CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME ARREGLADO
NAME EXTENSION (JR., SR)
FIRST NAME ALWYN

MIDDLE NAME DELFIN

3. DATE OF BIRTH
11/26/2005 16. CITIZENSHIP Dual
(mm/dd/yyyy) ✘ Filipino
Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH PUROK-1 MARGOS KAPATAGAN LANAO DEL NORTE
If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male MALE
✘ Female

6 CIVIL STATUS
✘ Single SINGLE Married 17. RESIDENTIAL ADDRESS PUROK-1
Widowed Separated House/Block/Lot No. Street
MARGOS
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5'2'' KAPATAGAN LANAO DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 49 9214
18. PERMANENT ADDRESS PUROK-1
9. BLOOD TYPE o
House/Block/Lot No. Street
MARGOS
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A KAPATAGAN LANAO DEL NORTE

City/Municipality Province
12. PHILHEALTH NO. N/A 9214 9214
13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. N/A 20. MOBILE NO. 09754785914
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) Alwyndelfin@gmail.com
II. FAMILY BACKGROUND
23. NAME of CHILDREN (Write full name and list
22. SPOUSE'S SURNAME N/A all)
DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) Jaysan D. Arreglado
FIRST NAME N/A 04/25/1994
Aljohn D. Arreglado
MIDDLE NAME N/A 9/7/1995
Joelito D. Arreglado jr.
OCCUPATION N/A 04/24/2004
Alwyn D. Arreglado
EMPLOYER/BUSINESS NAME N/A 11/26/2005

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ARREGLADO

SR.
FIRST NAME JOELITO

MIDDLE NAME INCIO

25. MOTHER'S MAIDEN NAME

SURNAME ARREGLADO

FIRST NAME SUSANA

MIDDLE NAME DELFIN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF LEVEL/ SCHOLARSHIP/
26. YEAR
ATTENDANCE UNITS ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From
graduated)
ELEMENTARY margos elementary school 2018
VOCATIONAL /
SECONDARY
VOCATIONAL /

TRADE
COURSE
COLLEGE TRADE
COURSE
GRADUATE STUDIES

(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
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

none none none none none

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

none none none none none none none

 (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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

none none none none none

(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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

none none none none none none

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
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 ✘ 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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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
YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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
a.
items:
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
VELLMA LOU L. BONTILAO PMNHS, KAPATAGAN, LDN 0927-4947-739 3.5 cm. X 4.5 cm
(passport size)

SOBOSOBO P. DIMALAWANG PMNHS, KAPATAGAN, LDN 0956-166-8148 With full and handwritten
name tag and signature over
printed name
LEAH U. CINCO PMNHS, KAPATAGAN, LDN 0956-7632-686
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 PHOTO
filing of 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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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