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 TABANAO
NAME EXTENSION (JR., SR)
FIRST NAME KEVIN ERNIE

MIDDLE NAME PAJIGAL

3. DATE OF BIRTH
(mm/dd/yyyy) 1/30/1994 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX MALE
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS MARRIED
House/Block/Lot No. Street
HMB TENORIO AWANG
Subdivision/Village Barangay
DATU ODIN SINSUAT MAGUINDANAO
7. HEIGHT (m) 5’6
City/Municipality Province
8. WEIGHT (kg) 80KG ZIP CODE 9601

18. PERMANENT ADDRESS

9. BLOOD TYPE A+
House/Block/Lot No. Street
HMB TENORIO AWANG
10. GSIS ID NO. 2005801833
Subdivision/Village Barangay
DATU ODIN SINSUAT MAGUINDANAO
11. PAG-IBIG ID NO. NA
City/Municipality Province

12. PHILHEALTH NO. NA ZIP CODE 9601

13. SSS NO. NA 19. TELEPHONE NO. NA

14. TIN NO. 768-143-791 20. MOBILE NO. 09052292493

15. AGENCY EMPLOYEE NO. NA 21. E-MAIL ADDRESS (if any) wishtabs@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME SINSUAT 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) DATU ZAIN EESHAN S. TABANAO
FIRST NAME AISA 5/11/2017

MIDDLE NAME SEISMUNDO DATU ZIAN KHALID S. TABANAO 5/5/2018

OCCUPATION GOVERNMENT EMPLOYEE

EMPLOYER/BUSINESS NAME LGU-DATU ODIN SINSUAT

BUSINESS ADDRESS POBLACION DALICAN, DATU ODIN SINSUAT, MAGUINDANAO

TELEPHONE NO. NA

24. FATHER'S SURNAME TABANAO

NAME EXTENSION (JR., SR)
FIRST NAME NESTOR

MIDDLE NAME CORSAME

25. MOTHER'S MAIDEN NAME

SURNAME PAJIGAL

FIRST NAME ERBELLA

MIDDLE NAME MEGRINO (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY ATENEO DE DAVAO UNIVERSITY ELEMENTARY 6/23/2001 6/29/2007 GRADUATED 2007 DIPLOMA

SECONDARY /
VOCATIONAL ATENEO DE DAVAO UNIVERSITY SECONDARY 6/30/2008 7/4/2012 GRADUATED 2012 DIPLOMA

NA NA NA NA NA NA
TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE PHILIPPINE WOMENS COLLEGE OF DAVAO
ENTREPRENEURSHIP
7/7/2015 7/11/2019 GRADUATED 2019 DIPLOMA

GRADUATE STUDIES NA NA NA NA NA NA
(Continue on separate sheet if necessary)

SIGNATURE DATE
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

CIVIL SERVICE ELIGIBILITY PROFESSIONAL 8/4/2019 DAVAO CITY

81.04

(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)
OFFICE OF THE MUNICIPAL VICE MAYOR,
1/1/2022 6/30/2022 ADMINISTRATIVE AIDE III 12713.00 3-1 COTERMINOUS YES
DATU ODIN SINSUAT, MAGUINDANAO
OFFICE OF THE MUNICIPAL VICE MAYOR,
1/1/2021 12/31/2021 ADMINISTRATIVE AIDE III 19085.00 3-1 COTERMINOUS YES
DATU ODIN SINSUAT, MAGUINDANAO
OFFICE OF THE MUNICIPAL VICE MAYOR,
1/2/2020 12/31/2020 ADMINISTRATIVE AIDE III 11219.00 3-1 COTERMINOUS YES
DATU ODIN SINSUAT, MAGUINDANAO
12/1/2014 2/15/2015 ACCOUNT FACILITATOR TRAINEE JRMT RESOURCE CORPORATION 3478.00 NA CONTRACTUAL NO

(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

NA

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

NA

(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)

NA

(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?
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
BAI ANESA S. AMPATUAN #02 ORTOUSTE ST. COTABATO CITY 9274778664 the last 6 months
4.5 cm. X 3.5 cm
(passport size)
POBLACION DALICAN, DATU ODIN
CHERYL MARY ROSE ANN L. SINSUAT SINSUAT
9272411658
Computer generated
DATU MOHAMMAD YASSER S. SINSUAT #02 ORTOUSTE ST. COTABATO CITY 9158581079 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 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: DRIVERS LICENSE

ID/License/Passport No.: L02-14-012956

Signature (Sign inside the box)

Date/Place of Issuance: 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