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 BENINSIG
NAME EXTENSION (JR., SR)
FIRST NAME JONEL KARL

MIDDLE NAME ABUAN

3. DATE OF BIRTH
(mm/dd/yyyy) 3/30/2002 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BAUANG, LA UNION If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
✘ Male
17. RESIDENTIAL ADDRESS 090 PUROK 2
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separate
- PUDOC
Other/s: d
Subdivision/Village Barangay
BAUANG LA UNION
7. HEIGHT (m) 1.60
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 2501

18. PERMANENT ADDRESS 090 PUROK 2

9. BLOOD TYPE A
House/Block/Lot No. Street
- PUDOC
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211309712169 BAUANG LA UNION

City/Municipality Province

12. PHILHEALTH NO. 05-252748878-8 ZIP CODE 2501

13. SSS NO. 35-1276389-0 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09386372464

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)
NAME EXTENSION (JR., SR) N/A
FIRST NAME 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 BENINSIG 12/30/1952

NAME EXTENSION (JR., SR)
FIRST NAME VILLAMOR

MIDDLE NAME CALICA

25. MOTHER'S MAIDEN NAME

SURNAME ABUAN 7/24/1960

FIRST NAME NIDA CRISTINA

MIDDLE NAME ABUAN (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 PUDOC ELEMENTARY SCHOOL ELEMENTARY 10/6/2008 10/4/2014 2014 WITH

HONOR

SECONDARY DON EULOGIO DE GUZMAN MEMORIAL NATIONAL JUNIOR HIGH SCHOOL ( SPECIAL PROGRAM IN
2/6/2014 6/4/2018 2018 WITH
HIGH SCHOOL FOREIGN LANGUAGE ) HONOR

SECONDARY DON EULOGIO DE GUZMAN MEMORIAL NATIONAL SENIOR HIGH SCHOOL ( ACCOUNTANCY,
4/6/2018 3/4/2020 2020 WITH HIGH
HIGH SCHOOL BUSINESS, AND MANAGEMENT ) HONOR
DON MARIANO MARCOS MEMORIAL STATE BACHELOR OF SCIENCE IN BUSINESS
COLLEGE UNIVERSITY MID LA UNION CAMPUS ADMINISTRATION MAJOR IN HUMAN 08/25/2020 PRESENT 2024
RESOURCE MANAGEMENT

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

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
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)

11/17/2023 12/1/2025 SANGGUNIANG KATABAAN MEMBER OFFICE OF THE SANGGUNIANG 0.00 000 ELECTIVE YES
KABATAAN NG PUDOC

(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

(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

BOOKKEEPPING WORKSHOP 5/22/2023 5/23/2023 8.0 Technical MR. HERNAN L. PARROCHA, CPA

Junior People Management Association of the Philippines -

JPMAP Q1 Webinar Series: "Outsetting Opportunities Towards Career Expidition" 5/3/2023 5/3/2023 4.0 Technical National

Work-Life Balance: Making a Living While Having a Life 01/31/2023 01/31/2023 4.0 Technical Polytechnic University of the Philippines - Biñan Campus

Junior People Management Association of the Philippines,

CAREER READINESS: PREPARING FOR LIFE AFTER GRADUATION 12/17/2022 12/17/2022 4.0 Foundation DMMMSU-MLUC Chapter

Junior People Management Association of the Philippines,

HANDLE YOUR FINANCES: CHOOSE TO INVEST AT AN EARLY AGE 12/3/2022 12/3/2022 4.0 Technical DMMMSU-MLUC Chapter

Junior People Management Association of the Philippines,

CS ELIGIBI80: CIVIL SERVICE EXAMINATION MUST-KNOWS 1/12/2022 1/12/2022 4.0 Foundation DMMMSU-MLUC Chapter

Junior People Management Association of the Philippines,

HOW TO BE YOU?: A GOOD CITIZEN 11/28/2022 11/28/2022 4.0 Foundation DMMMSU-MLUC Chapter

Junior People Management Association of the Philippines,

50'30'20' RULE: Your Money Game Plan To Get Rich 12/10/2022 12/10/2022 4.0 Technical DMMMSU-MLUC Chapter

SK MANDATORY TRAINING PROGRAM 11/14/2023 11/14/2023 6.0 Technical LOCAL GOVERNMENT OF BAUANG LA UNION

(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)

COMPUTER LITERATE N/A MEMBER OF JPMAP - DMMMSU MLUC

CHAPTER

COLLABORATION SKILLS

TIME MANAGEMENT SKILLS

COOKING SKILLS

PHOTOGRAPHY SKILLS

(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?
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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
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
SHERILYN MAE V. BUSTAMANTE PUDOC BAUANG LA UNION 9610526939 4.5 cm. X 3.5 cm
(passport size)

GERALD R. LLARENAS STA. MONICA BAUANG LA UNION 9664509114

Computer generated
or photocopied picture
DANIEL B. GACAYAN CITY OF SAN FERNANDO, LA UNION 9682071361 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: PASSPORT

ID/License/Passport No.: P3686677C

Signature (Sign inside the box)

Date/Place of Issuance: 03-25-2023 DFA LA UNION

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