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 Garcia
NAME EXTENSION (JR., SR)
FIRST NAME Reymar

MIDDLE NAME Encontro

3. DATE OF BIRTH
3/7/1997 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH Bayawan District Hospital 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 N/A

Widowed House/Block/Lot No. Street

Separate
N/A Sitio Lapay, Dawis
Other/s: d
Subdivision/Village Barangay
Bayawan City Negros Oriental
7. HEIGHT (m) 5'6
City/Municipality Province
8. WEIGHT (kg) 79 ZIP CODE 6221
18. PERMANENT ADDRESS N/A N/A
9. BLOOD TYPE O
House/Block/Lot No. Street
N/A Sitio Lapay, Dawis
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Bayawan City Negros Oriental
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 6221

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

14. TIN NO. N/A 20. MOBILE NO. 09059690414

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
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

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

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME Garcia N/A N/A

FIRST NAME Eladio

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

MIDDLE NAME Adalid N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME Garcia N/A N/A

FIRST NAME Emelia N/A N/A

MIDDLE NAME Encontro (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY Lapay Elementary School N/A N/A 2010-2011 N/A

SECONDARY /
VOCATIONAL Lapay High School N/A N/A 2014-2015 N/A

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

TRADE
COURSE
COLLEGE Negros Oriental State University Bachelor of Science in Criminology N/A 2020-2021 N/A

GRADUATE STUDIES 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

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

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

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

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

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

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

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

5/22/2018 on-going SK Member SANGGUNIANG KABATAAN N/A N/A N/A N/A

3/25/2017 3/25/2018 President PARISH YOUTH COUNCEL N/A N/A N/A N/A

4/6/2019 on-going Chapter Secretary RECON UMBER 7 BAYAWAN CHAPTER N/A N/A N/A N/A

9/25/2019 9/25/2021 Vice President STUDENT GOVERNMENT NORSU BSC N/A N/A N/A N/A

10/1/2020 12/31/2020 Admin Team VOLUNTARY CONTACT TRACER'S N/A N/A N/A N/A

MOTORTRADE NATIONWIDE CORPORATION

3/22/2021 9/15/2021 Marketing Assestant 10579.00 N/A N/A N/A

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

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

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

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

N/A 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 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

Recon Umber 7 Bayawan Chapter & Bayawan City, Negros Oriental N/A N/A N/A Chapter Secretary Of Recon Umber 7

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

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

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

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

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

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
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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

SK Mandatory Training 5/22/2018 5/22/2018 12 hours Managerial Siliman University Government Affairs(SUGA) Center

Contact Center Service NCII 6/14/2019 7/4/2019 144 hours Managerial Peoples Skills And Management Institute(PSMI)

First aid Measures & CPR Seminar 9/12/2019 9/12/2019 5hours Managerial NORSU-BSC Campus Clinic

Radio Emergency Communication Operation Network(RECON) Operation Procerdure

3/30/2019 3/30/2019 10hours Managerial Recon Philippines Incorporated
Seminar(ROP)

SK Strategic Planning Workshop 9/9/2020 9/11/2020 30hours Managerial Character first & LGU Bayawan

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

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

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

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

(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 in
(Write in full)
full)

Basic Microsoft Offices Best Research Award(Nosru Bsc Campus Research Office) Vice Pres. Student Government(Norsu Bsc)

Communication Certificate of Participation(First aid & CPR) Pres. Of Parish Youth Council(Dawis Parish)

Organizer Certificate of Participation(Mandatory Training) Chapter Sec. Of Recon Umber 7

Singing Certificate of Award for Best in Broadcasting(Contact Center Service NCII) N/A

Dancing Certificate of Completion(Stratigec planning Workshop) N/A

N/A Certificate of Menmbership( Recon Philippines Inconporated) N/A

N/A Certificate of Appreciation(Voluntary Service as Fronliners of Covid 19 LGU bayawan) N/A

(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? YES ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
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
YES ✘ NO
Barangay election)?
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
HON. CECIL G. CASIPONG, SP Dawis, Bayawan City, Negros Oriental 9159372347 4.5 cm. X 3.5 cm
(passport size)

AVA SHERLYN T. CATAPUSAN –TAN, C/MLGOO Dumaguete City, Negros Oriental 9950721254
Computer generated
or photocopied picture
MSGR. ROBERT A. BONGOYAN, HP. Larena, Siquijor, Negros Oriental 9173141773 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
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 (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID:

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

Date/Place of Issuance:
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