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 ALON ALON
NAME EXTENSION (JR., SR)
FIRST NAME RUFINO

MIDDLE NAME PAMILACAN

3. DATE OF BIRTH
(mm/dd/yyyy) NOV. 16, 1965 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH STA. CRUZ, LAGUNA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female Philippines

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 249 SITIO 3

Widowed Separated House/Block/Lot No. Street
SAN JUAN
Other/s:
Subdivision/Village Barangay
STA. CRUZ LAGUNA
7. HEIGHT (m) 5'4
City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 4009

18. PERMANENT ADDRESS 249 SITIO 3

9. BLOOD TYPE O
House/Block/Lot No. Street

10. GSIS ID NO. N/A SAN JUAN

STA. CRUZ LAGUNA

11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 4009

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

14. TIN NO. 413-489-837-000 20. MOBILE NO. 09265095044

15. AGENCY EMPLOYEE NO. 20160901-3702-JO 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME ALON ALON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) RHENZ MARK T. ALON ALON
FIRST NAME LAILANIE 4/5/1992

MIDDLE NAME TENIDO RONIE T. ALON ALON 12/7/1993

OCCUPATION VEGTABLE VENDOR RALPH T. ALON ALON 4/17/1995

EMPLOYER/BUSINESS NAME N/A RAINIER T. ALON ALON 11/28/2006

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ALON ALON

NAME EXTENSION (JR., SR)
FIRST NAME BENITO

MIDDLE NAME AUSTRIA

25. MOTHER'S MAIDEN NAME PAMILACAN

SURNAME ALON ALON

FIRST NAME NIEVES

MIDDLE NAME PINIERA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To
ELEMENTARY BUBUKAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1972 1978 GRADUATE 1978 N/A

SECONDARY /
VOCATIONAL 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

TRADE
COURSE
COLLEGE N/A N/A N/A N/A N/A N/A N/A

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

N/A N/A N/A N/A 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) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
GOVERNOR'S OFFICE - LEGAL SERVICES
1/3/2017 PRESENT LABORER PROVINCIAL GOVERNMENT OF LAGUNA
7,843.00 JOB ORDER YES

GOVERNOR'S OFFICE - LEGAL SERVICES

10/1/2016 12/31/2016 LABORER PROVINCIAL GOVERNMENT OF LAGUNA
7,332.00 JOB ORDER YES

GOVERNOR'S OFFICE - LEGAL SERVICES

9/1/2016 9/30/2016 LABORER PROVINCIAL GOVERNMENT OF LAGUNA
7,332.00 JOB ORDER YES
 (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

(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

N/A N/A N/A N/A N/A 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
(Write in full)
in full)

MAN POWER SKILLS N/A N/A

COOKING
 (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 ✘ NO

b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO

If YES, give details:

a. Have you ever been found guilty of any administrative offense? YES ✘ NO
35.

If YES, give details:

________________________________
________________________________
YES ✘ NO
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
YES ✘ NO
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:
________________________________
YES NO
________________________________
✘

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 If YES, give details:
out (abolition) in the public or private sector? ________________________________
YES ✘ NO
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YESIf YES, give details:
✘ NO

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? YESIf YES, give details:
✘ NO

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 YES ✘ NO
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?
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
GILBERTO MONDES SAN JUAN, STA CRUZ LAGUNA 5011115 3.5 cm. X 4.5 cm
(passport size)

MYRA BASILIA MATIENZO SAN JUAN, STA CRUZ LAGUNA 5013402 With full and handwritten
name tag and signature over
printed name
ATTY. RODEL T. PADERAYON CALAMBA CITY LAGUNA 5013402
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: TAX IDENTIFICATION NO.

ID/License/Passport No.: 413-489-837-000

Signature (Sign inside the box)

Date/Place of Issuance: CALAMBA CITY LAGUNA

Date/Place of Issuance: CALAMBA CITY LAGUNA
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