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 SALADINO
FIRST NAME MARK JOY NAME EXTENSION (JR., SR)

MIDDLE NAME SALAZAR

3. DATE OF BIRTH
(mm/dd/yyyy) 12/16/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH QUEZON CITY, METRO MANILA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street
PIAS SUR
Other/s:
Subdivision/Village Barangay
CURRIMAO ILOCOS NORTE
7. HEIGHT (m) 1.55
City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 2903

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. Street
PIAS SUR
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CURRIMAO ILOCOS NORTE
11. PAG-IBIG ID NO. 1212-2193-1173
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 2903

13. SSS NO. 34-7440689-7 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09636371212

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) saladinomarkjoy@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME SALADINO 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME LORDLEY LEANDRE MARQUEL SALADINO 3/4/2021

MIDDLE NAME ALEGRE

OCCUPATION POLICE LIEUTENANT
EMPLOYER/BUSINESS NAME PHILIPPINE NATIONAL POLICE
BUSINESS ADDRESS CAMP RAFAEL T CRAME, QUEZON CITY
TELEPHONE NO. (02)8722-0650
24. FATHER'S SURNAME SALAZAR
NAME EXTENSION (JR., SR)
FIRST NAME PETER
MIDDLE NAME PEÑARANDA
25. MOTHER'S MAIDEN NAME

SURNAME AUXTERO
FIRST NAME ELEANOR
MIDDLE NAME RONTAL (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

GRACIANO LOPEZ JAENA ELEMENTARY SCHOOL PRIMARY 2007 2008 GRADUATED 2008 N/A
ELEMENTARY PINAGLABANAN ELEMENTARY SCHOOL PRIMARY 2006 2007 GRADE 5 N/A N/A
DIOSDADO MACAPAGAL ELEMENTARY SCHOOL PRIMARY 2002 2006 GRADE 1-4 N/A N/A
NEW ERA UNIVERSITY SECONDARY/HIGH SCHOOL 2010 2012 GRADUATED 2012 N/A
VOCATIONAL
SECONDARY /
RAMON MAGSAYSAY HIGHSCHOOL SECONDARY/HIGH SCHOOL 2008 2010 1ST-2ND YR N/A N/A
N/A N/A N/A N/A N/A N/A N/A
TRADE BACHELOR OF SCIENCE IN TOURISM
TRINITY UNIVERSITY OF ASIA
MANAGEMENT
2015 2018 GRADUATED 2018 N/A
COURSE
COLLEGE
PAMANTASAN NG LUNGSOD NG MAYNILA BACHELOR OF SCIENCE IN SOCIAL WORK 2012 2015 109 UNITS 2014 N/A
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV.
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

FIRE OFFICER EXAMINTATION 82.53% OCTOBER 23, 2022 QUEZON CITY 553039 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) MONTHLY STATUS OF
(Write in full/Do not (Write SALARY
applicable)& STEP
APPOINTMENT
abbreviate) in full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

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

(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

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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
YMCA OF THE ROCKIES SNOW
INTERNATIONAL TRAINING PROGRAM IN FOOD SERVICE 5/18/2019 3/19/2020 2848 SUPERVISORY
MOUNTAIN RANCH

(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)

COMPUTER LITERATE N/A N/A

(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 ✘ 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
VINCENT BENEDICT C SALVADOR BADOC, ILOCOS NORTE 09774264464 3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

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 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: PASSPORT

ID/License/Passport No.: P8391822B

Signature (Sign inside the box)

Date/Place of Issuance: DFA MANILA

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