CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 APAITAN

FIRST NAME PAULO LOUISE NAME EXTENSION (JR., SR)

MIDDLE NAME FARINAS

3. DATE OF BIRTH
(mm/dd/yyyy) 9/15/1996 16. CITIZENSHIP
✘ Filipino Dual Citizenship

✘ by birth by naturalization
4. PLACE OF BIRTH ROXAS CITY, CAPIZ If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
✘ Male Female
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS Kalubihan
✘ Single Married House/Block/Lot No. Street
Widowed Separated
Other/s: Tanque
Subdivision/Village Barangay
7. HEIGHT (m) 1.6 Roxas Capiz
City/Municipality Province
8. WEIGHT (kg) 96kg ZIP CODE 5800

9. BLOOD TYPE B
18. PERMANENT ADDRESS Kalubihan
House/Block/Lot No. Street
Tanque
10. GSIS ID NO. n/a
Subdivision/Village Barangay

11. PAG-IBIG ID NO.

Roxas Capiz
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 5800

13. SSS NO. 34-7702236-2 19. TELEPHONE NO.

14. TIN NO. 726-205-504 20. MOBILE NO. 09296629640

15. AGENCY EMPLOYEE NO. 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 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 APAITAN

FIRST NAME MELITON NAME EXTENSION (JR.,

SR)
MIDDLE NAME PARCON
25. MOTHER'S MAIDEN NAME

SURNAME FARINAS
FIRST NAME ZENAIDA

MIDDLE NAME FUNA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SAINT MARTIN ACADEMY ELEMENTARY 2002 2008 GRADUATED 2008

SECONDARY /
VOCATIONAL SAINT MARTIN ACADEMY HIGH SCHOOL 2008 2012 GRADUATED 2012

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

TRADE BACHELOR OF SCIENCE IN INFORMATION
COLLEGE
COURSE COLEGIO DELA PURISIMA CONCEPCION 2014 2019 BSIT 2019
TECHNOLOGY

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 21, 2021

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

CAREER SERVICE PROFESSIONAL 82.0 3/18/2018 ROXAS CITY, CAPIZ

3/18/2018

(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) MONTHLY STATUS OF
(Write in full/Do not SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)

2/7/2018 08/15/2018 Statistical Researcher Philippine Statistics Authority 469/day Contractual YES

9/11/2018 1/5/2019 Customer Service Representative Eperformax 18000.00 Permanent NO

10/15/2019 02/17/2020 Technical Support Transcom 21000.00 Permanent NO

03/26/2021 06/15/2021 Census Area Supervisor (Dumalag) Philippine Statistics Authority 570/dy Contractual YES

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 21, 2021

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

NONE

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

NONE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

DRIVING

COMPUTER LITERATE

ORAL AND COMMUNICATION

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 21, 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 ✘ 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 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, 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
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
Jenny Villamor Twin Hears Subdivision, Roxas City, Capiz 8883847004 3.5 cm. X 4.5 cm
(passport size)

Anabel Pastolero Tigbauan, Iloilo City (033)3303800 With full and handwritten
name tag and signature over
printed name
Frankie D. Dordas Roxas City, Capiz 620-1606
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
Driver's License F04-15-002084

Signature (Sign inside the box)

Date/Place of Issuanc ROXAS CITY, CAPIZ 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