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 PELLEJO
FIRST NAME LOWELA NAME EXTENSION (JR., SR)

MIDDLE NAME MAGHINAY

3. DATE OF BIRTH
01/05/1988 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH BAGO CITY, NEGROS OCCIDENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street
Separate
Widowed ZONE 5 PUROK BROTHERHOOD SUM-AG
Other/s: d Subdivision/Village Barangay
BACOLOD CITY NEGROS OCCIDENTAL
7. HEIGHT (m) 1.52
City/Municipality Province
8. WEIGHT (kg) 57 ZIP CODE 6100

18. PERMANENT ADDRESS

9. BLOOD TYPE "O+"
House/Block/Lot No. Street
ZONE 5 PUROK BROTHERHOOD SUM-AG
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BACOLOD CITY NEGROS OCCIDENTAL
11. PAG-IBIG ID NO. 1580-0098-1868
City/Municipality Province

12. PHILHEALTH NO. 110503458292 ZIP CODE 6100

13. SSS NO. 07-2400897-7 19. TELEPHONE NO. NA

14. TIN NO. 307-471-208 20. MOBILE NO. 09158610603/09334908094

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PELLEJO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME JOHNYL NAME EXTENSION (JR., SR) JOSEPH RYLAND ELKHAN M. PELLEJO 5/15/2017
MIDDLE NAME ABUANA
OCCUPATION TECHNICIAN
EMPLOYER/BUSINESS NAME PONCE AUTOMOBILE CORPORATION (NISSAN BACOLOD)
BUSINESS ADDRESS
ARANETA STREET BRGY. SINGCANG BACOLOD CITY, NEGROS
OCC.
TELEPHONE NO. (034) 433-0567
24. FATHER'S SURNAME MAGHINAY
FIRST NAME LORETO JR

MIDDLE NAME MABASA

25. MOTHER'S MAIDEN NAME
SURNAME NICAVERA
FIRST NAME WENZUELA
MIDDLE NAME SANTILLAN (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

ELEMENTARY DR. P. F. ELIZALDE ELEM. SCHOOL ELEMENTARY 1994 2000 N/A 2000 WITH HONOR
OUR LADY OF THE PILLAR ACADEMY - BAGO
SECONDARY
INCORPORATED
SECONDARY 2000 2004 N/A 2004 N/A
VOCATIONAL /
N/A
TRADE COURSE
BACHELORS OF SCIENCE IN BUSINESS
CARLOS HILADO MEMORIAL STATE COLLEGE -
COLLEGE
FORTUNE TOWN CAMPUS
ADMINISTRATION MAJOR IN FINANCE AND 2004 2008 N/A 2008 N/A
MANAGEMENT ACCOUNTING

GRADUATE STUDIES BAGO CITY COLLEGE TEACHER CERTIFICATE IN EDUCATION 2017 2018 18 Units 2018 N/A

GRADUATE STUDIES LA CARLOTA CITY COLLEGE MASTER IN BUSINESS ADMINISTRATION 2019 2021 CAR 39-Units N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 17, 2022

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
UNIVERSITY OF NEGROS OCCIDENTAL -
LICENSURE EXAMINATION FOR TEACHER 76.40 3/24/2019 1797378 1/5/2025
RECOLETOS BACOLOD CITY

(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)
RAMON TORRES MALINGIN NATIONAL
10/14/2021 12/18/2021 SENIOR HIGH SCHOOL TEACHER 23,877.00 N/A Substitute Y
HIGH SCHOOL

5/27/2014 9/22/2019 BRANCH MANAGER M. LHUILLIER PHILIPPINES 14,780.00 N/A Regular N

6/1/2011 5/26/2014 ASSISTANT BRANCH MANAGER M. LHUILLIER PHILIPPINES 10,000.00 N/A Regular N

3/8/2011 5/31/2011 TELLER M. LHUILLIER PHILIPPINES 7,950.00 N/A Regular N

3/8/2010 3/7/2011 TELLER M. LHUILLIER PHILIPPINES 6,890.00 N/A Contractual N

9/1/2009 12/1/2009 ACCOUNTING CLERK RUSTAN SPECIALTY CONCEPTS INC. 16,000.00 N/A Contractual N

5/5/2008 10/5/2008 CASHIER MSB-SM CITY BACOLOD 6,110.00 N/A Contractual N

6/12/2007 9/14/2007 STUDENT TRAINEE PHILIPPINE NATIONAL BANK N/A N/A TRAINEE N

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 17, 2022

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
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

BOOKKEEPING ( NATIONAL CERTIFICATE III ) 12/15/2020 2/2/2021 292 TECHNICAL LASALTECH INCORPORATED
GREAT HARVEST ACADEMY OF TECHNICAL
PASTRY MAKING - CERTIFICATE OF COMPLETION 12/27/2019 1/17/2020 104 TECHNICAL
SKILLS
ANTI-MONEY LAUNDERING LAW 5/22/2018 5/22/2018 8 SUPERVISORY BANGKO SENTRAL NG PILIPINAS

WORLD CLASS CUSTOMER SERVICE 7/19/2017 7/20/2017 16 MANAGERIAL CREATIVE MAGNATE INSTITUTE

INTERACTIVE TEACHING STRATEGIES 6/23/2017 6/23/2017 8 MANAGERIAL BAGO CITY COLLEGE

BRIEFING ON PAWNSHOP REGULATIONS 4/23/2015 4/23/2015 8 MANAGERIAL BANGKO SENTRAL NG PILIPINAS

PAWNSHOP REGULATIONS; ANTI FENCING RULES & ML POLICIES AND PROCEDURES 3/6/2015 3/6/2015 8 MANAGERIAL M. LHUILLIER PHILIPPINES

BASIC JEWELRY - WATCH APPRAISAL SEMINAR 5/22/2011 5/22/2011 8 TECHNICAL M. LHUILLIER PHILIPPINES

WORK ATTITUDE AND CUSTOMER SERVICE SEMINAR 1/10/2011 1/10/2011 8 TECHNICAL M. LHUILLIER PHILIPPINES

(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)

MICROSOFT OFFICE N/A N/A

COMPUTER LITERATE

BAKING

QUICKBOOKS

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 17, 2022

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
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
DONDON V. ESCOPIN MTCC-OCC BACOLOD CITY 9106249591 3.5 cm. X 4.5 cm
(passport size)

JEANNAMIE G. MATIAS MLHUILLIER GATUSLAO, BACOLOD CITY 9298399524 With full and handwritten
name tag and signature over
MLHUILLIER RAFAEL SALAS DRIVE, printed name
ANNA MAE D. OLITA BAGOCITY
9950140524
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
is not acceptable
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: SSS

ID/License/Passport No.: 0007-2400897-7

Signature (Sign inside the box)
AUGUST 17, 2022
Date/Place of Issuance: BACOLOD 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