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 CABILI
NAME EXTENSION (JR., SR)
FIRST NAME ARAPIA

MIDDLE NAME MACUD

3. DATE OF BIRTH
(mm/dd/yyyy) 11/20/1994 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH MAPANTAO, LUMBA BAYABAO LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE PHILIPPINES
17. RESIDENTIAL ADDRESS 07 PUROK
6 CIVIL STATUS
House/Block/Lot No. Street
SINGLE MAPANTAO
Subdivision/Village Barangay
LUMBA BAYABAO LANAO DEL SUR
7. HEIGHT (m) 5`4
City/Municipality Province
8. WEIGHT (kg) 66 ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE A
House/Block/Lot No. Street
9313 MAPANTAO
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121276047405 LUMBA BAYABAO LANAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 150255661959 ZIP CODE 9700

13. SSS NO. 35-0393955-2 19. TELEPHONE NO. N/A

14. TIN NO. 384-285-315-000 20. MOBILE NO. 09512020384

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) arapiamacudcabili20@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME DIMARONSING

NAME EXTENSION (JR., SR)
FIRST NAME CABILI

MIDDLE NAME IMAM

25. MOTHER'S MAIDEN NAME

SURNAME HADJI MORA

FIRST NAME ROHAIMAH

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

GENERAL METOKER LAMPING ELEMENTARY

ELEMENTARY
SCHOOL
PRIMARY EDUCATION 3/26/2003 3/31/2008 N/A 2008 N/A

VOCATIONAL / MAPANDI MEMORIAL MEDICAL EDUCATIONAL

SECONDARY
CENTER
SECONDARY EDUCATION 3/28/2008 4/2/2012 N/A 2012 N/A

N/A N/A N/A N/A N/A N/A N/A

MAPANDI MEMORIAL MEDICAL EDUCATIONAL
COLLEGE TRADE BACHELOR SCEINCE IN NURSING 6/1/2012 4/3/2018 N/A 2017 N/A
COURSE CENTER

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE November 1, 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

NURSING LICENSURE EXAMINATION 82.0 11/16,17/2019 CAGAYAN DE ORO CITY 0922173 11/20/2022

(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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)

8/25/2020 PRESENT STAFF NURSE SABAL HOSPITAL INC. 18K

 (Continue on separate sheet if necessary)

SIGNATURE DATE November 01, 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

(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
CAPITOL UNIVERSITY MEDICAL CENTER, CAGAYAN
PRIVATE DUTY NURSE/CAREGIVER TRAINING COURSE 1/22/2018 1/26/2018 40 HOURS
DE ORO CITY
TUBERCULOSIS "INTRAOPERATIVE MANAGEMENT OF ENTERIC PERFORATIONS
FROM GASTROINTESTINAL TUBERCULOSIS" AND "SURGICAL MANAGEMENT OF 3/16/2022 3/16/2022 2 HOURS DELEX PHARMA INTERNATIONAL INC.
PULMONARY TB"
PICU MRT 3rd STATION: PEDIATRIC COVID-19 A YEAR AFTER: "COVID HEART IN
4/28/2021 4/28/2022 2 HOURS DELEX PHARMA INTERNATIONAL INC.
PEDIATRICS" AND "WHAT'S NEW IN PEDIATRIC COVID-19 AND MIS-C?"
SICU PROCEDURES: "CENTRAL VENOUS CATHETER AND ARTERIAL LINE
4/21/2021 4/21/2021 2 HOURS DELEX PHARMA INTERNATIONAL INC.
PLACEMENT" AND "SEDATING PATIENTS IN THE ICU: THE TOP TIPS"

(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)

Reading Books
Watching Educational Movies

(Continue on separate sheet if necessary)

SIGNATURE DATE November 01, 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? No
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:
________________________________
NO
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed: NO
________________________________
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:
________________________________
No
________________________________
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? ________________________________
NO
________________________________
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: NO

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: NO
39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):
NO
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: YES
b. Are you a person with disability?
If YES, please specify ID No: NO
c. Are you a solo parent?
If YES, please specify ID No: NO

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) ID picture taken within
the last 6 months
NAME ADDRESS TEL. NO. 3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

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: PRC
ID/License/Passport No.: 0922173
Signature (Sign inside the box)

Date/Place of Issuance: 12/23/2019 AT CAGAYAN DE ORO 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