CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes
with "
" and use separate sheet if necessary.
(to be filled up by CSC)
1. CS ID No.
I. PERSONAL INFORMATION
2. SURNAME
APO S T O L
FIRST NAME
CYNTHIA
MIDDLE NAME
CATUDAY
3. NAME EXTENSION (e.g. Jr., Sr N/A
4. DATE OF BIRTH (mm/dd/yyyy)
5. PLACE OF BIRTH
04/05/1967
DOLORES, EASTERN SAMAR
Male
6. SEX
7. CIVIL STATUS
16. RESIDENTIAL ADDRESS
BLK.13,LOT 4,5&6,VILLA LOLITA SUBD.,COGON,SAN
JOSE, TACLOBAN CITY
X Fem ale
Widowed
Separated
Others, specify ___________
Single
X Married
Annulled
ZIP CODE
6500
17. TELEPHONE NO.
053 530 1814
18. PERMANENT ADDRESS
609 EMILIO ASTORGA ST., BARUGO, LEYTE
8. CITIZENSHIP
FILIPINO
9. HEIGHT (m)
1.55 (m.)
10. WEIGHT (kg)
52 (kgs.)
11. BLOOD TYPE
"A"
19. TELEPHONE NO.
N/A
12. GSIS ID NO.
CRN 006-0018-0705-7
20. E-MAIL ADDRESS (if any)
[email protected]
13. PAG-IBIG ID NO.
0005-016511-09
21. CELLPHONE NO. (if any)
09173219339
14. PHILHEALTH NO.
13-000100076-5
22. AGENCY EMPLOYEE NO.
N/A
15. SSS NO.
N/A
23. TIN
926-681-751
ZIP CODE
6519
II. FAMILY BACKGROUND
24.
SPOUSE'S SURNAME
25. NAME OF CHILD (Write full name and list all)
APOSTOL
DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME
EDGARDO
MIDDLE NAME
EMNAS
HARLENE DEMETRIA
02/12/1989
OCCUPATION
ELECTION OFFICER
HAROLD EDGAR
12/23/1989
EMPLOYER/BUS. NAME
COMMISSION ON ELECTION
MA. HARRIETTE
09/14/1992
BUSINESS ADDRESS
INTRAMUROS,MANILA
EDGARDO, JR.
11/27/1993
(02)521-2408
MA. HAZEL ROSARY
10/07/1995
NOTHING FOLLOWS
NOTHING FOLLOWS
TELEPHONE NO.
(Continue on separate sheet if necessary)
26.FATHER'S SURNAME
CATUDAY
FIRST NAME
AMADOR
MIDDLE NAME
BALACA
27.
MOTHER'S MAIDEN NAME
SURNAME
VILLARAZO
FIRST NAME
VIRGINIA
MIDDLE NAME
OLEGARIO
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
28.
YEAR
GRADUATED
NAME OF SCHOOL
LEVEL
(Write in full)
DEGREE COURSE
(Write in full)
ELEMENTARY
DOLORES ELEMENTARY SCHOOL
GRADUATED
SECONDARY
VOCATIONAL /
ASSUMPTION ACADEMY OF
SAMAR,GUIUAN EASTERN SAMAR
GRADUATED
N/A
COLLEGE
TRADE COURSE
GRADUATE STUDIES
N/A
HIGHEST
GRADE/
LEVEL/
UNITS
EARNED
(if not
(if graduated)
graduated)
1980
GRADE VI
1984
N/A
INCLUSIVE DATES OF
ATTENDANCE
FOURTH
YEAR
N/A
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
From
To
1974
1980
FIRST
HON.MENTION
1980
1984
FIRST
HON.MENTION
N/A
N/A
N/A
DIVINE WORD UNIVERSITY
BACHELOR OF ARTS
IN POLITICAL
SCIENCE
1988
GRADUATE
1984
1988
DEAN'S LISTER
SAN BEDA COLLEGE OF
LAW/ARELLANO LAW SCHOOL
BACHELOR OF LAWS
1998
GRADUATE
1988
1998
NONE
NOTHING FOLLOWS
NOTHING FOLLOWS
NOTHING FOLLOWS
NOTHING FOLLOWS
(Continue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29.
RATING
DATE OF
EXAMINATION /
CONFERMENT
CAREER SERVICE SUB-PROFESSIONAL
EXAMINATION
75.24%
07/26/1987
CAREER SERVICE PROFESSIONAL
EXAMINATION
82.97%
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
UNDER SPECIAL LAWS/ CES/ CSEE
08/18/1998
LICENSE (if applicable)
PLACE OF EXAMINATION / CONFERMENT
NUMBER
DATE OF
RELEASE
TACLOBAN CITY
TACLOBAN CITY
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.
INCLUSIVE DATES
(mm/dd/yyyy)
POSITION TITLE
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
(Write in full)
GOV'T
SERVICE
MONTHLY
SALARY
SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
STATUS OF
APPOINTMENT
From
To
01/05/2015
PRESENT
LEGAL ASSISTANT
DENR-CENRO, Palo
19,980.00
Contractual
YES
02/2/2014
12/31/2014
LEGAL ASSISTANT
DENR-CENRO, Palo
19,980.00
Contractual
YES
03/18/2002
02/1/2014
ATTORNEY II
DEPARTMENT OF ENVIRONMENT AND
NATURAL RESOURCES,R8,TAC.CITY
31,351.00
TEMPORARY
YES
NOTHING FOLLOWS
NOTHING FOLLOWS
(Yes / No)
18
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
31.
INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION
(Write in full)
NUMBER OF
HOURS
(mm/dd/yyyy)
From
NONE
POSITION / NATURE OF WORK
To
N/A
N/A
N/A
N/A
VII. TRAINING PROGRAMS (Start from the most recent training.)
INCLUSIVE DATES OF ATTENDANCE
32.
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in
full)
NUMBER OF
HOURS
(mm/dd/yyyy)
CONDUCTED/ SPONSORED BY
(Write in full)
From
To
DENR ORIENTATION & SERVICE EFFECTIVENESS SEMINAR
09/1802002
09/20/2002
24 hours
DENR REGIONAL FORUM ON PUBLIC LAND DISPOSITION AND MANAGEMENT
OF FORESHORE AREAS
10/09/2005
10/21/2005
24 HOURS
DENR-LAND MANAGEMENT BUREAU
SEMINAR ON CLEAN WATER ACT (RA 9275)
10/25/2005
10/26/2005
16 HOURS
ENVIRONMENTAL MANAGEMENT BUREAU & POLLUTION CONTROL
ASSOCIATION OF THE PHILS.(PCAP 8)
LEGAL PRACTITIONER'S ORIENTATION COURSE
11/24/2005
10/25/2005
16 HOURS
CIVIL SERVICE COMMISSION,REG.8,PALO,LEYTE
FRONTLINERS MANAGEMENT TRAINING
11/29/2005
11/30/2005
16 HOURS
DENR-LAND MANAGEMENT BUREAU
GAD PLANNING WORKSHOP
03/02/2006
03/02/2006
8 HOURS
DENR,REG.8,TACLOBAN CITY
TRAINING OF WILDLIFE ENFORCEMENT OFFICERS
05/03/2006
05/03/2006
8 HOURS
DENR,REG.8,TACLOBAN CITY
CONFERENCE OF HRM OFFICERS
11/07/2006
11/07/2006
8 HOURS
DENR,REG.8,TACLOBAN CITY
TRAINING ON STATEMENT OF ASSETS & LIABILITIES & NETWORTH
06/20/2007
06/20/2007
24 HOURS
CIVIL SERVICE COMMISSION,REG.8,PALO,LEYTE
DENR-CARP FORUM,ASSESSMENT 7 REPROGRAMMING WORKSHOP
07/13/2011
07/15/2011
16 HOURS
DENR-LAND MANAGEMENT SERVICE
FORUM ON LAND MANAGEMENT & DISPOSITION
10/27/2011
10/28/2011
16 HOURS
DENR-LAND MANAGEMENT SERVICE
PHIL.ASSOCIATION OF ASSESSING OFFICERS CONVENTION (PAAO,INC.)
06/18/2013
06/21/2013
32 HOURS
PHILIPPINE REGULATION COMMISSION (PRC)
DENR,HUMAN RESOURCES MANAGEMENT DIVISION
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
33.
SPECIAL SKILLS / HOBBIES:
COMPUTER LITERATE
34.
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
(Write in full)
NONE
35.
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
EVDENREU MEMBER-REG.8 CHAPTER
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
36.
Are you related by consanguinity or affinity to any of the following :
a.
Within the third degree (for National Government Employees):
appointing authority, recommending authority, chief of office/bureau/department or person who has
immediate supervision over you in the Office, Bureau or Department where you will be appointed?
YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________
b.
Within the fourth degree (for Local Government Employees):
appointing authority or recommending authority where you will be appointed?
YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________
37
a. Have you ever been formally charged?
YES
NO
If YES, give details:
________________________________
________________________________
YES
b. Have you ever been guilty of any administrative offense?
NO
If YES, give details:
________________________________
________________________________
38.
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
by any court or tribunal?
39.
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, AWOL or
phased out, in the public or private sector?
40.
Have you ever been a candidate in a national or local election (except Barangay election)?
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
If YES, give details:
________________________________
________________________________
YES
NO
If YES, give details:
________________________________
________________________________
41.
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?
b.
Are you differently abled?
c.
Are you a solo parent?
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME
ADDRESS
ESMERAL B. ORTEGA
DAGAMI. LEYTE
ATTY. EDGAR T. OCTA
ATTY. III, DENR, LEGAL DIV.
ATTY. ANTONIO PAGATPAT
43.
TEL. NO.
9173241447
NATIONAL BUREAU OF
INVESTIGATION
ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
325-2255
9196119889
Computer generated
or xerox copy of picture
is not acceptable
I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this
information shall remain confidential.
PHOTO
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT
SIGNATURE (Sign inside the box)
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
02/09/2015
RIGHT THUMBMARK
CS FORM 212 (Revised 2005), Page 4 of 4
continuation from V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.
INCLUSIVE DATES
(mm/dd/yyyy)
From
To
POSITION TITLE
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
(Write in full)
MONTHLY
SALARY
SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
GOV'T
SERVICE
STATUS OF
APPOINTMENT
(Yes / No)
GOV'T
SERVICE
POSITION TITLE
From
To
02-25-92
PRESENT
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full)
(Write in full)
MONTHLY
SALARY
SALARY GRADE
& STEP
INCREMENT
(Format "00-0")
STATUS OF
APPOINTMENT
(Yes / No)
ELECTION OFFICER II
NOTHING FOLLOWS
COMMISSION ON ELECTION
NOTHING FOLLOWS
P 17,391
15
PERM.
YES
