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 ARCEDE
NAME EXTENSION (JR., SR)
FIRST NAME IVAN CYRIL

MIDDLE NAME PROVENDIDO

3. DATE OF BIRTH
(mm/dd/yyyy) 3/12/1997 16. CITIZENSHIP
✘ Filipino Dual Citizenship

by birth by
4. PLACE OF BIRTH BLISS, BUUG, ZAMBOANGA SIBUGAY If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
✘ Male Female
17. RESIDENTIAL ADDRESS PUROK 1
6 CIVIL STATUS Single ✘ Married House/Block/Lot No. Street
Widowed Separate MEJO
Other/s: d Subdivision/Village Barangay
DIPLAHAN ZAMBOANGA SIBUGAY
7. HEIGHT (m) 1.524 meters
City/Municipality Province
8. WEIGHT (kg) 68 kgs ZIP CODE 7039

18. PERMANENT ADDRESS PUROK 1

9. BLOOD TYPE A
House/Block/Lot No. Street
MEJO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
DIPLAHAN ZAMBOANGA SIBUGAY
11. PAG-IBIG ID NO. 1212-0405-8137
City/Municipality Province

12. PHILHEALTH NO. 14-251484901-2 ZIP CODE 7039

13. SSS NO. 10-1245212-4 19. TELEPHONE NO.

14. TIN NO. 704-331-436 20. MOBILE NO. 09525607025/09511963565

15. AGENCY EMPLOYEE NO. 1243-18 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ARCEDE 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME PERLY JOY

NAME EXTENSION (JR., SR) ZIPPORAH MARIE P. ARCEDE 6/3/2021

MIDDLE NAME PEDROSA 2/13/1996

OCCUPATION HOUSEWIFE

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ARCEDE 5/2/1958

FIRST NAME CECILIO SR

MIDDLE NAME SANDUETA

25. MOTHER'S MAIDEN NAME

SURNAME PROVENDIDO

FIRST NAME MARILOU 12/4/1960

MIDDLE NAME INOCENCIO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BLISS ELEMENTARY SCHOOL 6/1/2003 3/30/2009 2009

SECONDARY SAINT PAUL SCHOOL OF BUUG 6/1/2009 3/30/2013 2013

VOCATIONAL /

TRADE
COURSE BACHELOR OF SCIENCE IN ENVIRONMENTAL
COLLEGE MINDANAO STATE UNIVERSITY- BUUG SCIENCE 6/10/2013 5/23/2017 2017

GRADUATE STUDIES LUCAN CENTRAL COLLEGE PROFESSIONAL EDUCATION COURSE 1/20/2023 7/2/2023 2023
(Continue on separate sheet if necessary)

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

LICENSURE EXAMINATION FOR TEACHER 75.0 3/17/2024 JH CERILLES STATE COLLEGE PAGADIAN 2232793 3/12/2027

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

10/2/2017 PRESENT ACCOUNT OFFICER 1ST VALLEY BANK- BAYOG 14,900.00 REGULAR

(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

N/A N/A

(Continue on separate sheet if necessary)

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

BASIC BANKING OPERATIONS TRAINING 12/12/2022 12/14/2022 3 DAYS 1ST VALLEY BANK HEAD OFFICE

BANGKO SENTRAL NG PILIPINAS

KNOW YOUR MONEY 3/3/2023 3/3/2023 6 HOURS

1ST VALLEY BANK HEAD OFFICE

ANTI- MONEY LAUNDERING ACT AND COMPLIANCE MATTERS 11/9/2023 11/9/2023 6 HOURS

BASIC COMPUTER LITERACY 8/19/2024 8/30/2024 80 HOURS

INFINITECH TRAINING CENTER

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

N/A N/A N/A

(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

✘
b. within the fourth degree (for Local Government Unit - Career Employees)? YES

✘
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, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
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 YES
election to promote/actively campaign for a national or local candidate? ✘ NO
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
the last 6 months
EDGAR P. CATILOC ,BRANCH MANAGER PAGADIAN CITY 9178390855 4.5 cm. X 3.5 cm
(passport size)

SHEILA MAE S. ATABILO, ADAS II BAYOG, ZDS 9164337193

Computer generated
or photocopied picture
PRINCESS LEAH P. YAN. ADMIN.OFFICER II POBLACION, DIPLAHAN, ZSP 9488268267 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: PRC LICENSE

ID/License/Passport No.: 2232793

Signature (Sign inside the box)

Date/Place of Issuance: 08/16/2024 PAGADIAN 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