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CS Form No.

212
Revised 2017

PERSONAL DATA SHEET


WARNING: Any misinterpretation 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
SURNAME BALLOBAN

FIRST NAME CATHERINE

MIDDLE NAME UY
3. DATE OF BIRTH
(mm/dd/yyyy)
10/22/1991 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH VALENZUELA CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

Single ✘ Married 17. RESIDENTIAL ADDRESS CENTRAL AVENUE


6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
POBLACION
Other/s:
Subdivision/Village Barangay
MANDAON MASBATE
7. HEIGHT (m) 1.61m
City/Municipality Province
8. WEIGHT (kg) 69kg ZIP CODE 5411
18. PERMANENT ADDRESS CENTRAL AVENUE
9. BLOOD TYPE B+
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MANDAON MASBATE
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 100-2518-78468 ZIP CODE 5411

13. SSS NO. 05-1261177-0 19. TELEPHONE NO. NONE

14. TIN NO. 433-730-085-000 20. MOBILE NO. 09636589451

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND


22. SPOUSE'S SURNAME BALLOBAN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME TEMOTEO THEA CAITLYN U. BALLOBAN 8/25/2018

MIDDLE NAME BOLOSITO

OCCUPATION SELF-EMPLOYED

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS POBLACION, MANDAON,MASBATE

TELEPHONE NO. N/A

24. FATHER'S SURNAME UY


NAME EXTENSION (JR., SR)
FIRST NAME RONALDO

MIDDLE NAME DIAZ

25. MOTHER'S MAIDEN NAME

SURNAME MERCADER

FIRST NAME DORIS

MIDDLE NAME GOLOGABIN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


HIGHEST
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE LEVEL/ SCHOLARSHIP/
YEAR
UNITS ACADEMIC
LEVEL (Write in full) EARNED
GRADUATED
HONORS
(Write in full) (if not RECEIVED
From To
graduated)
JOSE ZURBITO MESA SR. MEM. ELEM.
ELEMENTARY
SCHOOL
1998 2004 2004
MASBATE NATIONAL
SECONDARY
COMPREHENSIVE HIGH SCHOOL
2004 2008 2008

COLLEGE BICOL UNIVERSITY B.S. SOCIAL WORK 2008 2012 2012

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

RA 1080 6/1/2012 BICOL COLLEGE, DARAGA, ALBAY 0019744 10/22/2024

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
in full/Do not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
COMMUNITY SUPPORT SERVICES
7/1/2022 12/31/2022 NATIONAL HOUSING AUTHORITY P31,001 CONTRUCTUAL Y
OFFICER
COMMUNITY SUPPORT SERVICES
1/5/2022 6/30/2022 NATIONAL HOUSING AUTHORITY P31,002 CONTRUCTUAL Y
OFFICER
COMMUNITY SUPPORT SERVICES
7/1/2021 12/31/2021 NATIONAL HOUSING AUTHORITY P31,001 CONTRUCTUAL Y
OFFICER
COMMUNITY SUPPORT SERVICES
2/17/2021 6/30/2021
OFFICER
NATIONAL HOUSING AUTHORITY P31,000 CONTRUCTUAL Y

DEPARTMENT OF SOCIAL WELFARE AND


2/1/2013 1/31/2014 MUNICIPAL LINK DEVELOPMENT OFFICE
P 24,498 RESIGNED Y

(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

BCCDI (BICOL CENTER FOR COMMUNITY DEVELOPMENT INC.) 11/5/2011 2/28/2012 COMMUNITY ORGANIZER
PASWI (PHILIPPINE ASSOCIATION OF SOCIAL WORKER INC.) 6/1/2012 MEMBER
6/1/2013
RED CROSS PHILIPPINES 6/1/2012 6/1/2013 MEMBER

GAWAD KALINGA MASBATE 4/1/2015 PRESENT MEMBER

YOUTH FOR CHRIST 4/1/2016 3/1/2018 MEMBER

COUPLES FOR CHRIST 3/1/2018 PRESENT MEMBER

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

AKO PARA SA BATA 2022 "TEACHER, ANONG GAGAWIN SA AKO PARA SA BATA (CHILD PROTECTION
10/21/2022 10/21/2022 2 HOURS
SUMBONG NG PANG-AABUSO" NETWORK)

AKO PARA SA BATA 2022 " ANDYAN SI ALENG PULIS" AT " AKO PARA SA BATA (CHILD PROTECTION
10/14/2022 10/14/2022 2 HOURS
TESTEFYING NG BATA" NETWORK)

CAPABILITY BUILDING TRAINING DISHWASHING LIQUID PRESIDENTIAL COMMISSION FOR THE URBAN
7/19/2022 7/19/2022 8 HOURS
TRAINING POOR

AKO PARA SA BATA-SPOTLIGHT ON THE PRIVATE


SECTOR: ADDRESSING ONLINE VIOLENCE AGAINST 11/18/2021 11/18/2021 2 HOURS CHILD PROTECTION NETWORK
CHILDREN

AKO PARA SA BATA: REIMAGINING THE FUTURE


(BREAKING BARRIERS, BRIDGING GAPS) LESSON
11/11/2021 11/11/2021 2 HOURS CHILD PROTECTION NETWORK
LEARNED FROM COVID: STRENGTHENING INDIVIDUAL
AND ORGANIZATIONAL RESILLIENCY

PRESIDENTIAL COMMISSION FOR THE URBAN


GENDER AND DEVELOPMENT TRAINING 11/9/2021 11/9/2021 5 HOURS
POOR

LIVELIHOOD TRAINING: DISHWASHING LIQUID MAKING AS PRESIDENTIAL COMMISSION FOR THE URBAN
6/21/2021 6/21/2021 5 HOURS
A MEANS OF LIVELIHOOD DURING PANDEMIC POOR

ORIENTATION AND TRAINING ON ONLINE SEXUAL ABUSE


7/24/2021 7/25/2021 16 HOURS DUX REGULUS INC.
AND EXPLOITATION OF CHILDREN

STRESS MANAGEMENT WITH BASIC COGNITIVE


4/14/2019 4/14/2019 8 HOURS ST. JUDE TRAINING CENTER
BEHAVIORAL THERAPY

PERSONALITY DEVELOPMENT: REDISCOVERING INNER


4/13/2019 4/13/2019 8 HOURS ST. JUDE TRAINING CENTER
BEING

DEPRESSION AND SUICIDE 4/12/2019 4/12/2019 8 HOURS ST. JUDE TRAINING CENTER

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
READING BOOKS SPEAKER FOR DAY CARE RECOGNITION REDCROSS

TRAVELLING VOLUNTEER FOR TYPHOON YOLANDA GAWAD KALINGA MASBATE

SOCIALIZING YOUTH FOR CHRIST COUPLES FOR CHRIST

(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 ✘ 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
YES ✘ NO
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, YES ✘ NO
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? ________________________________
a. Have you ever been a candidate in a national or local election held within the last year ________________________________
38. YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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
Community Support Services Officer the last 6 months
JOCELYN E. MENDOZA 9952179133 3.5 cm. X 4.5 cm
(passport size)
Senior Community Support Services With full and handwritten
JHONNA RONCESVALLES-CADERON Officer 9437064080
name tag and signature over
printed name
Resettlement and Development
JALINE CASSANDRA DILAO Services Officer 9266857842 Computer generated
or photocopied picture
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 PHOTO
filing of 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: PRC

ID/License/Passport No.: 0019744


Signature (Sign inside the box)

Date/Place of Issuance: MANILA


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

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