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STANDARD SIZE: 10
PERO PWEDE LIITAN BASTA NABABASA
PA DIN PO YUNG TEXT/MAGKASYA SA
BOX

PWEDE DIN PO MAG INSERT NG ROW IF FULL DATE

MAY ADDITIONAL COURSE NA NATAPOS
Personal Data Sheet Page 2
Size: 10 / ARIAL / BOLD
Sana po
hindi
expired. 

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Personal Data Sheet Page 2

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1. Most recent work experience po sa pinakataas pababa.
 Personal Data Sheet Page 3

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 TECHNICAL
PERSONAL DATA SHEET PAGE 3 LANG PO LAGI
NILALAGAY
DITO

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MAY NOTE PO SA NEXT SLIDE PAANO MAGSAGOT

DITO
PERSONAL DATA SHEET PAGE 3
NOTE:
1. Most recent training po sa pinakataas pababa. (kapag naka 5 yrs na do not include na)
2. Relevant training/program for the last 5 years ONLY.
3. Kung ano pong title sa certificate yun po ilalagay ninyo.
NO ABBREVIATIONS sa “title” at “conducted/sponsored by.”
ex. ✔ DEPARTMENT OF EDUCATION – DIVISION OF RIZAL
✘ DEPED / DEPED RIZAL / PANTAY NHS / PNHS / DEPED TERESA DISTRICT
4. STANDARD SIZE: 10 PERO PWEDE LIITAN BASTA NABABASA PA DIN PO YUNG
TEXT/MAGKASYA SA BOX.
5. Kung ang training nyo po ay staggered date;
ex. DATE OF SEMINAR:
FROM: TO: NUMBER OF HOURS:
✘ 01/21, 25, 27/2020 01/ 31/2020 N/A
✔ 01/21/2020 01/31/2020 16.0

- ito po ang tama kasi sa no. of hours dun nyo naman po ideclare ilang oras kayo let’s say na
4days nga yung seminar nyo pero halfday lang/4hrs per day lang po yun (eh di 4hrs per day times
4days = 16 hrs.
- usually nakalagy din naman po sa certificate ang no. of hours completed
PERSONAL DATA SHEET PAGE 3

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 Personal Data Sheet Page 4

34. Are y ou 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 super vision ov er y ou in the Office,
Bureau or Department where y ou will be apppointed,
a. within the third degree? YES NO
b. within the fourth degree (for Local Gov ernment Unit - Career Employ ees)? YES NO
If YES, giv e details:

35. a. Hav e y ou ev er been found guilty of any administrativ e offense? YES NO

If YES, giv e details:
________________________________ 34 b.
b. Hav e y ou been criminally charged before any court? YES
If YES, giv e details:
NO
wala pong ichecheck dyan
kasi po for LGU yan.
________________________________
Date Filed:
Status of Case/s:
36. Hav e you ev er been convicted of any crime or v iolation of any law, decree, ordinance or
regulation by any court or tribunal?
YES
If YES, giv e details:
NO
Thanks 
________________________________

37. Hav e you ev er been separated from the serv ice in any of the following modes: resignation, YES NO
retirement, dropped from the rolls, dismissal, termination, end of ter m, finished contr act or phased If YES, giv e details:
out (abolition) in the public or private sector? RESIGNATION
38. a. Hav e y ou ev er been a candidate in a national or local election held within the last y ear (except
YES NO
Barangay election)? If YES, giv e details:
b. Hav e y ou resigned from the gov ernment serv ice during the three (3)-month period before the YES NO
last election to promote/actively campaign for a national or local candidate? If YES, giv e details:

39. Hav e you acquired the status of an immigrant or permanent resident of another country ?
YES NO
If YES, giv e 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 y ou a member of any indigenous group? YES NO
. If YES, please specify :
b Are y ou a person with disability ? YES NO
. If YES, please specify ID No:
c Are y ou a solo parent? YES NO
. If YES, please specify ID No:
 Personal Data Sheet Page 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 superv ision over y ou 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 Employ ees)? YES NO
If YES, give details:

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

b. Have you been criminally charged before any court?

37.
YES NO
If YES, give details:
________________________________
Date Filed:
Status of Case/s: If nagresign/natapos ang
36. Hav e y ou ever been conv icted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
YES
If YES, give details:
NO

________________________________
kontrata sa dating work
37. Hav e y ou ever been separated from the serv ice in any of the following modes: resignation, YES NO
(private or pubic) ang
ichecheck po dito ay:
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
a. Have you ev er been a candidate in a national or local election held within the last year (except

✔ YES
38.
YES NO
Barangay election)? If YES, give details:

b. Have you resigned from the government serv ice during the three (3)-month period before the
last election to promote/actively campaign for a national or local candidate?
YES
If YES, give details:
NO
Details: RESIGNATION
39. Hav e y ou acquired the status of an immigrant or permanent resident of another country?
YES NO
If YES, give details (country):
Or FINISHED CONTRACT
40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
Alin po sa dalawang yan.
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:
 PERSONAL DATA SHEET PAGE 4
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
NAD DEE SAN MATEO 650-2639 3.5 cm. X 4.5 cm

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(passport size)

AUGUST LERONA SAN MATEO 650-2639 With f ull and handwritten

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name tag and signature ov er
printed name
JASON ANTAZO RODRIGUEZ RIZAL 650-2639
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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 BOLD
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.

Gov ernment Issued ID (i.e.P assport, GSIS, SSS, P RC, Driver's

License, etc.) PLEASE INDICATE ID Number
Gov ernment Issued ID: PRC

ID/License/Passport No.: 9323222

Signature (Sign inside the box )

Date/Place of Issuance: 01/31/2017

May 31, 2018
Date Accomplished Right Thumbmark

FULL DATE
SUBSCRIBED AND SWORN to before me this May 31, 2018 , affiant ex hibiting his/her validly issued government ID as indicated above.

SAGUTAN NYO LANG

PO TIMOTHY A. BAUTISTA
Person Administering Oath

CS F ORM 212 (Revised 2017), P age 4 of 4

NOTE:
• SAVE YOUR PDS with file name:
PDS of LAST NAME, FIRST NAME MIDDLE NAME

Ex: PDS of DELA CRUZ, JUAN ANTONIO

• Submmit/send your final PDS to your department head. Thank you.

Thank you!