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 Talattad
NAME EXTENSION (JR., SR)
FIRST NAME Jeff

MIDDLE NAME Cacayurin

3. DATE OF BIRTH
(mm/dd/yyyy) 7/12/1979 16. CITIZENSHIP

4. PLACE OF BIRTH Luna, Apayao If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS 07 Purok Kamatis

6 CIVIL STATUS
House/Block/Lot No. Street
Malibabag
Subdivision/Village Barangay
Peñablanca Cagayan Valley
7. HEIGHT (m) 5'6"
City/Municipality Province
8. WEIGHT (kg) 85 ZIP CODE

18. PERMANENT ADDRESS 07 Purok Kamatis

9. BLOOD TYPE AB+
House/Block/Lot No. Street
Malibabag
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Peñablanca Cagayan valley
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 06-025294897-2 ZIP CODE 3502

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 487-595-672-000 20. MOBILE NO. 00639064724817

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) talattadjeffc1979@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)

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Talattad 10/21/1957

NAME EXTENSION (JR., SR)
FIRST NAME Clifford

MIDDLE NAME Daquioag

25. MOTHER'S MAIDEN NAME

SURNAME Cacayurin 11/25/1957

FIRST NAME Relie

MIDDLE NAME Udaundo (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Peñablanca East Central School Elementary 1986 1992 Elementary 1992 N/A
VOCATIONAL /
SECONDARY University of Cagayan Valley Secondary 1992 1996 Secondary 1996 N/A

TRADE
COLLEGE
COURSE St. Paul University Philippines Bachelor in Secondary Education 1996 2000 2000 N/A

GRADUATE STUDIES Cagayan State University Juris Doctor 2016 2022 2022 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE April 27, 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

Career Service (Professional) Examination 80.22% 11/18/2001 Tuguegarao City 1058

Liscensure Examination for Teachers ( PRC) 75.00% 11/5/2002 Tuguegarao City 0760256 7/12/2021

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

1/3/2022 to present National Irrigation Administration- N/A

Community Relation Assistant B Pinacanauan River Irrigation System 761.72/d Job Order N

10/15/2022 12/26/2022 National Irrigation Administration- N/A

Community Relation Assistant B Pinacanauan River Irrigation System 761.72/d Job Order N
07/08/2019 12/31/2019 Administrative Aide DOH-DATRC San Antonio, Ilagan, Isabela 14,000 N/A Job Order N
Document Analyst cum Executive Qatar Technology Group ( Al Shaab Group
12/25/2012 12/25/2014 5,500 QR N/A N/A N
Secretary of Companies, Doha Qatar
3/19/2012 12/15/2012 Barista/ Coffee Master Esquires Coffee Houses, Abu Dhabi U.A.E 4,500 Aed N/A N/A N

1/10/2006 1/15/2012 Barista/ Coffee Master Starbucks Coffee, Abu Dhabi U.A.E 4,500 Aed N/A N/A N
Vice-Mayor Office, Municipality of
5/1/2000 12/31/2005 Legal Researcher P 5000.00 N/A Job Order N
Peñablanca
 (Continue on separate sheet if necessary)

SIGNATURE DATE April 27, 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

(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
National Irrigation Administration-Regional 02, RTC,
Supervisory Monitoring,Evaluation, and Support (SMES) 12/15/2022 12/16/2022 16 Supervisory
Maddarulug, Solana, Cagayan
National Irrigation Administration-Regional 02, JAPI,
Year-end Supervisory Monitoring,Evaluation, and Support (SMES) 12/72022 12/9/2022 24 Supervisory
Cauayan, Isabela
College of Law, Cagayan State University Andrews
Enhancement Lecture Series- Civil Procedure 4/2/2016 4/2/2016 8 School Activity
Campus
College of Law, Cagayan State University Andrews
Enhancement Lecture Series- Taxation Law 3/6/2016 3/6/2016 8 School Activity
Campus

(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)

Dancing N/A N/A

Computer literate ( Surfing internet, words, excel
and power point)
 (Continue on separate sheet if necessary)

SIGNATURE DATE 4/27/2023

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?
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:
________________________________
________________________________
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.

ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
Vice-Governor Provincial Government of
Remy L. Albano Apayao
9166876223 (passport size)

With full and handwritten

name tag and signature over
printed name
Engineer Ronald Fredeluces Head of Engineering Section DOH-DATRC 9064475593 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 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 ( LET )

ID/License/Passport No.: 0760256

Signature (Sign inside the box)
April 27, 2023
Date/Place of Issuance: Tuguegarao City, 11/5/2002
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