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.

I. PERSONAL INFORMATION
2. SURNAME GUINSAN

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

MIDDLE NAME DE JESUS

3. DATE OF BIRTH
(mm/dd/yyyy) 5/30/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalizat

4. PLACE OF BIRTH DUMAGUETE CITY, NEG. OR. If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS 47
Widowed Separated House/Block/Lot No.
PUROK 2
Other/s:
Subdivision/Village

7. HEIGHT (m) 1.62m SANTO DOMINGO

City/Municipality
8. WEIGHT (kg) 57kg ZIP CODE 4508

9. BLOOD TYPE AB+

18. PERMANENT ADDRESS 47
House/Block/Lot No.

10. GSIS ID NO. NONE PUROK 2

Subdivision/Village
SANTO DOMINGO
11. PAG-IBIG ID NO. 121261318325
City/Municipality

12. PHILHEALTH NO. 100253733750 ZIP CODE 4508

13. SSS NO. 34-8406228-9 19. TELEPHONE NO. N/A

14. TIN NO. 363-769-923-000 20. MOBILE NO. 09859886474

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) guinsanjophenna@gm
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME GUINSAN

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

25. MOTHER'S MAIDEN NAME

SURNAME DE JESUS

FIRST NAME WELMA

MIDDLE NAME BABOR (Continue on separate sheet if n

III. EDUCATIONAL BACKGROUND

26. PERIOD OF ATTENDANCE HIGHEST LEVEL/

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

ELEMENTARY
ELEMENTARY SOUTH CITY ELEMENTARY SCHOOL PRIMARY 6/4/2001 4/5/2007
GRADUATE

HIGH SCHOOL
SECONDARY DUMAGUETE CITY HIGH SCHOOL HIGH SCHOOL 6/10/2009 4/7/2013
VOCATIONAL / GRADUATE

NONE N/A N/A N/A N/A

TRADE
COURSE BACHELOR OF SECONDARY- SOCIAL
COLLEGE RIZAL TECHNOLOGICAL UNIVERSITY 6/12/2014 6/14/2019 COLLEGE GRADUATE
STUDIES

GRADUATE STUDIES NONE N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
L DATA SHEET
ing of administrative/criminal case/s against the person concerned.

PDS FORM.
(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

by naturalization

Pls. indicate country:

SAN PEDRO STREET

Street
BRGY. SAN PEDRO
Barangay
ALBAY
Province
4508
SAN PEDRO STREET
Street
BRGY. SAN PEDRO
Barangay
ALBAY
Province

09859886474

guinsanjophenna@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

(Continue on separate sheet if necessary)

YEAR GRADUATED SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

 YEAR GRADUATED SCHOLARSHIP/ ACADEMIC HONORS RECEIVED

2007 NONE

2013 ATHLETIC RECOGNITION; MERIT AWARDEE

N/A N/A

2019 ATHLETIC SCHOLARSHIP AWARDEE

N/A N/A
on separate sheet if necessary)

April 14, 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

(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)
 (Continue on separate sheet if necessary)

SIGNATURE DATE
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

(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

(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)
 (Continue on separate sheet if necessary)

SIGNATURE DATE
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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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? ________________________________
________________________________
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:

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
(passport size)

With full and handwritten

name tag and signature over
printed name

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.: 1811049
Signature (Sign inside the box)

Date/Place of Issuance: 12/18/2023

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