CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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. D1. CS ID N (Do not fill up. For CSC use only)
I. PERSONAL INFORMATION
2. SURNAME ALFORTE
NAME EXTENSION
FIRST NAME JANICE

MIDDLE NAME OLIVA

3. DATE OF BIRTH
(mm/dd/yyyy) 3/25/1997 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH POBLACION, QUEZON, PALAWAN If holder of dual citizenship, Pls. indicate country: PHILIPPI
please indicate the details.
5. SEX FEMALE
17. RESIDENTIAL ADDRES NA SITTIO SPRINGSIDE
6 CIVIL STATUS SINGLE
House/Block/Lot No. Street
NA POBLACION
Subdivision/Village Barangay
7. HEIGHT (m) 50cm ABORLAN PALAWAN
City/Municipality Province
8. WEIGHT (kg) 67kg ZIP CODE 5302

18. PERMANENT ADDRES NA SITTIO SPRINGSIDE

9. BLOOD TYPE AB
House/Block/Lot No. Street
NA POBLACION
10. GSIS ID NO. NA
Subdivision/Village Barangay
11. PAG-IBIG ID NO. NA ABORLAN PALAWAN
City/Municipality Province

2. PHILHEALTH NO. NA ZIP CODE 5302

3. SSS NO. NA 19. TELEPHONE NO NA

14. TIN NO. NA 20. MOBILE NO 09385260684

15. AGENCY EMPLOYEE NO. NA 21. E-MAIL ADDRESS (if an alfortejanice@gmail.com

II. FAMILY BACKGROUND

23. NAME of CHILDREN (Write full name and DATE OF BIRTH
22 SPOUSE'S SURNAME NA list all) (mm/dd/yyyy)
FIRST NAME
NAME EXTENSION (JR., SR) SAMANTHA JEAN A. REJANO
5/10/2018

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAM

BUSINESS ADDRESS

TELEPHONE NO.

24.ATHER'S SURNAME ALFORTE

NAME EXTENSION (SR)
FIRST NAME WELINTON

MIDDLE NAME MASDO

25 MOTHER'S MAIDEN NAME

SURNAME OLIVA

FIRST NAME BEVERLY

MIDDLE NAME BUENAFLOR (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

PERIOD OF SCHOLARSHIP
26. HIGHESTLEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE ATTENDANCE YEAR / ACADEMIC
LEVEL UNITSEARNED
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
From To RECEIVED

ELEMENTARY QUEZONCENTRAL SCHOOL ELEMENTARY 2003 2009 2009 NA

SECONDARY QUEZONNATIONAL HIGHSCHOOL HIGHSCHOOL 2009 2013 2013

VOCATIONAL /
TRADE COURSE
NA
PALAWAN STATE UNIVERSITY(QUEZON BACHELOR OF SCIENCE IN 2013 2017 26 UNITS FOR
COLLEGE PALAWAN), WESTERN PHILIPPINES AGRICULTURE AND CERTIFICATE IN PROFESSIONA 2017
UNIVERSITY(ABORLAN) TEACHING PROGRAM 2019 2020 L EDUCATION

GRADUATE STUDIES NA

(Continue on separate sheet if necessary)

SIGNATURE DATE April 11, 2024

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

LICENSED PROFESSIONAL TEACHER 80.4 11/2/2022 PUERTO PRINCESSA CITY 2043291 3/25/2026

(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/ PAY
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if applicable)& STATUS OF GOV'T SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY STEP (Format "00 APPOINTMENT (Y/ N)
-0")/ INCREMENT
From To
FRANSSELL EMPLOYMENT AND
11/14/2022 5/9/2023 SALES ASSOCIATE 7500.00 N
SERVICE PROVIDER AGENCY

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 11, 2024
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

NA

(Continue on separate sheet if necessary)

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

PERSONAL COMPUTER OPERATION 5/3/2023 5/20/2023 120 HRS TECHNICAL ANTIPULUAN COLLEGE OF TECHNOLOGY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

ABILITY TO WORK INDEPENDENTLY AS

NA NA
WELL AS PART OF THE TEAM
ABLE TO LEARN NEW TASKS AND
PERFORM THE ASSIGNED TASKS QUICKLY
STRONG ABILITIES TO TAKE AND FOLLOW
INSTRUCTIONS
STRONG VERBAL AND WRITTEN
COMMUNICATION SKILLS
COMPUTER LITERATE

ATTENTION TO DETAIL

THRIVE UNDER PRESSURE

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 11, 2024

CS FORM 212 (Revised 2017), Page 3 of 4
34. Are you related by consanguinity or affinity to the appointing or recommending
chief of bureau or office or to the person who has immediate supervision over
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:
NO

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
NO

b. Have you been criminally charged before any court?

NO
Date Filed:
tatus 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:
NO

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 If YES, give details:
term, finished contract or phased out (abolition) in the public or private sector? NO
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: NO
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 If YES, give details: NO
local candidate?
39. Have you acquired the status of an immigrant or permanent resident of another
country?
If YES, give details (country):
NO
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)
a. please
Are you aanswer
member theoffollowing items: group?
any indigenous
If YES, please specify: NO
b. Are you a person with disability?
If YES, please specify ID No: NO
c. Are you a solo parent?
If YES, please specify ID No: NO

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

ID picture taken within
NAME ADDRESS TEL. NO. the last 6 months
4.5 cm. X 3.5 cm
BEVERLY P. CADAYDAYON PUERTO PRINCESSA CITY 9126136573 (passport size)

BGY. MAASIN, BROOKE'S POINT, Computer generated

CELIA R. NAIBAN PALAWAN 9467200137 or photocopied picture
is not acceptable

JESSA S. REY BGY. IRAAN, ABORLAN, PALAWAN 9972012024

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 PHOTO
misrepresentation made in this document and its attachments shall cause the 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: PROFESSIONAL IDENTIFICATION CARD

ID/License/Passport No.2043291
Signature (Sign inside the box)

Date/Place of Issuance: 05/08/2023- PUERTO PRINCESSA 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

Yes/No Cstat Gender
Yes Single Male
No Married Female
Separated
Widowed