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 HUNAHUNAN
NAME EXTENSION (JR., SR) N/A
FIRST NAME JONARD
MIDDLE NAME ANTAD
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 10/19/1982 ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH CANTILAN, SURIGAO DEL SUR 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 PUROK KALIPAYAN
House/Block/Lot No. Street
Separat
Widowed N/A BONGTUD
Other/s: ed
Subdivision/Village Barangay
7. HEIGHT (m) 1.69 m TANDAG CITY SURIGAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 70 kgs. ZIP CODE 8300
9. BLOOD TYPE AB
18. PERMANENT ADDRESS N/A PUROK KALIPAYAN
House/Block/Lot No. Street
10. GSIS ID NO. N/A N/A BONGTUD
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 1210-1801-0051 TANDAG CITY SURIGAO DEL SUR
City/Municipality Province
12. PHILHEALTH NO. N/A ZIP CODE 8300
13. SSS NO. 04-1981216-3 19. TELEPHONE NO. N/A
14. TIN NO. 274-126-392 20. MOBILE NO. 09481440344
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) N/A
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME SOLIS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ANGELINE AVIANNA GRACE A. HUNAHUNAN 5/3/2021
MIDDLE NAME ATABELO
OCCUPATION HOUSEWIFE
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME HUNAHUNAN
NAME EXTENSION (JR., SR)
FIRST NAME CALIXTRATO
MIDDLE NAME ILIGAN
25. MOTHER'S MAIDEN NAME
SURNAME PUNSON
FIRST NAME PILAR
MIDDLE NAME ANTAD (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE YEAR SCHOLARSHIP/
LEVEL (Write in (Write UNITS EARNED GRADUATED ACADEMIC HONORS
full) in full) RECEIVED
From To (if not graduated)
ELEMENTARY PAG-ANTAYAN ELEM. SCHOOL ELEMENTARY 1992 1998 N/A 1998 N/A
SECONDARY /
VOCATIONAL MADRID NATIONAL HIGH SCHOOL HIGHSCHOOL 1998 2002 N/A 2002 N/A
N/A N/A N/A N/A N/A N/A N/A
TRADE
COURSE BACHELOR OF SCIENCE IN
COLLEGE SSPSCU CANTILAN INDUSTRIAL TECHNOLOGY 2003 2007 N/A 2007 N/A
(ELECTRICAL)
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE 01/28/2025
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 EXAMINATION /
SPECIAL LAWS/ CES/ CSEE (If Applicable) CONFERMENT PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE NUMBER Date of
Validity
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/ SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
PAY GRADE (if
STATUS OF
applicable)&
(Write in full/Do (Write in full/Do SALARY STEP (Format APPOINTMENT
not abbreviate) not abbreviate) "00-0")/
From To INCREMENT
(Y/ N)
01/02/2025 PRESENT ELECTRICIAN CITY ENGINEERING OFFICE 400.00/DAY N/A JOB ORDER Y
01/02/2024 12/31/2024 ELECTRICIAN CITY ENGINEERING OFFICE 400.00/DAY N/A JOB ORDER Y
(Continue on separate sheet if necessary)
SIGNATURE DATE 01/28/2025
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
(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
(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)
ELECTRIC WIRING N/A N/A
BASKETBALL
VOLLEYBALL
(Continue on separate sheet if necessary)
SIGNATURE DATE 01/28/2025
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 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
APRIL GWENN MACSABEJON MABUA, TANDAG CITY 9979940310 3.5 cm. X 4.5 cm
(passport size)
ENGR. JAYVEE S. EVANGELIO BONGTUD, TANDAG CTIY 9070656854 With full and handwritten
name tag and signature over
printed name
BEVELYN SOLIS BONGTUD, TANDAG CITY 9461046488
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 ([Link], GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: TIN
ID/License/Passport No.: 274-126-392-000
Signature (Sign inside the box)
01/28/2025
Date/Place of Issuance: TANDAG CITY
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
