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 ARROYO
NAME EXTENSION (JR., SR)
FIRST NAME JEALY ANN

MIDDLE NAME FAMISARAN

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 07/30/1997 ✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH ZAMBOANGA SIBUGAY If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS ✘ Single Married House/Block/Lot No. Street
Widowed Separat PUROK 3 TIBAO
Other/s: ed Subdivision/Village Barangay

7. HEIGHT (m) 1.59 M'LANG NORTH COTABATO

City/Municipality Province
8. WEIGHT (kg) 46 ZIP CODE 8010
18. PERMANENT ADDRESS
9. BLOOD TYPE A+
House/Block/Lot No. Street

10. GSIS ID NO. N/A PUROK 3 TIBAO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121277912816 M'LANG NORTH COTABATO

City/Municipality Province

12. PHILHEALTH NO. 16-251291686-4 ZIP CODE 8010

13. SSS NO. 35-007666-7 19. TELEPHONE NO. N/A

14. TIN NO. 702-386-048-000 20. MOBILE NO. 0968 770 1581

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) jealyannarroyo@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.,
FIRST NAME N/A N/A N/A
SR)
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ARROYO

NAME EXTENSION (JR.,
FIRST NAME JOEBERT, SR. SR)
MIDDLE NAME CATALAN

25. MOTHER'S MAIDEN NAME

SURNAME FAMISARAN

FIRST NAME JENNIFER

MIDDLE NAME GUERRA (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
TULUNAN CENTRAL ELEMENTARY GRADE 1 -
PRIMARY EDUCATION 2006 2009 3RD HONOR
SCHOOL GRADE 4
ELEMENTARY
MALALAG CENTRAL ELEMENTARY GRADE 5 -
PRIMARY EDUCATION 2009 2011 2011 WITH MERIT
SCHOOL GRADE 6

SECONDARY DAVAO DEL SUR SCHOOL OF FISHERIES HIGH SCHOOL 2011 2015 GRADUATED 2015 WITH HONOR
VOCATIONAL /
CARMELO C. DE LOS CIENTOS SR.
FOOD AND BEVERAGE NC II 2019 2019 COMPLETED 2019 COMPLETED
NATIONAL TRADE SCHOOL
TRADE COURSE
SOUTHEASTERN COLLEGE OF PADADA, BACHELOR OF SECONDARY
COLLEGE 2015 2020 GRADUATED 2020 CUM LAUDE
INC. EDUCATION IN ENGLISH

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 5/2/2023

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

COR JESU COLLEGE, INC. / PROFESSIONAL

RA 1080 (TEACHER) 85.6 10/2/2022 2026469 7/30/2026
REGULATION COMMISSION

PD 907 - HONOR GRADUATE N/A 3/19/2021 CIVIL SERVICE COMMISSION REGION XI 100111210043 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
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES PAY GRADE (if
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY applicable)& STATUS OF
(Write in full/Do not (Write in SALARY STEP (Format APPOINTMENT
abbreviate) full/Do not abbreviate) "00-0")/
From To INCREMENT
(Y/ N)

6/21/2021 3/8/2023 TECHNICAL SUPPORT REPRESENTATIVE HARTE HANKS PHILIPPINES P22,000 N/A REGULAR NO
DAVAO CAVALIERS SECURITY AGENCY,
1/12/2021 5/15/2021 COLLECTION & BILLING OFFICER P12,000 N/A PROBATIONARY NO
INC.
3/17/2017 2/3/2021 ONLINE ENGLISH TUTOR ENGOO TUTORS P20,000 N/A CONTRACTUAL NO

(Continue on separate sheet if necessary)

SIGNATURE DATE 5/2/2023

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
(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

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

(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 SKILLS (MICROSOFT OFFICE:

N/A N/A
WORD, EXCEL, POWERPOINT, ETC.)
ENGLISH COMMUNICATION SKILLS (WRITTEN
& VERBAL)
ORGANISATIONAL SKILLS

DANCING

(Continue on separate sheet if necessary)

SIGNATURE DATE 5/2/2023

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 any court or tribunal? YES ✘ NO
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
YES ✘ NO
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)? YES ✘ NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the YES ✘ NO
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?
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
MARIA MELANIE S. GALAN TIBAO, M'LANG, NORTH COTABATO 0930 243 5496 3.5 cm. X 4.5 cm
(passport size)

ERLINDA A. ALCOY PADADA, DAVAO DEL SUR 0910 589 9792 With full and handwritten
name tag and signature over
printed name
BELLA D. PANTALEON MALALAG, DAVAO DEL SUR 0907 810 9079
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: PRC ID

ID/License/Passport No.: 2026469

Signature (Sign inside the box)
5/2/2023
Date/Place of Issuance: 04/17/23 / PRC DIGOS CITY BRANCH
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