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 SALES
NAME EXTENSION (JR., SR)
FIRST NAME CHENEE N/A

MIDDLE NAME SALLE Wido

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) 12/14/1996 ✘
by
by naturalization
birth
4. PLACE OF BIRTH GENERAL SANTOS CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female Othe
✘ Single Married 17. RESIDENTIAL ADDRESS 038 SAMPAGUITA
6 CIVIL STATUS
Widowe Separated House/Block/Lot No. Street
d N/A DADIANGAS EAST
Other/s: Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
7. HEIGHT (m) 5'1
City/Municipality Province
8. WEIGHT (kg) 52 kgs. ZIP CODE 9500

18. PERMANENT ADDRESS 038 SAMPAGUITA

9. BLOOD TYPE "B+"
House/Block/Lot No. Street
N/A DADIANGAS EAST
10. GSIS ID NO. N/A
Subdivision/Village Barangay
GENERAL SANTOS CITY SOUTH COTABATO
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 17-201890398-4 ZIP CODE 9500

13. SSS NO. 09-4888633-1 19. TELEPHONE NO. N/A

14. TIN NO. 720-391-068-000 20. MOBILE NO. 0938-030-6713

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) salesc179@gmail.com
II. FAMILY BACKGROUND Bosn
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 N/A TRISHA S. TANDOY 8/14/2018

MIDDLE NAME N/A ALTHEA ELISSE SALES 4/21/2020

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME SALES

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

MIDDLE NAME VALERIO

25. MOTHER'S MAIDEN NAME

SURNAME SALLE

FIRST NAME EUNICE

MIDDLE NAME FULGENCIO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

DADIANGAS WEST CENTRAL

ELEMENTARY ELEMENTARY 2003 2009 GRADUATED 2009 DIPLOMA
ELEMENTARY SCHOOL
IRINEO L. SANTIAGO NATIONAL HIGH
SECONDARY
VOCATIONAL / HIGH SCHOOL 2009 2013 GRADUATED 2013 DIPLOMA
SCHOOL OF METRO DADIANGAS

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

TRADE
COURSE BACHELOR OF SCIENCE IN BUSINESS
COLLEGE GENSANTOS FOUNDATION COLLEGE INC. ADMINISTRATION/FINANCIAL 2013 2017 GRADUATED 2017 DIPLOMA
MANAGEMENT

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

(Continue on separate sheet if necessary)

SIGNATURE DATE April 4, 2023

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LICENSE (if applicable)
RATING DATE OF EXAMINATION /
LAWS/ CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT
(If Applicable) CONFERMENT NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE
Validity

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

8/16/2022 PRESENT BARANGAY RECORD KEEPER BARANGAY DADIANGAS EAST 7,000.00 N/A JOB ORDER Y

7/29/2019 PRESENT SK TREASURER BARANGAY DADIANGAS EAST N/A N/A BY TERM Y

12/1/2016 12/23/2016 ASSISTING STAFF DEVELOPMENT BANK OF THE PHILIPPINES N/A N/A BY SEMESTER N

Government
3/16/2015 9/16/2015 SOCIAL SERVICES CLERK BARANGAY DADIANGAS SOUTH 5,000.00 N/A
Internship Program
Y

(Continue on separate sheet if necessary)

SIGNATURE DATE April 4, 2023

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

INCLUSIVE DATES OF ATTENDANCE Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
(mm/dd/yyyy) NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
Technical/etc)
From To

HANDBOOK ON THE FINANCIAL TRANSACTIONS OF THE SANGGUNIANG KABATAAN 11/14/22 11/17/22 32 TECHNICAL COMMISSION ON AUDIT
ASSOCIATION OF BARANGAY TREASURERS
ENHANCEMENT TRAINING FOR DEPUTIZED BARANGAY COLLECTORS(DBC) IT'S DUTIES,
10/22/22 10/23/22 16 TECHNICAL AND RECORD KEEPERS OF GENERAL SANTOS
FUNCTIONS AND RESPONSIBILITIES IN EFFECTIVE BARANGAY REVENUE GENERATIONS
CITY INCORPORATED
COMMUNITY BASED DISASTER MANAGEMENT AND CLIMATE CHANGE ADAPTATION IN
04/08/22 04/10/22 24 TECHNICAL DUX REGULUS
LGUS AND BARANGAYS
ASSOCIATION OF BARANGAY TREASURERS
SEMINAR OF BIR UPDATES:COMPUTATION OF WITHHOLDING TAXES AND
03/25/22 03/25/22 8 TECHNICAL AND RECORD KEEPERS OF GENERAL SANTOS
CORRESPONDING FORMS
CITY INCORPORATED
TECHNICAL EDUCATION AND SKILLS
NATIONAL CERTIFICATE III (BOOKKEEPING) 11/07/19 12/06/19 145 TECHNICAL
DEVELOPMENT AUTHORITY

DEPARTMENT OF INTERIOR AND LOCAL

SANGGUNIANG KABATAAN MANDATORY TRAINING 07/29/19 07/30/19 16 TECHNICAL
GOVERNMENT GENSAN

(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 full)
(Write in full)

COMPUTER LITERATE N/A N/A

TYPEWRITTING SKILLS N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE April 4, 2023

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 by
YES ✘ NO
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, YES ✘ NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in If YES, give details:
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: N/A

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
JELLY O. JABAT GENERAL SANTOS CITY 0981-061-6408 4.5 cm. X 3.5 cm
(passport size)

MARY JANE MARTHA M. GABUCAN KORONADAL CITY 0946-562-2469

Computer generated
DADIANGAS EAST, GENERAL SANTOS or photocopied picture
DELFIN E. CUEVAS CITY
0943-245-1443 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: NATIONAL ID

ID/License/Passport No.: PCN: 4829-4025-0798

Signature (Sign inside the box)

Date/Place of Issuance: 12/08/2022 GENERAL SANTOS 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