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 ESTACION
NAME EXTENSION (JR., SR)
FIRST NAME MAXANDRA FAITH

MIDDLE NAME CAMPONG

3. DATE OF BIRTH
(mm/dd/yyyy) 2/7/2001 16. CITIZENSHIP
✘ Filipino Dualby Citizenship
by
birt
naturalization
4. PLACE OF BIRTH CAGAYAN DE ORO CITY, MISAMIS ORIENTAL If holder of dual citizenship,
h
Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Singl Married 17. RESIDENTIAL ADDRESS B1 L1 SAMPAGUITA STREET
e
Wido Separat House/Block/Lot No. Street
wed ed ELENITA HEIGHTS, GARDEN VILLAS CATALUNAN GRANDE
Other Subdivision/Village Barangay
/s: DAVAO CITY DAVAO DEL SUR
7. HEIGHT (m) 1.52
City/Municipality Province
8. WEIGHT (kg) 68 ZIP CODE

9. BLOOD TYPE O 18. PERMANENT ADDRESS B1 L1 SAMPAGUITA STREET

House/Block/Lot No. Street

10. GSIS ID NO. N/A ELENITA HEIGHTS, GARDEN VILLAS CATALUNAN GRANDE
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A DAVAO CITY DAVAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 8000

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

14. TIN NO. N/A 20. MOBILE NO. 09679117087

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

FIRST NAME N/A

NAME EXTENSION (JR., SR) N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ESTACION

FIRST NAME MAXIMO III

MIDDLE NAME PATRIANA

25. MOTHER'S MAIDEN NAME

SURNAME CAMPONG

FIRST NAME LETECIA

MIDDLE NAME LOMPON (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 MANOLO FORTICH CENTRAL ELEMENTARY ELEMENTARY 2010 2014 N/A 2014 ACADEMIC
SCHOOL HONORS

SECONDARY BROKENSHIRE COLLEGE SHS - HUMANITIES AND SOCIAL SCIENCES 2018 2020 N/A 2020 ACADEMIC
VOCATIONAL / HONORS

N/A N/A N/A N/A N/A

TRADE
COURSE
COLLEGE UNIVERSITY OF MINDANAO BACHELOR OF ARTS IN POLITICAL SCIENCE 2020 2024 N/A 2024 DEAN'S
LISTER

GRADUATE STUDIES UNIVERSITY OF MINDANAO JURIS DOCTOR 2024 PRESENT N/A N/A EBSU
SCHOLAR
(Continue on separate sheet if necessary)

SIGNATURE DATE January 25, 2025

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

(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

(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)

(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?
NO
YES
If YES, give details:
________________________________
________________________________

b. Have you been criminally charged before any court? NO

YES
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? NO
YES
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 NO
YES give details:
If YES,
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 (except
Barangay election)? NO
YES
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last NO
election to promote/actively campaign for a national or local candidate? YES
If YES, give details:

39. Have you acquired the status of an immigrant or permanent resident of another country?
NO
YES
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?
NO
YES
If YES, please specify:
b. Are you a person with disability? NO
YES
If YES, please specify ID No:
c. Are you a solo parent? NO
YES
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