CS Form No.
212
Revised 2017CARPENTER H
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 IGCASAN
NAME EXTENSION (JR., SR) N/A
FIRST NAME ELMER
MIDDLE NAME DIDELES
3. DATE OF BIRTH
(mm/dd/yyyy) 02/25/1994 16. CITIZENSHIP
4. PLACE OF BIRTH KORONADAL CITY, SOUTH COTABATO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX MALE
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
House/Block/Lot No. Street
prk mabuhay 1 Carpenter hill
Subdivision/Village Barangay
7. HEIGHT (m) 1.54 KORONADAL CITY SOUTH COTABATO
City/Municipality Province
8. WEIGHT (kg) 57 ZIP CODE
18. PERMANENT ADDRESS
9. BLOOD TYPE "O
House/Block/Lot No. Street
CARPENTER HILL
10. GSIS ID NO. N/A
Subdivision/Village Barangay
KORONADAL CITY SOUTH COTABATO
11. PAG-IBIG ID NO.
City/Municipality Province
12. PHILHEALTH NO. 170503518050 ZIP CODE 9506
13. SSS NO. 09-3939055-1 19. TELEPHONE NO. N/A
14. TIN NO. 20. MOBILE NO. 09517166781
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any
[email protected]II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24.FATHER'S SURNAME IGCASAN
FIRST NAME EFRAIM
MIDDLE NAME SERENIO
25. MOTHER'S MAIDEN NAME
SURNAME IGCASAN
FIRST NAME EMILY
MIDDLE NAME DIDELES (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
SCHOLARS
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/
26. PERIOD OF ATTENDANCE YEAR HIP/
UNITS
LEVEL (Write EARNED
GRADUATED ACADEMIC
(Write in full) in full) HONORS
(if not graduated)
From To RECEIVED
ELEMENTARY SAN ROQUE ELEMENTARY SCHOOL PRIMARY EDUCATION 6月22日 6月30日 2008 N/A
VOCATIONAL
SECONDARY / SARAVIA NATIONAL HIGH SCHOOL SECONDARY EDUCATION 6月30日 7月4日 2012 N/A
CHAMPAGNAT COMMUNITY COLLEGE DIPLOMA IN AUTOMATIVE
(NDMU) TECHNOLOGY
7月4日 7月6日 2014 N/A
SOUTH EAST ASIAN INSTITUTE BACHELOR OF SCIENCE IN
COLLEGE
TRADE COURSE 7月11日 7月15日 2023 N/A
TECHNOLOGY INFORMATION TECHNOLOGY
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE 02/02/2024
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) LICENSE (if applicable)
DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE RATING
EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / (If Applicable) NUMBER Date of
CONFERMENT
DRIVER'S LICENSE 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 ExperienceGOV'T
sheet.
SERVICE
SALARY/ JOB/
28. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / PAY GRADE (if
(mm/dd/yyyy) POSITION TITLE
COMPANY MONTHLY applicable)& STATUS OF
(Write in full/Do not SALARY STEP (Format APPOINTMENT
(Write in full/Do not abbreviate) "00-0")/
From To abbreviate) INCREMENT
(Y/
Contractcontractu N)
11/15/2018 05/20/2019 Mechanic Gemma Construction Suplply inc 8708.00 N/A Y
al
(Continue on separate sheet if necessary)
SIGNATURE DATE 02/02/2024
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 NUMBER OF
(Write in full) POSITION / NATURE OF WORK
(mm/dd/yyyy) HOURS
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
ATTENDANCE
30. Type of LD
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
PROGRAMS (Write in full) HOURS Supervisory/ (Write in full)
Technical/etc)
From To
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write
in full)
DRIVING N/A N/A
MECHANIC
COOKING
TRAVELLING
(Continue on separate sheet if necessary)
SIGNATURE DATE 02/02/2024
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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details: ________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details: ________________________________
________________________________
b. Have you been criminally charged before any court?
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?
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 If YES, give details: ________________________________
phased out (abolition) in the public or private sector? ________________________________
RESIGNED IN A PRIVATE SECTO
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:
REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
41.
NAME ADDRESS TEL. NO. ID picture taken within
the last 6 months
Darwin F. Natalio Koronadal City 0967 974 7753 3.5 cm. X 4.5 cm
(passport size)
Jonathan Catedral Koronadal City N/A With full and
handwritten
name tag and
signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement Computer generated
pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency or photocopied picture
is not acceptable
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:DRIVERS LICENSE
ID/License/Passport NoL05-16-005592
Signature (Sign inside the box)
02/ 02/2024
11/21/2021
Date/Place of Issuance02/24/2021 KORONADAL 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
CS FORM 212 (Revised 2017), Page 4 of 4
