CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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. 9174142

I. PERSONAL INFORMATION
2. SURNAME GADIA
FIRST NAME JOVIELYN NAME EXTENSION (JR., SR)

MIDDLE NAME MARQUEZ

3. DATE OF BIRTH
(mm/dd/yyyy) 02 / 02 / 1974 16. CITIZENSHIP Filipino
Philippines
4. PLACE OF BIRTH Tawi-Tawi If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
6 CIVIL STATUS Separated 17. RESIDENTIAL ADDRESS 121 Scorpio st.
House/Block/Lot No. Street
Davao Housing Subd. Toril
Subdivision/Village Barangay

7. HEIGHT (m) 1.55 Davao City Davao Del Sur

City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 8000
9. BLOOD TYPE A 18. PERMANENT ADDRESS 121 Scorpio st.
House/Block/Lot No. Street

10. GSIS ID NO. N/A Davao Housing Subd. Toril

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1760-00629548 Davao City Davao Del Sur

City/Municipality Province

12. PHILHEALTH NO. 14-000010779-0 ZIP CODE 8000

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 906-428-484 20. MOBILE NO. 09307458121

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) marquezjovv@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 N/A Jezreel Gadia 4/29/1999
MIDDLE NAME Janine Gadia 4/24/2000

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Marquez

NAME EXTENSION (JR., SR)
FIRST NAME Luis (deceased)
MIDDLE NAME Uy
25. MOTHER'S MAIDEN NAME

SURNAME Soon
FIRST NAME Delia
MIDDLE NAME M (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

ELEMENTARY
West tabawan Elementary
School
SECONDARY
VOCATIONAL / Notre Dame of Tabawan 1991

TESDA cookery NC II
TRADE
Ateneo de Zamboanga
COURSE
COLLEGE BSCommerce 1997
University
GRADUATE STUDIES University of Mindanao MAED-EM 33
(Continue on separate sheet if necessary)

SIGNATURE DATE August 17, 2022

CS FORM 212 (Revised 2017), Page 1 of 4
1
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

Career Service Sub.

EN/CN
Professional Exam 80.9 8/1/1995 Zamboanga City
675242

Teachers Board (LET) 81.2 3/1/2018 Davao City 1634053

(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 (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
full/Do not abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)

2010 June 2015 May Bookkeeper Pretty Fine Skincare

2001 March 2002 Jan Clerk Major Chords Lending Investor

2000 Feb 2000 Dec Clerk Crlisader Lending Investor

Phil-Canada Local Government Co-
1997 Jan 1999 Dec Bookkeeper III Support PROGRAM IX Terminus
w/ the
project
 (Continue on separate sheet if necessary)

SIGNATURE DATE August 17,2022

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
Member-Facilitates Learning
Rotaract Club of Zamboanga Community Based 1998 2000
Developing professional
and Leadership skills, Feeding Program
to less
Fortunate kids & children /community

Member- Outreach Program and

Zamboanga City alliance evangelical church 1997 2000
Community Service

(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

Cookery NC II Aug Oct. 2018 Samson Polythenic College of Davao

Philippines Public Safety

"Every teacher, -A character builder" Dec 21 12/22/2019
and Order Support Group
"Creating a safe physical and psychological learning 12/23/2019 12/23/2019
Philippines Public Safety
Environment" and Order Support Group

(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)
Rotaract Club of Zamboanga City
Cooking Community Service Award Central-Community Based
 Rotaract Club of Zamboanga City
Reading Good books Central-Community Based
Rotaract Club of Zamboanga City
Singer and playing guitar
Central-Community Based

(Continue on separate sheet if necessary)

SIGNATURE DATE August 17, 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?
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:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
If YES, give details:
________________________________
Co-Terminus w/ the Project
________________________________
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? ________________________________
________________________________
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:
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:
39. Have you acquired the status of an immigrant or permanent resident of another country?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:

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

NAME ADDRESS TEL. NO.

Carepoint Review Center,
Paul Rye Munoz
Davao City
Dr. Aracelie C. Arellano Mudiang, Bunawan, Davao City

Jocelyn Latag Rosalina, Puan, Davao City 09239776496

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 administrative/criminal case/s against me.

PHOTO

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.: 1634053
Signature (Sign inside the box)
August 17, 2022
Date/Place of Issuance: 2018-01-15/Davao 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