CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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
ANUADA
NAME EXTENSION (JR., SR)
FIRST NAME JAYSON
MIDDLE NAME MAESTRE
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy)
AUGUST 12, 1997 X
Xby birth by naturalization

4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:

DONSOL, SORSOGON
please indicate the details.
5. SEX X Male Female

6 CIVIL STATUS X Single Married 17. RESIDENTIAL ADDRESS 0070 3

Widowed Separated House/Block/Lot No. Street

Other/s: SIBAGO
Subdivision/Village Barangay
7. HEIGHT (m) DONSOL SORSOGON
City/Municipality Province
8. WEIGHT (kg) ZIP CODE 4715
9. BLOOD TYPE 18. PERMANENT ADDRESS 0070 3
House/Block/Lot No. Street

10. GSIS ID NO. SIBAGO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121245721943 DONSOL SORSOGON

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 4715

13. SSS NO. 05 - 1503238 - 5 19. TELEPHONE NO. N/A
14. TIN NO. 20. MOBILE NO. 09519346615
15. AGENCY EMPLOYEE NO. 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)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ANUADA RONEL MAESTRE ANUADA 6/15/1987

NAME EXTENSION (JR., SR)
FIRST NAME NILO DAISY ANUADA APINADO 12/8/1992
MIDDLE NAME ALCANTARA ARVEN MAESTRE ANUADA 4/21/1995
25. MOTHER'S MAIDEN NAME

SURNAME MAESTRE
FIRST NAME SHIRLY
MIDDLE NAME MORETE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE HIGHEST LEVEL/
YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
RECEIVED
From To

ELEMENTARY
SIBAGO, ELEMENTARY
SCHOOL 2004 2010
DONSOL, VOCATIONAL, HIGH AUTOMOTIVE SERVICING 2010 2016
BEST IN
SECONDARY LITERATURE
SCHOOL TUPAS, DONSOL NC I
VOCATIONAL /
TRADE COURSE
STUDENT
COLLEGE
DONSOL, COMMUNITY, BACHELOR OF TECHNICAL
COLLEGE TEACHER EDUCATION 2016 2020 LEADER
AWARD
GRADUATE STUDIES

(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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

SANGGUNIANG KABATAAN (SK KAGAWAD)

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

JULY 27, DECEMBER PROFILER DEPARTMENT OF LABOR AND 8,060 CONTRUCTUAL Y

2021 31, 2021 EMPLOYMENT
JUNE 1, 2021 JULY 15, 2021 PROMODISER NATIONAL BOOK STORE LEGAZPI CITY 8,680 PART TIME N

APRIL 1, 2021 MAY 30, 2021 SERVICE CREW GRACELAND LEGAZPI CITY PART TIME N

(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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
BARANGAY CHILDRENS ORGANIZATION ADULT SUPPORT
2020 2021
SIBAGO, DONSOL, SORSOGON
DONSOL COMMUNITY VOLUNTEER TEAM 2020 2021 VOLUNTEER ORGANIZING TEAM
SIBAGO, DONSOL, SORSOGON
SANGGUNIANG KABATAAN 2018 2021 YOUTH VOLUNTEER
SIBAGO, DONSOL, SORSOGON

BRIGADA EKOLOHIYA 2018 2020 VOLUNTEER

(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 Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

MEETINGS, RESOLUTIONS, PLANNING AND BUDGETING SK FUND

DECENTRALIZATION AND LOCAL GOVERNANCE NATIONAL YOUTH COMMISSION
CODE OF CONDUCT AND ETHICAL STANDARD 06/22/2019 06/23/2019 12 HOURS LOCAL GOVERNMENT UNIT OF DONSOL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

TECHNICAL WRITINGS CERTIFICATE OF RECOGNITION BARANGAY CHILDRENSORGANIZATION

COMPUTER LITERATE VOLUNTEER ORGANIZING TEAM

SK KAGAWAD

(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 X NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES X NO
If YES, give details:

35. a. Have you ever been found guilty of any administrative offense? YES X NO
If YES, give details:

b. Have you been criminally charged before any court? YES X 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 YES X NO
any court or tribunal? If YES, give details:
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, X 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? FINISHED CONTRACT

38. a. Have you ever been a candidate in a national or local election held within the last year (except YES X 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 X 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 X 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? X YES NO
If YES, please specify: AGTA TABANGNON
b. Are you a person with disability? YES X NO
If YES, please specify ID No:
c. Are you a solo parent? YES X 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
DR. SHARON A. VITO DONSOL, SORSOGON 3.5 cm. X 4.5 cm
(passport size)
MR. JOAQUIN G. ATAYZA DONSOL SORSOGON With full and handwritten
name tag and signature over
ARNEL P. MARINAY printed name
SIBAGO, DONSOL, SORSOGON
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 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: POSTAL IDENTITY CARD

ID/License/Passport No.: F02220244790

Signature (Sign inside the box)

Date/Place of Issuance: MAY 4, 2022/LEGAZPI 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