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

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

MIDDLE NAME GESTA

3. DATE OF BIRTH
(mm/dd/yyyy) 06/23/1198 16. CITIZENSHIP

4. PLACE OF BIRTH BRGY. STO. NIÑO, MULANAY, QUEZON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS N/A CENTRO III

6 CIVIL STATUS
House/Block/Lot No. Street
N/A STO. NIÑO
Subdivision/Village Barangay
MULANAY QUEZON
7. HEIGHT (m) 155
City/Municipality Province
8. WEIGHT (kg) 65 ZIP CODE

18. PERMANENT ADDRESS BLK.23, Lot 3 N/A

9. BLOOD TYPE A
House/Block/Lot No. Street
Grand Acasia Banaybanay
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Cabuyao Laguna
11. PAG-IBIG ID NO. 121290274696
City/Municipality Province

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

13. SSS NO. N/A 19. TELEPHONE NO. NONE

14. TIN NO. 358-204-355-000 20. MOBILE NO. 09677942333

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

ELEMENTARY AJOS ELEMENTARY SCHOOL PRIMARY 2007 2012 N/A 2012 NONE

SECONDARY /
VOCATIONAL AJOS NATIONAL HIGH SCHOOL SECONDARY 2012 2015 N/A 2015 FIRST HONORABLE MENTION

QUEZON NATIONAL AGRICULTURAL NATIONAL CERTIFICATE (AGRICROP

2018 2019 N/A 2019 NONE
SCHOOL PRODUCTION II)
TRADE
POLYTECHNIC UNIVERSITY OF THE COLLEGE (BACHELOR OF SCIENCE IN
COURSE
COLLEGE 2015 2019 N/A 2019 NONE
PHILIPPINES MULANAY CAMPUS AGRIBUSINESS MANAGEMENT)

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
NOVEMBER 5-7, MANUEL S. ENVERGA UNIVERSITY
RA 1080 (AGRICULTURIST) 79.83% 2019
0033708 6/23/2025
FOUNDATION SHS BUILDING

(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) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
CONTRACTUA
6/15/2020 7/15/2021 Data Analyst and Technical Staff LIBUTAN ENGINEEERING SERVICES N/A N
L
7/11/2022 9/17/2022 Swine Technician Winner Dioko Farm 11284.00 N/A Contractual N

(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. (BRGY. TIMOGAN LOS
7/13/2021 12/1/2023 N/A MEMBER
BAÑOS, LAGUNA)

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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 DE
PROBATIONARY OFFICER TRAINING CORPS 10/30/2021 2/28/2022 N/A SUPERVISORY
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
11/5/2021 11/5/2021 2 TECHNICAL PAMPANGA STATE AGRICULTURAL UNIVERSITY
UNDERSTANDING ON SUSTAINABLE FOREST AND FOREST GOVERNANCE
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
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 COMMITTEE
THE HAMMER AND DANCE OF A COVID WORLD: COPING WITH A NEW REALITY 10/14/2021 10/14/2021 2 TECHNICAL
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)
4TH REGIONAL COMMUNITY DEFENSE GROUP,
ADVANCE ROTC ACADEMIC PHASE TRAINING (ARAPT MS-41/42) 2017 06/10/2017 06/23/2017 156 SUPERVISORY Army Reserve Command, Camp General Macario
Sakay, Los Baños, Laguna
HEADQUARTERS, Army Reserve Command, Camp
ADVANCE ROTC ACADEMIC PHASE TRAINING (ARAPT MS-31/32) 2016 05/09/2016 05/22/2016 130 SUPERVISORY
Riego de Dios, Tanza, Cavite
HEADQUARTERS, Army Reserve Command, Camp
ROTC SUMMER CAMP TRAINING (RSCT) 2016 04/25/2016 05/08/2016 130 SUPERVISORY
Riego de Dios, Tanza, Cavite
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
PUP MULANAY, LGU MULANAY, RELIGIOUS
BonPen YOUTH LEADERSHIP SUMMIT 2015 07/24/2015 07/26/2015 36 SUPERVISORY SECTOR, PNP & 74TH INFANTRY BATTALION,
2ID,PA
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

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION

31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)
MICROSOFT SKILLS (data filters, power point, Certificate of Attendance for actively participating on the virtual Philippine Association of PHILIPPINE ASSOCIATION OF AGRICULTURISTS
data sorting,excel shortcut keys) Agriculturists 9th General Assembly held on July 31, 2021 INC-MEMBER
Knowledge in Crop Cultivation (distinguished pest
and plant diseases, soil type identification, create Chess Champion ( Board 2) 2018 & 2019
organic fertilizers and pesticide)

Certificate of Completion of the Advance Reserve Officers Training Corps (ROTC) Component of
Plant Propagation (Marcotting, Budding, Grafting)
National Service Training Program (NSTP) 2015-2018
Certificate of Recognition for dedication and commitment to work contributed in Official Student
(Hobbies: Planting, Biking, Swimming)
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)
Certificate of Participation in recognition for outstanding performance in participating the 20th Arbor
Day at PUP Mulanay (July 27, 2018)

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?
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
4.5 cm. X 3.5 cm
Engr. Benny Libutan Masbate City 9338144778 (passport size)

Prof. Edgardo Regencia Mulanay, Quezon 9482022819 Computer generated

or photocopied picture
is not acceptable
Prof. Mercy O. Manalo Mulanay, Quezon 9176774500
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/License/Passport No.: 0033708 Signature (Sign inside the box)

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