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
2. SURNAME ESTORQUE
NAME EXTENSION (JR., SR)
FIRST NAME ANGELIE REGIE

MIDDLE NAME JOLAMPONG

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 10/28/1998

4. PLACE OF BIRTH PASAY CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS MCKINLEY

6 CIVIL STATUS
House/Block/Lot No. Street
POB. ILAYA
Subdivision/Village Barangay
DAO Capiz
7. HEIGHT (m) 1'62"
City/Municipality Province
8. WEIGHT (kg) 86 ZIP CODE 5810
18. PERMANENT ADDRESS MCKINLEY
9. BLOOD TYPE O+
House/Block/Lot No. Street
POB. ILAYA
10. GSIS ID NO. N/A
Subdivision/Village Barangay
DAO Capiz
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 5810

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

14. TIN NO. N/A 20. MOBILE NO. 09099840211

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO.

24. FATHER'S SURNAME ESTORQUE

NAME EXTENSION (JR., SR)
FIRST NAME JOSUE MA.

MIDDLE NAME RAMOS

25. MOTHER'S MAIDEN NAME

SURNAME JOLAMPONG

FIRST NAME REGINA

MIDDLE NAME CALOLOT (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY DAO ELEMENTARY SCHOOL ELEMENTARY GRADUATE 2006 2012 GRADUATED 2012

HERCOR COLLEGE HIGH SCHOOL WITH

SECONDARY
VOCATIONAL / DEPARTMENT
HIGH SCHOOL GRADUATE 2012 2,018 GRADUATED 2018 HONORS

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

TRADE
COURSE BACHELOR OF SCIENCE IN CHED
COLLEGE HERCOR COLLEGE MAIN CAMPUS
CRIMINOLOGY
2018 2022 GRADUATED 2022 SCHOLAR

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

CRIMINOLOGY LICENSURE EXAMINATION 78.30 DEC. 4-6, 2022 ILOILO 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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) STATUS OF
(Write in full/Do not MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To (Y/ N)
PHILIPPINE EMPLOYMENT SERVICE
4/16/2018 5/28/2018 STUDENT CLERK ENCODER 7,000.00 CONTRACTUAL YES
OFFICE

(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

GAWAD KALINGA 8/10/2018 7/31/2022 MEMBER

TAMANG SIKAD DAO CHAPTER 3/20/2020 6/30/2022 PRESIDENT

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

From To

HERCOR COLLEGE MAIN CAMPUS, ROXAS CITY PHILIPPINE NATIONAL

ON THE JOB TRAINING PROGRAM 9/20/2021 3/23/2022 540 TECHNICAL POLICE AND BUREAU OF FIRE OF THE PHILIPPINES

ORIENTATION ON RED CROSS MOVEMENT AND BASICS OF

3/23/2022 3/23/2022 8 TECHNICAL PHILIPPINE RED CROSS
INTERNATIONAL HUMANITARIAN LAW (IHL)
RAATI AND PE HERCOR COLLEGE ROTC
ROTC UNIT MISSION TRAINING 11/10/2018 3/21/2019 120 TECHNICAL
UNIT
INDUSTRY IMMERSION ON INFORMATION TECHNOLOGY AND COMMUNICATION HERCOR COLLEGE HIGH SCHOOL DEPARTMENT & OXORD
ON OXORD ELECTRONICS
1/15/2018 3/15/2018 80 TECHNICAL ELECTRONIC ROXAS CITY

(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
(Write in full)
in full)

PLAYING TENNIS BRONZE MEDALIST IN 2012 WESTERN VISAYAS REGIONAL ATHLETIC ASSOCIATION GAWAD KALINGA

COMPUTER LITERATE DAO TENNIS ASSOCIATION

SINGING

PLAYING BASKETBALL/VOLLEYBALL

(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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
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, 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
Barangay election)?
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 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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
JSSUPT JAIRUS ANTHONY DOGELIO ROXAS CITY 3.5 cm. X 4.5 cm
(passport size)

PD DILG JOHN ACE AZARCON ANTIQUE With full and handwritten

name tag and signature over
printed name
ATTY. CYRIL JAMES V. DOLOR ROXAS CITY
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 PHOTO
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