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 C

I. PERSONAL INFORMATION
2. SURNAME PULIDO
NAME EXTENSION (JR., SR) N/A
FIRST NAME JERANO PAULO

MIDDLE NAME BELLIDO

3. DATE OF BIRTH
(mm/dd/yyyy)
8/9/1988 16. CITIZENSHIP

4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 292 M.H.DEL PILAR
House/Block/Lot No. Street
N/A POBLACION
Subdivision/Village Barangay
7. HEIGHT (m) 1.67 KABACAN NORTH COTABATO
City/Municipality Province
8. WEIGHT (kg) 76 ZIP CODE 9407

18. PERMANENT ADDRESS 292 M.H.DEL PILAR

9. BLOOD TYPE N/A
House/Block/Lot No. Street
N/A POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay
KABACAN NORTH COTABATO
11. PAG-IBIG ID NO. 121134142048
City/Municipality Province

12. PHILHEALTH NO. 17-025300439-0 ZIP CODE 9407

13. SSS NO. 09-3855499-0 19. TELEPHONE NO. N/A

14. TIN NO. 319-987-352 20. MOBILE NO. 0926-529-8385

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/d
NAME EXTENSION (JR., SR)N/A N/A
FIRST NAME N/A N/A

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME PULIDO N/A N/A

NAME EXTENSION (JR.,SR)N/A N/A
FIRST NAME JERRY N/A

MIDDLE NAME DULAY N/A N/A

25. MOTHER'S MAIDEN NAME ANA MALAYSIA BAUTISTA BELLIDO N/A N/A

SURNAME PULIDO N/A N/A

FIRST NAME ANA MALAYSIA N/A N/A

MIDDLE NAME BELLIDO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY NOTRE DAME OF KABACAN PRIMARY EDUCATION 1995 2001 N/A 2005

SECONDARY
VOCATIONAL / NOTRE DAME OF KABACAN HIGH SCHOOL 2001 2005 N/A 2005

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

TRADE
COURSE
COLLEGE NOTRE DAME UNIVERSITY AB PHILOSOPHY 2005 2009 N/A 2005

GRADUATE STUDIES UNIVERSITY OF MINDANAO BACHELOR OF LAWS 2009 2013 N/A 2005

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017),
L DATA SHEET
ce Sheet shall cause the filing of administrative/criminal case/s against the person concerned.

DS FORM.
(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Pls. indicate country:

M.H.DEL PILAR
Street
POBLACION
Barangay
NORTH COTABATO
Province
9407

M.H.DEL PILAR
Street
POBLACION
Barangay
NORTH COTABATO
Province

N/A

0926-529-8385

[email protected]

DATE OF BIRTH (mm/dd/yyyy)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED
 SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED

N/A

N/A

N/A

DEAN'S
LISTER
FIRST
HONOR
n separate sheet if necessary)

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

BAR PASSER 83.25 6/17/2016 UNIVERSITY OF SANTO TOMAS 65318 N/A

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
1/17/2019 PRESENT ATTORNEY III DEPARTMENT OF PUBLIC WORKS AND 52554.00 21 PERMANENT Y
HIGHWAYS
1/4/2018 6/13/2018 PRIVATE LAWYER PULIDO LAW OFFICE 30000.00 N/A N/A N

7/31/2016 9/15/2017 PRIVATE LAWYER QUITAIN LAW OFFICE 15000.00 N/A N/A N

1/8/2016 9/15/2017 TECHNICAL ADVISER CITY COUNCILOR QUITAIN'S OFFICE 20000.00 N/A N/A N

1/6/2017 10/31/2017 LAW PROFESSOR RIZAL MEMORIAL COLLEGES 4000.00 N/A N/A N

1/1/2017 10/31/2017 BIOETHICS COMMITTEE MEMBER METRO DAVAO MEDICAL & RESEARCH N/A N/A N/A N
CENTER,INC.
1/2/2011 11/30/2012 PARALEGAL & BILLING OFFICER TORREON LAW FIRM 10000.00 N/A N/A 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

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

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

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

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

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

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

N/A N/A N/A 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 ATTENDANCE Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

MANDATORY CONTINUING LEGAL EDUCATION 10/25/2017 10/26/2017 16.0 N/A INTEGRATED BAR OF THE PHILIPPINES

BIOETHICS ISSUES SYMPOSIUM 1/13/2017 1/13/2017 4.0 N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
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 out (abolition) in the If YES, give details:
public or private sector? RESIGNATION
________________________________
________________________________
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:
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 local candidate? If YES, give details:

39. Have you acquired the status of an immigrant or permanent resident of another country?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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 w
the last 6 month
COA COMMISSIONER ROLAND PONDOC MANILA 931-9207 3.5 cm. X 4.5 cm
(passport size

ATTY. J. MELCHOR QUITAIN, JR. DAVAO CITY 227-4248 With full and handw
name tag and signatu
printed name
ATTY. ANGELITO RAMOS DAVAO CITY 222-1865
Computer genera
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied pic
is not acceptab
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: DRIVER'S LICENSE

ID/License/Passport No.: M06-09-004271

Signature (Sign inside the box)

Date/Place of Issuance: 08/16/2016 DAVAO CITY

Date Accomplished Right Thumbma

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above

Person Administering Oath

CS FORM 212 (Revis

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details (country):

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO
 Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4