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 CAPOY
NAME EXTENSION (JR., SR)
FIRST NAME ELEANOR

MIDDLE NAME CASANOVA

3. DATE OF BIRTH
AUGUST 14, 1963 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH PALUAN, OCCIDENTAL MINDORO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street
✘ Widowe Separat
BRGY. BAGUA III
dOther/s: ed
Subdivision/Village Barangay
COTABATO CITY
7. HEIGHT (m) 5'1 ft
City/Municipality Province
8. WEIGHT (kg) 55 kg ZIP CODE 9600

18. PERMANENT ADDRESS 002-P T.V. JULIANO AVE.

9. BLOOD TYPE B+
House/Block/Lot No. Street
COTABATO CITY
10. GSIS ID NO. 63081401791
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1940-0024-5684

City/Municipality Province

12. PHILHEALTH NO. 19-000398565-6 ZIP CODE 9600

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 176-176-800 20. MOBILE NO. 09064280814

15. AGENCY EMPLOYEE NO. 4270828 21. E-MAIL ADDRESS (if any) NONE

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME CAPOY 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JESSA MANE C. CAPOY
FIRST NAME CELSO 8/12/1982
ANN-CHERL C. CAPOY
MIDDLE NAME SALDOVAL 05/30/1984
SYLVESTER C. CAPOY
OCCUPATION GOVERNMENT EMPLOYEE 5/7/1989

EMPLOYER/BUSINESS NAME PHILIPPINE POSTAL CORPORATION

BUSINESS ADDRESS DAVAO CITY

TELEPHONE NO. NONE

24. FATHER'S SURNAME CASANOVA

NAME EXTENSION (JR., SR)
FIRST NAME DOMINADOR

MIDDLE NAME ENRIQUEZ

25. MOTHER'S MAIDEN NAME

SURNAME ROBLES

FIRST NAME DOLORES

MIDDLE NAME TAPIRI (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MAMBURAO CENTREL ELEM. SCHOOL PRIMARY EDUCATION GRADUATED 1976

SECONDARY WEST MINDORO ACADEMY HIGH SCHOOL GRADUATED 1980

VOCATIONAL /

NOTRE DAME UNIVERSITY 3RD YEAR BSE

TRADE
COURSE
COLLEGE PHILIPPINE HARVARDIAN COLLEGE BACHELOR OF ARTS GRADUATED 1990

GRADUATE STUDIES COTABATO POLYTECHNIC COLLEGE MASTER IN PUBLIC ADMINISTRATION GRADUATED 2008
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

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

(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

PERSONNEL OTHERS OF PHIL 6/21/1905 TO PRESENT MEMBER

(Continue on separate sheet if necessary)

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

SEMINAR-WORKSHOP ON APPIONTMENT & OTHER PERSONNEL ACTIONS 2/9/1987 4/9/1987 24.0 ADMINISTRATIVE CIVIL SERVICE COMMISSION-XII

COMMUNICATION SKILLS IMPROVEMENT 1/10/1992 10/21/1992 24.0 ADMINISTRATIVE

CIVIL SERVICE COMMISSION-XII

TOTAL QUALITY MANAGEMENT 1/9/1999 3/9/1999 24.0 ADMINISTRATIVE

POAP
HRM PARADIGMS Y2K 1/12/1999 3/12/1999 24.0 ADMINISTRATIVE
POAP
BUILDING LINKAGES & ALLIANCES:Institution Partnership for Effective HRM 6/12/2000 8/12/1999 24.0 ADMINISTRATIVE
POAP
ADVANCED HRM SKILLS 08/14/2018 08/17/2018 32.0 ADMINISTRATIVE
POAP
EFFECTIVE PUBLIC MANAGEMENT 07/24/2018 07/27/2018 32.0 SUPERVISORY
POAP

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE

(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
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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES NO
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
administrative/criminal case/s against me. PHOTO

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