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 DUDO
NAME EXTENSION (JR., SR)
FIRST NAME ARJAY

MIDDLE NAME GABRIEL

3. DATE OF BIRTH
7/5/1998 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH Lambayong, Sultan Kudarat If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separated
Linglingay Poblacion
Other/s:
Subdivision/Village Barangay
Lambayong Sultan Kudarat
7. HEIGHT (m) 1.78
City/Municipality Province
8. WEIGHT (kg) 72 ZIP CODE 9802

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. Street
Linglingay Poblacion
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LAMBAYONG SULTAN KUDARAT
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 17-251585512-8 ZIP CODE 9802

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

14. TIN NO. 000865491063 20. MOBILE NO. 0938 203 4794

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) trojan4avast2@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)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A
N/A
MIDDLE NAME N/A N/A
N/A
OCCUPATION N/A N/A
N/A
EMPLOYER/BUSINESS NAME N/A N/A
N/A
BUSINESS ADDRESS N/A N/A
N/A
TELEPHONE NO. N/A N/A
N/A
24. FATHER'S SURNAME DUDO N/A
NAME EXTENSION (JR., SR) N/A
FIRST NAME RAMON N/A
N/A
MIDDLE NAME JAVIER N/A
N/A
25. MOTHER'S MAIDEN NAME VILLANUEVA N/A
N/A
SURNAME DUDO N/A
N/A
FIRST NAME MERCEDES N/A

MIDDLE NAME GABRIEL (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

LAMBAYONG CENTRAL ELEMENTARY

ELEMENTARY
SCHOOL
N/A 6/6/2004 4/4/2010 N/A 2010 N/A

SECONDARY
VOCATIONAL / NOTRE DAME OF LAMBAYONG INC. N/A 6/6/2010 04/042014 N/A 2014 N/A

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

TRADE
BACHELOR OF SCIENCE IN INFORMATION
COURSE
COLLEGE SULTAN KUDARAT STATE UNIVERSITY
TECHNOLOGY
11/11/2016 10/12/2021 N/A 2021 NA

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE September 7, 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

DRIVER'S LICENSED N/A N/A N/A M07-18-004421 7/5/2028

(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)

09/20/2022 1/6/2023 IT STAFF A & G LPG SUPPLY 8000.00 N/A JO N

10/2/2022 04/20/2022 DP COORDINATOR VITARICH CORPORATION 7000.00 N/A JO N

(Continue on separate sheet if necessary)

SIGNATURE DATE September 7, 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
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

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

(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)

COMPUTER TECHNICIAN N/A N/A

UI/UX DESIGNER N/A N/A

CELLPHONE REPAIR N/A N/A

MS OFFICE N/A N/A

PHOTO/VIDEO EDITOR N/A N/A

WEB DEVELOPER N/A N/A

SYSTEM ANALYST N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE September 7, 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 ✘

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
by any court or tribunal? YES ✘ NO
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:
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
4.5 cm. X 3.5 cm
(passport size)

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 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.: M07-18-004421

Signature (Sign inside the box)
September 7, 2023
Date/Place of Issuance: 05/11/2023 - TACURONG CITY DO
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this Arjay Gabriel Dudo , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4