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 DELA CRUZ
FIRST NAME JUAN NAME EXTENSION (JR., SR) JR
MIDDLE NAME UY
3. DATE OF BIRTH
04/20/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH DIGOS, DAVAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 0147 CURVE ST.
Widowed House/Block/Lot No. Street
Separated
ZONE 3
Other/s: Subdivision/Village Barangay
7. HEIGHT (m) 1.67 DIGOS DAVAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 54 ZIP CODE 8002

9. BLOOD TYPE O+
18. PERMANENT ADDRESS SELDA
House/Block/Lot No. Street

10. GSIS ID NO. N/A PEOPLES VILLAGE MA-A

Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A DAVAO DAVAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 1605-222222-22 ZIP CODE 8000

13. SSS NO. N/A 19. TELEPHONE NO. 082-237-1111

14. TIN NO. 437 987 540 000 20. MOBILE NO. 09101234567

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) juan_delacruz@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME DELA CRUZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) SCARLETTE SNOW LIM DELA CRUZ

FIRST NAME JUANITA N/A 10/01/2016

MIDDLE NAME LIM ZIA CADENCE LIM DELA CRUZ 02/05/2018

OCCUPATION N/A

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME DELA CRUZ

NAME EXTENSION (JR., SR)
FIRST NAME PEDRO JR.

MIDDLE NAME PENDUKO

25. MOTHER'S MAIDEN NAME

SURNAME UY

FIRST NAME STARLA

MIDDLE NAME GO (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
From To

ELEMENTARY MA-A ELEMENTARY SCHOOL ELEMENTARY 2001 2007 GRADUATED 2001 N/A

DAVAO DEL SUR NATIONAL HIGH WITH

SECONDARY
VOCATIONAL / HIGH SCHOOL 2007 2011 GRADUATED 2005
SCHOOL HONORS

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

TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE UNIVERSITY OF MINDANAO DAVAO 2011 2015 GRADUATED 2013 CUM LAUDE
ACCOUNTANCY
MASTER IN BUSINESS
GRADUATE STUDIES UNIVERSITY OF MINDANAO DAVAO 2016 2019 42 UNITS N/A
ADMINISTRATION
(Continue on separate sheet if necessary)

SIGNATURE DATE 05/02/2023

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER LICENSE (if applicable)
RATING DATE OF EXAMINATION
SPECIAL LAWS/ CES/ CSEE PLACE OF EXAMINATION / CONFERMENT
(If Applicable) / CONFERMENT NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
Validity
PALMA GIL ELEMENTARY SCHOOL -
CAREER SERVICE PROFESSIONAL 85.50 04/17/2016 N/A N/A
QUIRINO AVE. DAVAO CITY

PROFESSIONAL TEACHER 86.71 05/10-12/2015 UNIVERSITY OF MINDANAO MATINA CAMPUS 123456 04/20/2020

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

07/16/2018 PRESENT AUDITOR SNB ACCOUNTING FIRM 42,000.00 REGULAR N

CONTRACTUA
04/24/2015 07/15/2018 ACCOUNTING STAFF RJE GENERAL MERCHANDISE 17,000.00 N
L

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/02/2023

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

FINANCIAL REPORTING vs TAX REPORTING 10/11/2018 10/15/2018 40 TECHNICAL BUREAU OF INTERNAL REVENUE

BOOKKEEPING SEMINAR 07/25/2017 07/28/2017 32 TECHNICAL BUREAU OF INTERNAL REVENUE

TAXATION SEMINAR 04/25/2017 04/25/2017 8 TECHNICAL BUREAU OF INTERNAL REVENUE

SMALL AND MEDIUM ENTERPRISE SEMINAR 08/21/2016 08/22/2016 16 TECHNICAL DEPARTMENT OF TRADE AND INDUSTRY
LAPANDAY SKILLS TRAINING CENTER-
BASIC COMPUTER APPLICATIONS 04/16/2011 05/15/2011 120 TECHNICAL TECHNICAL SKILLS EDUCATION
DEVELOPMENT AUTHORITY

(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
(Write in full)
in full)
PHILIPPINE INSTITUE OF CERTIFIED PUBLIC
COMPUTER LITERATE N/A
ACCOUNTANT
DRIVING

AUDITING

WRITING

BOOKKEEPING

DANCING

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/02/2023

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
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? RESIGNATION
________________________________
________________________________
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: KALAGAN
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
CARDO DALISAY MATINA, DAVAO CITY 09081234567 3.5 cm. X 4.5 cm
(passport size)

RENATO HIPOLITO MA-A, DAVAO CITY 082-237-0852 With full and handwritten
name tag and signature over
printed name
OSCAR HIDALGO HAGONOY, DVO. DEL SUR 09129876543
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: DRIVER'S LICENSE

ID/License/Passport No.: L03-15-051234

Signature (Sign inside the box)
05/02/2023
Date/Place of Issuance: 04/20/2018 - DIGOS 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