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 SAPINO
FIRST NAME ELOISA NAME EXTENSION (JR., SR) N/A
MIDDLE NAME DAMPO
3. DATE OF BIRTH
(mm/dd/yyyy) 1/15/1998 16. CITIZENSHIP
Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH MANKAYAN, BENGUET If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS FB-055 TABANGAOEN

House/Block/Lot No. Street
Separat
Widowed N/A BALILI
Other/s: ed Subdivision/Village Barangay

7. HEIGHT (m) 1.524 LA TRINIDAD BENGUET

City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 2601
9. BLOOD TYPE O 18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street

10. GSIS ID NO. N/A LOWER LABA-AN TABIO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1213-1006-2457 MANKAYAN BENGUET

City/Municipality Province

12. PHILHEALTH NO. 04-250764753-1 ZIP CODE 2608

13. SSS NO. N/A 19. TELEPHONE NO. N/A
14. TIN NO. 607-398-284 20. MOBILE NO. 0950-866-1892
15. AGENCY EMPLOYEE NO. COS 00873 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
NAME EXTENSION (JR., SR)
N/A
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAM

BUSINESS ADDRESS

TELEPHONE NO.

24.FATHER'S SURNAME SAPINO

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

MIDDLE NAME LONAS

25. MOTHER'S MAIDEN NAME

SURNAME DAMPO
FIRST NAME JULIET
MIDDLE NAME NARCISO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Mankayan Central School PRIMARY EDUCATION 2004 2010 2010 N/A

SECONDARY Mankayan National High School SECONDARY EDUCATION 2010 2014 2014 N/A

Organic Agriculture Production

VOCATIONAL / COSMIC FARM 2020 2020 2021 TESDA-YAP
NCII

TRADE COURSE
VOCATIONAL /

TRADE COURSE Heavy Equipment Operator-

BENGUET VOCATIONAL SCHOOL 2020 2020 2021 TESDA-YAP
Hydraulic Ecavator NCII

Bachelor of Science in
BENGUET STATE UNIVERSITY-LA
COLLEGE Biosystems and Agricultural 2020 2020 2020 N/A
TRINIDAD CAMPUS
Engineering

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE May 30, 2023

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ DATE OF LICENSE (if applicable)
RATING
CES/ CSEE BARANGAY ELIGIBILITY / EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
DRIVER'S LICENSE CONFERMENT
Validity

CIVIL SERVICE EXAM-PROFESSIONAL BENGUET STATE UNIVERSITY- LA

LEVEL
81.17 3/13/2022
TRINIDAD, BENGUET
N/A N/A

AURORA A QUEZON ELEMENTARY

CIVIL SERVICE EXAM- PENOLOGY OFFICER 81.60 4/22/2022 SCHOOL- CORDILLERA STREET, QUEZON N/A N/A
CITY

SKILLS ELIGIBILITY- CATEGORY II PASSED LILY OF THE VALLEY- LA TRINIDAD, BENGUET

(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. SALARY/ JOB/ SERVICE
INCLUSIVE DATES (mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
POSITION TITLE
(Write in full/Do MONTHLY SALARY applicable)& STEP STATUS OF APPOINTMENT
(Write in full/Do not abbreviate) (Format "00-0")/
not abbreviate) INCREMENT
From To
(Y/ N)
BENGUET GENERAL CONTRACT OF
2/1/2023 PRESENT ADMINISTRATIVE AIDE III 16950.00 3 N
HOSPITAL SERVICE

GOVERNMENT INTERNSHIP BENGUET GENERAL

CONTRACT OF
3/15/2022 12/19/2022 PROGRAM-DEPARTMENT OF HOSPITAL ( SUPPLY 7000.00 N/A N
SERVICE
LABOR AND EMPLOYMENT WAREHOUSE)

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 30, 2023

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

LEADERSHIP EXCELLENCE FOR AFFIRMATIVE

3/8/2017 5/8/2017 16.0 TECHNICAL NIIT-BAGUIO CITY
DEVELOPMENT

INFORMATION AND COMMUNICATIONS TECHNOLOGY

( ICT) TRAINING ( MS EXCEL, MS POWERPOINT, MS 7/29/2017 2/8/2017 40.0 TECHNICAL NIIT-BAGUIO CITY
WORD)

INFORMATION AND COMMUNICATIONS TECHNOLOGY

( ICT) TRAINING ( COMPUTER HARDWARE AND
7/24/2017 7/28/2017 40.0 TECHNICAL NIIT-BAGUIO CITY
SYSTEM SERVICING AND CUSTOMER ELECTRONIC
SERVICING)

(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)

BENGUET STATE UNIVERSITY

BASIC AUTOCAD N/A
ALUMNI ASSOCIATION

GARDENING/ LANDSCAPING

SPORTS RECREATION

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 30, 2023

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 by any court or tribunal?
YES ✘ NO
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, YES
✘ NO
dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private sector? If YES, give details: ________________________________
________________________________
FINISHED CONTRACT

38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)?
YES ✘ NO
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 YES ✘ NO
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: KANKANA-EY
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
Engr. Leonardo D. Dumalhin BENGUET STATE UNIVERSITY 0919-695-2043 4.5 cm. X 3.5 cm
(passport size)

Engr. Alvin C. Dulay BENGUET STATE UNIVERSITY 0999-302-4497

Computer generated
or photocopied picture
Engr. Marvin T. Valentin BENGUET STATE UNIVERSITY 0912-889-9563 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 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: PhilHealth ID
ID/License/Passport No.: 04-250764753-1 Signature (Sign inside the box)
MAY 30, 2023
Date/Place of Issuance: Mankayan, Benguet
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