAN, MAYABONG NA KAGUBATAN: FOSTERING PAMPANGA STATE AGRICULTURAL
11/5/2021 11/5/2021 2 TECHNICAL
UNDERSTANDING ON SUSTAINABLE FOREST AND FOREST GOVERNANCE UNIVERSITY
RANCHER'S CLUB PHILIPPINES & CENTRAL
ALL ABOUT AGRICULTURE: BROILER PRODUCTION 10/29/2021 10/29/2021 2 TECHNICAL
LUZON STATE UNIVERSITY
CENTRAL BICOL STATE UNIVERSITY OF
ADAPTATION AND MITIGATION INITIATIVES IN AGRICULTURE: AN OVERVIEW 10/22/2021 10/22/2021 2 TECHNICAL
AGRICULTURE
DEPARTMENT OF TRADE AND INDUSTRY-
CONSUMER AWARENESS AND RESPONSIVENESS EDUCATION SEMINAR 10/21/2021 10/21/2021 2 TECHNICAL ZAMBALES
COLLEGE OF AGRICULTURE AND FOOD
SOCIAL ENTREPRENEURSHIP 10/19/2021 10/19/2021 2 TECHNICAL
SCIENCE UP LOS BAÑOS, LAGUNA
COLLEGE OF AGRICULTURE AND FOOD
GRIT AND PASSION IN EXTENSION SERVICE 8/24/2021 8/24/2021 2 TECHNICAL
SCIENCE UP LOS BAÑOS, LAGUNA
STUDENT HEALTH AND WELFARE
THE HAMMER AND DANCE OF A COVID WORLD: COPING WITH A NEW REALITY 10/14/2021 10/14/2021 2 TECHNICAL
COMMITTEE UP LOS BAÑOS
COLLEGE OF AGRICULTURE AND FOOD
ACHIEVING AGRICULTURE AND FOOD SECURITY IN PUERTO PRINCESA 10/12/2021 10/12/2021 2 TECHNICAL
SCIENCE UP LOS BAÑOS, LAGUNA
COLLEGE OF AGRICULTURE AND FOOD
BEQUEATHING INDIGENOUS KNOWLEDGE FOR THE NEXT GENERATION 9/30/2021 9/30/2021 3 TECHNICAL
SCIENCE UP LOS BAÑOS, LAGUNA
FOOD FOR THE SOUL: WARMING HOMES AGAINST FOOD WASTAGE & BANANA COLLEGE OF AGRICULTURE AND FOOD
9/28/2021 9/28/2021 3 TECHNICAL
CHIPS: A BUNCH OF HAPPINESS IN A PACK SCIENCE UP LOS BAÑOS, LAGUNA
THE GRIT AND PASSION BEHIND PERMACULTURE FARMING & WHEN COLLEGE OF AGRICULTURE AND FOOD
9/23/2021 9/23/2021 3 TECHNICAL
EMPOWERMENT MEANS GROWING A FARM SCHOOL SCIENCE UP LOS BAÑOS, LAGUNA
FEEDING THE MIND, BODY, AND SOUL: THE ARTFUL SIDE OF AGRICULTURE & COLLEGE OF AGRICULTURE AND FOOD
6/24/2021 6/24/2021 4 TECHNICAL
DARE TO DREAM, DARE TO DAIRY SCIENCE UP LOS BAÑOS, LAGUNA
OFFICE OF THE SPECIAL AGRICULTURE
PRACTICAL FREE RANGE CHICKEN PRODUCTION 5/15/2021 5/15/2021 2 TECHNICAL
REPRESENTATIVE BANGKOK & DA- ATI
1ST MULTI-DISCIPLINARY RESEARCH COLLOQUIUM WITH THE THEME:
PRECURSOR TO THE UPLIFTMENT OF QUALITY LIFE ON EDUCATION, 4/15/2019 4/15/2019 12 SUPERVISORY PUP MULANAY FACULTY STAFF
BUSINESS, MANAGEMENT, ENTREPRENEURSHIP AND TECHNOLOGY
ON THE JOB TRAINING ENTITLED STRENGHTENING RESILIENCY OF MULANAY'S
4/15/2018 5/18/2018 240 SUPERVISORY PHILIPPINE RICE RESEARCH INSTITUTE
RAINFED FARMING COMMUNITIES TO CLIMATE CHANGE
TRAINING WORKSHOP ON ORGANIC AGRICULTURE FOR ORGANIZATION IN THE COLLEGE OF BUSINESS MULANAY CAMPUS
2/27/2017 3/1/2017 16 SUPERVISORY
MUNICIPALITY OF MULANAY, PROVINCE OF QUEZON (Agribusiness Management Department)
OFFICIAL STUDENT PUBLICATION PUP
THE COLLEGIUM SKILLS and WRITING WORKSHOP 02/19/2016 02/19/2016 12 SUPERVISORY
MULANAY
GENDER AWARENESS AND SENSITIVITY SEMINAR 10/06/2015 10/06/2015 8 SUPERVISORY PUP MULANAY FACULTY STAFF
TRICHOGRAMMA LECTURES with the Theme " Inspire People to Plant, Nurture and COLLEGE OF BUSINESS MULANAY CAMPUS
07/15/2015 07/15/2015 4 SUPERVISORY
Celebrate Trees" (Agribusiness Management Department)
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES
MICROSOFT SKILLS (data filters, power point,
data sorting,excel shortcut keys)
Knowledge in Crop Cultivation (distinguished pest
and plant diseases, soil type identification, create
organic fertilizers and pesticide)
Plant Propagation (Marcotting, Budding, Grafting)
(Hobbies: Planting, Biking, Swimming)
Certificate of Participation in recognition for outstanding performance in participating the 20th Arbor
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
32. 33. (Write in
(Write in full)
full)
Certificate of Attendance for actively participating on the virtual Philippine Association of PHILIPPINE ASSOCIATION OF
Agriculturists 9th General Assembly held on July 31, 2021 AGRICULTURISTS INC-MEMBER
Chess Champion ( Board 2) 2018 & 2019
Certificate of Completion of the Advance Reserve Officers Training Corps (ROTC) Component of
National Service Training Program (NSTP) 2015-2018
Certificate of Recognition for dedication and commitment to work contributed in Official Student
Publication as Staffer (2015-2019)
Certificate of Recognition for participating the Kabataang Organic Agriculture Quiz Bee during the
yearly National Organic Agriculture held at Southern Luzon State University, Lucban Quezon on
November 9, 2018
Certificate of Appreciation for sharing effort, talent and expertise as Secretary of Agribusiness
Society (ABS) (Academic Year 2018-2019)
Day at PUP Mulanay (July 27, 2018)
(Continue on separate sheet if necessary)
SIGNATURE DATE
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 ✘

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

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
the last 6 months
ENGR. BENNY LIBUTAN MULANAY, QUEZON 0917-360-1571 4.5 cm. X 3.5 cm
(passport size)

PROF. MERCY O. MANALO MULANAY, QUEZON 0976-774-5001

Computer generated
or photocopied picture
EDGARDO R. REGENCIA MULANAY, QUEZON 0948-202-2819 is not acceptable

42. 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: PRC ID

ID/License/Passport No.: 0033708

Signature (Sign inside the box)

Date/Place of Issuance: 12/09/2019/PRC LUCENA 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