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

MIDDLE NAME MONTEZA

3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
03/14/180 ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH PALO, LEYTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS N/A ACEBEDO ST.

Widowed House/Block/Lot No. Street

Separate
d N/A CAVITE EAST
Other/s:
Subdivision/Village Barangay
PALO LEYTE
7. HEIGHT (m) 1.651 m
City/Municipality Province
8. WEIGHT (kg) 65 KLS ZIP CODE 6501

18. PERMANENT ADDRESS N/A ACEBEDO ST.

9. BLOOD TYPE A+
House/Block/Lot No. Street
N/A CAVITE EAST
10. GSIS ID NO. N/A
Subdivision/Village Barangay
PALO LEYTE
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 6501

13. SSS NO. 0610763288 19. TELEPHONE NO. N/A

14. TIN NO. 661-259-797-00000 20. MOBILE NO. 09306926877

15. AGENCY EMPLOYEE NO. 20241007218 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PLIMACO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME LORIE JANE ALJORNE D. PLIMACO 02/23/2003

MIDDLE NAME DOMINGO ANGELO D. PLIMACO 07/18/2006

OCCUPATION HOUSEWIFE AJAY D. PLIMACO 05/02/2012

EMPLOYER/BUSINESS NAME N/A ANGHEL D. PLIMACO 03/08/2015

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PLAIMACO (DECEASED)

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

MIDDLE NAME DOTADO

25. MOTHER'S MAIDEN NAME

SURNAME MONTEZA

FIRST NAME ANECITA

MIDDLE NAME GASTALLA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY PALO I CENTRAL SCHOOL ELEMENTARY 1993 1994 GRADUATE 1994 N/A
SECONDARY ANAHAWAY NATIONAL HIGH SCHOOL HIGH SCHOOL 1999 2000 GRADUATE 2000 N/A
VOCATIONAL /

HELPING FOUNDATION VOCATIONAL 2000 2000 GRADUATE 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 JANUARY 06, 2025

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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
not abbreviate) (Write in full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)

10/07/2024 PRESENT MARKET POLICE PALO PUBLIC MARKET 10,935.00 Y

10/25/2015 10/06/2024 TANOD BRGY. TANOD 2,200.00 Y

02/10/1999 12/31/2024 PALO CATER CORNER PALO CATER CORNER Y

09/26/2001 02/25/2002 UTILITY UNILAB Y

10/02/2000 03/31/2001 HELPER PHILUSA Y

 (Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 06, 2025

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

(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
30. ATTENDANCE Type of LD
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(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

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

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 06, 2025

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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or YES ✘ NO
phased 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 YES ✘ NO
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?
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
ALAN PARADO BRGY. CAVITE EAST PALO, LEYTE 09925980369 3.5 cm. X 4.5 cm
(passport size)
GIRLIE DALUT BRGY. CAVITE EAST PALO, LEYTE 09502808229 With full and handwritten
name tag and signature over
printed name
ALMA OBERO BRGY. CAVITE EAST PALO, LEYTE 09100412315
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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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: BIR TIN

ID/License/Passport No.: 661-259-797-00000

ID/License/Passport No.: 661-259-797-00000
Signature (Sign inside the box)
JANUARY 06, 2025
Date/Place of Issuance: 10/18/2024 TACLOBAN CITY
Date Accomplished Right Thumbmark

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

Person Administering Oath

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