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

NAME EXTENSION (JR., SR) N/A

FIRST NAME

MIDDLE NAME

3. DATE OF BIRTH
16. CITIZENSHIP Dual
(mm/dd/yyyy) ✘ Filipino
Citizenship
✘
by by
4. PLACE OF BIRTH Pls. birth naturalization
indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS Single 17. RESIDENTIAL ADDRESS N/A PROMISE LAND
Widowe Married House/Block/Lot No. Street
Separat
ZONE-2 POBLACION
✘ Other/s
d ed Subdivision/Village Barangay
: MALITBOG BUKIDNON
7. HEIGHT (m) 1.70 m
City/Municipality Province
8. WEIGHT (kg) 85 ZIP CODE 8704

9. BLOOD TYPE O
18. PERMANENT ADDRESS N/A PROMISE LAND
House/Block/Lot No. Street

10. GSIS ID NO. 2003692516 ZONE-2 POBLACION

11. PAG-IBIG ID NO. 108000751009 MALITBOG BUKIDNON

City/Municipality Province

12. PHILHEALTH NO. 030002222996 ZIP CODE 8704

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

14. TIN NO. 229-989-172 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 20060100487 21. E-MAIL ADDRESS (if any)

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME

NAME EXTENSION (JR., SR) (Huwag lagyan ng BDATE
FIRST NAME N/A ang father/mother)
MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (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

MALITBOG CENTRAL ELEMENTARY

ELEMENTARY PRIMARY EDUCATION 1989 1995 GRADUATE 1995 N/A
SCHOOL

SECONDARY /
VOCATIONAL MALITBOG NATIONAL HIGH SCHOLL HIGH SCHOOL 1995 1999 GRADUATE 1999 N/A

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

TRADE
COURSE COLLEGE BACHELOR OF SCIENCE IN
CAGAYAN DE ORO COLLEGE 1999 2003 GRADUATE 2003 N/A
CRIMINOLOGY

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

R.A. 6506 76.60 08/05/2003 CAGAYAN DE ORO CITY 0021604 11/04/2025

NAPOLCOM POLICE OFFICER EXAMINATION 70.26 04/29/2007 CALAMBA CITY N/A N/A

NAPOLCOM SENIOR POLICE EXAMINATON 75.66 04/17/2011 ZAMBOANGA CITY 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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
in full/Do not abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
PHILIPPINE NATIONAL POLICE-
06/30/2016 To Date POLICE CAPTAIN
SPECIAL ACTION FORCE
35,312 SG23-2 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
4/11/2013 06/30/2016 POLICE INSPECTOR
SPECIAL ACTION FORCE
32,341 SG22-1 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
12/14/2012 4/11/2013 POLICE INSPECTOR
SPECIAL ACTION FORCE
32,341 SG22-1 TEMPORARY YES
PHILIPPINE NATIONAL POLICE-
5/10/2010 12/14/2012 POLICE OFFICER 3
SPECIAL ACTION FORCE
15,307 SG14-0 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
1/8/2010 1/10/2010 POLICE OFFICER 2
SPECIAL ACTION FORCE
13,210 SG12-0 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
12/31/2009 1/8/2010 POLICE OFFICER 2
SPECIAL ACTION FORCE
12,210 SG10-0 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
1/8/2009 12/13/2009 POLICE OFFICER 1 SPECIAL ACTION FORCE
10,808 SG10-0 PERMANENT YES
PHILIPPINE NATIONAL POLICE-
1/7/2008 1/8/2009 POLICE OFFICER 1 SPECIAL ACTION FORCE
9,044 SG10-0 PERMANENT 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 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
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

SAF COMMANDO COURSE 05/17/2021 07/10/2021 768 SAF TRAINING BRANCH

(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)

BASKETBALL MEDALYA NG KADAKILAAN (4) SAFAAI

SWIMMING MEDALYA NG PAGLABAN SA MANLILIGALIG (2) PHILIPPINES EAGLES CLUB

DRIVING MEDALYA NG KAGALINGAN (18)

WATCHING MOVIES MEDALYA NG KASANAYAN (34)

FISHING MEDALYA NG PAPURI (29)

WILD PIG, DUCK and BIRD HUNTING MEDALYA NG UGNAYANG PAMPULISYA (2), MEDALYA NG MABUTING ASAL (3)

MEDALYA NG PAGTULONG SA NASALANTA (5) , TSAPA SA NATATANGING UNIT (1)

 MEDALYA NG PAGLILINGKOD SA SANTO PAPA (1) , LOYALTY BADGE (1)

(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? ✘ NO
YES
b. within the fourth degree (for Local Government Unit - Career Employees)? ✘ NO
YES
If YES, give details: ________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense? ✘ NO
YES
If YES, give details: ________________________________
________________________________

b. Have you been criminally charged before any court? ✘ NO

YES
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?
✘ NO
YESgive details: ________________________________
If YES,
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or YESgive details: ________________________________
If YES,
phased 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)?
✘ NO
YES
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before ✘ NO
the last election to promote/actively campaign for a national or local candidate? YES
If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
✘ NO
YESgive details (country):
If YES,

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
a.
items:
Are you a member of any indigenous group? ✘ NO
If YES,YES
please specify:
b. Are you a person with disability? ✘ NO
If YES,YES
please specify ID No:
c. Are you a solo parent? ✘ NO
If YES,YES
please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

PASSPORT
ID picture takenSIZE
within
CAMP BAGONG DIWA BICUTAN WITH GOA
the last NO
6 months
KIRBY JOHN B KRAF TAGUIG CITY 09177002105 3.5 cm. X 4.5 cm
HEADGEAR
(passport size)
RIZALITO G GAPAS
CAMP BAGONG DIWA BICUTAN
09475913124 NAME TAG AND
TAGUIG CITY
SIGNATUREONLY
With full and handwritten
name tag and signature over
CAMP BAGONG DIWA BICUTAN (HINDI 2X2)
FORD SUDAIPAN TAGUIG CITY 09283971743 printed name

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
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 PHOTO
administrative/criminal case/s against me.

Government Issued ID ([Link], GSIS, SSS, PRC, Driver's License,

etc.) PLEASE INDICATE ID Number and Date of
Issuance

Government Issued ID: PNP ID

ID/License/Passport No.: 21J2800307 Signature (Sign inside the box)

Date/Place of Issuance: 10/28/2021 CAMP CRAME huwag lagyan ng Date

Date Accomplished Right Thumbmark

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

PLT JORAM F BANDO

Chief, Admin Section

Person Administering Oath

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