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 Babala
NAME EXTENSION (JR., SR)
FIRST NAME Noe Jay

MIDDLE NAME Bacalla

3. DATE OF BIRTH
(mm/dd/yyyy)
9/28/2000 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH Daet Camarines Norte If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street
P.Tsiko Gubat
Other/s:
Subdivision/Village Barangay
Daet Camarines Norte
7. HEIGHT (m) 5'3
City/Municipality Province
8. WEIGHT (kg) 62 ZIP CODE 4600

18. PERMANENT ADDRESS

9. BLOOD TYPE A+
House/Block/Lot No. Street
P.Tsiko Gubat
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121333257741 Daet Camarines Norte

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 4600

13. SSS NO. 0517235481 19. TELEPHONE NO. 09194897195

14. TIN NO. 20. MOBILE NO. 09194897195

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE SURNAME Jessica D. Babala 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME Jessica 9/7/2000

MIDDLE NAME De Vera

OCCUPATION Self Employed

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Babala 8/27/1971

NAME EXTENSION (JR., SR)
FIRST NAME Noel

MIDDLE NAME Dacillo

25. MOTHER'S MAIDEN NAME

SURNAME Bacalla 4/17/1973

FIRST NAME Renea

MIDDLE NAME Salo (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Daet Elementary School Primary 2006 2012 GRADUATED 2011 N/A

WITH
SECONDARY Chung Hua High School High School 2013 2017 GRADUATED 2017
HONORS
VOCATIONAL /
Microsystems College Foundation, INC. Computer System Servicing NCII 2019 2019 GRADUATED 2019 N/A

COLLEGE Mabini Colleges Inc. Education 2020 2023 GRADUATED 2023 Cum Laude

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(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
RA 1080 (LICENSURE EXAMINATION FOR
79.6 3/17/2023 Lucena City 7488950 9/28/2027
TEACHERS)
Presidential Dcree No. 907.Honor Graduate N/A N/A N/A N/A 6/17/2023

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

(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) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

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

Computer System Servicing NCII 2019 2019 280.0 Technical Microsystems College Foundation, INC.

(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)

Proficeint in Microsoft Word 2017 Provincial Meet Gold medalist in Acrhery N/A

Computer Literate

Self Learned Cellphone Technician

Communication Skills
Highly Responsible and Reliable

Anime

Archery
(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 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
P.4 Cabanbanan, San Vicente, the last 6 months
Ernie Nemi 9273006144 4.5 cm. X 3.5 cm
Camarines Norte (passport size)
F. Pimentel Ave Brgy. 2 Daet, Camarines
Maureen D. De Roma 9957385675
Norte
Computer generated
or photocopied picture
Angel Joy S. Villamin San Vicente, Camarines Norte 9171371380 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 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: PRC License

ID/License/Passport No.: 7488950

Signature (Sign inside the box)

Date/Place of Issuance: 07/16/2024

1/20/2025
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