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
Esgana
NAME EXTENSION (JR., SR)
FIRST NAME
Davy Mark
MIDDLE NAME
Salidaga
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) /
January 24 1992 by birth by naturalization
4. PLACE OF BIRTH Quezon province If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX / Male Female

6 CIVIL STATUS / Single Married 17. RESIDENTIAL ADDRESS blk 6 lot 6 west los angeles
Widowed Separated House/Block/Lot No. Street

Other/s: california
Subdivision/Village
san bartolome
Barangay
7. HEIGHT (m)
171 novaliches quezon city
City/Municipality Province
8. WEIGHT (kg)
65 kg ZIP CODE 1116
9. BLOOD TYPE 18. PERMANENT ADDRESS blk 6 lot 6 west los angeles
House/Block/Lot No. Street

10. GSIS ID NO. california san bartolome

Subdivision/Village Barangay

11. PAG-IBIG ID NO.

1211 6554 6034 novaliches
City/Municipality
quezon city Province

12. PHILHEALTH NO. 08-201396645-8 ZIP CODE 1116

13. SSS NO. 04626344395 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO.

09164254046
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) esgana.davymark.sectiond@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Esgana

NAME EXTENSION (JR., SR)
FIRST NAME
Dolphy
MIDDLE NAME Tolda
25. MOTHER'S MAIDEN NAME

SURNAME Salidaga
FIRST NAME Arsenia
MIDDLE NAME (Continue on separate sheet if necessary)
Monares
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE UNITS YEAR ACADEMIC
LEVEL
(Write in full) (Write in full) EARNED GRADUATED HONORS
(if not graduated) RECEIVED
From To

ELEMENTARY
Casay Elementary school 2001 2006 2006
SECONDARY
Casay National HS 2006 2010 2010
VOCATIONAL /

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DAVY MARK ESGANA DATE 1/6/23

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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

(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
INCLUSIVE DATES SALARY/ JOB/ PAY
28. POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
SERVICE
GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in applicable)& STEP
SALARY (Format "00-0")/ APPOINTMENT
abbreviate) full/Do not abbreviate)
From To INCREMENT

2015 2021 OPERATOR A1 multinational packaging

Inc

(Continue on separate sheet if necessary)

SIGNATURE DAVY MARK ESGANA DATE 1/6/23

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

Sacred Heart CenterOn the job training Child care 10/3/22 10/14/22 80 care giver
Sto Nino Home For Aged INC. 80 care giver

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

Caregiver NC II 01/26/2208/12/22 978 asia pacific caregiver and

Health Care Services NC II health care training center
inc

(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)

(Continue on separate sheet if necessary)

SIGNATURE DAVY MARK ESGANA DATE 1/6/23

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 / NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES / NO
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
angeline s, rodrigo novaliches qc 09550460940 4.5 cm. X 3.5 cm
(passport size)

Computer generated
or photocopied picture
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: umid id DAVY MARK ESGANA
ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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