CS Form No.

212

P ERSONA L DA T A 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 ACCOM PLISHING 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 ARANCIS
NA M E EXTENSION (J R., SR) N/A
FIRST NAME JAMAICA

MIDDLE NAME GALANG

3. DATE OF BIRTH
07/31/1998 16. CITIZENSHIP
(mm/dd/y y y y ) Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH SAN JUAN, MANILA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

17. RESIDENTIAL ADDRESS M. PEÑARANDA ST.

6 CIVIL STATUS Single Married
House/Block/Lot No. Street
Widowed Separated
WAWA
Other/s: Subdivision/Village Barangay

7. HEIGHT (m) 1.524 TANAY RIZAL

City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 1980
18. PERMANENT ADDRESS M. PEÑARANDA ST.
9. BLOOD TYPE
House/Block/Lot No. Street

10. GSIS ID NO. N/A WAWA

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121226354767 TANAY RIZAL

City/Municipality Province

12. PHILHEALTH NO. 030262953536 ZIP CODE 1980

13. SSS NO. 3475781362 19. TELEPHONE NO. N/A

14. TIN NO. 634924488 20. MOBILE NO. 09978530025

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any ) [email protected]
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/y y y y )
NA M E EXTENSION (J R., SR)
FIRST NAME
N/A
N/A N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ARANCIS

NA M E EXTENSION (J R., SR)
FIRST NAME JAY N/A

MIDDLE NAME LANGRES

25. MOTHER'S MAIDEN NAME

SURNAME GALANG

FIRST NAME LERMA

MIDDLE NAME VILLANUEVA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARS
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE P ERIOD OF HIGHEST LEVEL/ YEA R HIP /
LEVEL ATTENDA NCE UNITS EARNED GRADUATE ACADEM IC
(Write in full) (Write in full)
(if not graduated) D HONORS
From To RECEIVED

ELEMENTARY WAWA ELEMENTARY SCHOOL PRIMARY EDUCATION 2004 2010 GRADUATED 2010 N/A

SECONDARY TANAY NATIONAL HIGH SCHOOL HIGH SCHOOL 2010 2014 GRADUATED 2014 N/A
VOCATIONAL /
N/A
TRADE COURSE
BACHELOR OF SECONDARY
COLLEGE UNIVERSITY OF RIZAL SYSTEM 2014 2018 GRADUATED 2018 N/A
EDUCATION MAJOR IN FILIPINO
CAT GRADUATE STUDIES N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSURE EXAMINATION FOR TEACHER 78.60 10/02/2022 NATIONAL UNIVERSIY 1981890 07/31/2026

(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.
INCLUSIVE DATES SALARY / J OB/
28. PAY GRADE (if
(mm/dd/y y y y ) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY M ONTHLY applicable)& STA TUS OF
GOV'T
SERVICE
(Write in full/Do not abbrev iate) (Write in full/Do not abbrev iate) SALA RY STEP (Format AP P OINTM ENT
(Y/ N)
From To "00-0")/
INCREM ENT

10/09/2023 02/17/2024 STORE CREW ALFAMARKETING INC. 14,000 N/A CONTRACTUAL N

05/01/2018 06/31/2023 TEACHER GREENFIELD MONTESSORI SCHOOL 10,000 N/A CONTRACTUAL N

(Continue on separate sheet if necessary)

SIGNATURE DATE

CS FORM 212 (Revised 2017), P age 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/y y y y ) NUM BER OF POSITION / NATURE OF WORK
HOURS
From To

N/A N/A

(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
Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE NUM BER OF ( M anagerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/y y y y ) HOURS Supervisory/ (Write in full)
Technical/etc)
From To

BASIC COMPUTER LITERACY 01/03/24 01/13/24 80 SUPERVISORY ELTECH LEARNING HUB

(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)

COMPUTER LITERATE N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), P age 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 phased If YES, give details:
out (abolition) in the public or private sector? FINISHED CONTRACT
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 YES NO
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 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
FERLA MILLENDEZ NICOLABO TANAY 9694169669 the last 6 months
3.5 cm. X 4.5 cm
MIRASOL P. PEÑAMORA PILILLA 9392607316 (passport size)

With f ull and handwritten

MARK JOHN P. PERNIA PILILLA 9368197215 name tag and signature ov er
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
is not acceptable
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.P assport, GSIS, SSS, P RC, Driver's

License, etc.) PLEASE INDICATE ID Number
Gov ernment Issued ID: P ROFESSIONAL REGILATION COMMISSION

ID/License/Passport No.: 1981890

Signature (Sign inside the box )

Date/Place of Issuance: 03/08/2023 MANILA

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), P age 4 of 4