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 SICAD

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

MIDDLE NAME SICAD

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 11/9/1987 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH QUEZON CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 185 F. BENITEZ ST

Widowed Separated House/Block/Lot No. Street

Other/s: PASADENA
Subdivision/Village Barangay
7. HEIGHT (m) 1.67 SA SAN JUAN CITY METRO MANILA
City/Municipality Province
8. WEIGHT (kg) 75 ZIP CODE 1500

9. BLOOD TYPE "O"

18. PERMANENT ADDRESS 185 F. BENITEZ ST
House/Block/Lot No. Street

10. GSIS ID NO. N/A PASADENA

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 105002053930 SAN JUAN CITY METRO MANILA

City/Municipality Province

12. PHILHEALTH NO. 02-0504117929 ZIP CODE 1500

13. SSS NO. 33-9238054-5 19. TELEPHONE NO. N/A

14. TIN NO. 238-033-517 20. MOBILE NO. 09398730089

15. AGENCY EMPLOYEE NO. 000-088-079-000 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SICAD 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME IANNE GILLIAN N/A AKILAH THAYNE BUENALUZ SICAD 07/15/2015

MIDDLE NAME BUENALUZ

OCCUPATION COMPUTER ASSOCIATES

EMPLOYER/BUSINESS NAME MAERKS

BUSINESS ADDRESS ESTANCIA PASIG CITY

TELEPHONE NO. 723-0401

24. FATHER'S SURNAME SICAD

NAME EXTENSION (JR., SR)
FIRST NAME DOMINGO JR

MIDDLE NAME LEGASPI

25. MOTHER'S MAIDEN NAME

SURNAME MAURICIO

FIRST NAME EVELYN

MIDDLE NAME BALIWAG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

SAN JUAN ELEMENTARY

ELEMENTARY PRIMARY EDUCATION 1994 2000 GRADUATED 2000 N/A
SCHOOL
SAN JUAN MUNICIPAL HIGH
SECONDARY
VOCATIONAL / HIGH SCHOOL 2000 2004 GRADUATED 2004 N/A
SCHOOL

N/A
TRADE BACHELOR OF SCIENCE
PHILIPPINE COLLEGE OF
COURSE
COLLEGE IN 2009 2013 GRADUATED 2013 N/A
CRIMINOLOGY
CRIMINOLOGY
GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

BOARD OF CRIMINOLOGY 75.00 9/4/2013 NATIONAL CAPITAL REGION N/A 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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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 (Y/
From To N)

POLICE SENIOR EXECUTIVE MASTER

PRESENT PHILIPPINE NATIONAL POLICE P38,366.00 19-3 PERMANENT Y
SERGEANT

03/15/2019 PRESENT POLICE CORPORAL PHILIPPINE NATIONAL POLICE P30,867.00 12-1 PERMANENT Y

01/01/2018 03/14/2019 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P29,668.00 10 PERMANENT Y

07/06/2015 12/31/2017 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P14,834.00 10 PERMANENT Y

12/13/2013 07/06/2015 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE P14,834.00 10 TEMPORARY Y

(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

(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)

MANDATORY TRAINING ONLY 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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
NATIONAL CAPITAL REGION
PUBLIC SAFETY FIELD TRAINING PROGRAM 12/13/2013 02/23/2015 640 TECHNICAL
TRAINING SCHOOL

(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 full)
(Write in full)

COMPUTER LITERATE MEDALYA NG KAGALINGAN (5) N/A

MEDALYA NG KASANAYAN (15)

MEDALYA NG PAPURI (7)

MEDALYA NG KADAKILAAN (2)

MEDALYA NG PAGLILINGKOD LABAN SA KRIMINALIDAD (2)

MEDALYA NG PAGLILINGKOD SA SANTO PAPA

TSAPA NG NATATANGING YUNIT (1)

COMMENDATIONS (50)

(Continue on separate sheet if necessary)

SIGNATURE DATE 03/04/2021

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
YES ✘ NO
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? ________________________________
________________________________
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 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
A DELAS ALAS ST SANTA ANA the last 6 months
GEO ARIZA COLIBAO MANILA MANILA RIVER CITY 9171929404 3.5 cm. X 4.5 cm
RESIDENCES
#14 CYPRESS ST., APPLE (passport size)

RIZALDY MATITO EXECUTIVE VILLAGE, VALLEY 9209520315 With full and handwritten
GOLF CAINTA RIZAL name tag and signature over
2403 SUN RESIDENCES MAYON printed name
GENESIS CRISTOBAL ALILING ST., QUEZON CITY
9770168700
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
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.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: PHILIPPINE NATIONAL POLICE

ID/License/Passport No.: 19F240784 Signature (Sign inside the box)

Date/Place of Issuance: 06/24/2019 / QUEZON CITY

Date Accomplished Right Thumbmark

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

PLT AMIE M CETRO-TIU

CHIEF, SIDMB
Person Administering Oath

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