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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET


Print legibly. Mark appropriate boxes

with "

" and use separate sheet if necessary.

(to be filled up by CSC)

1. CS ID No.

I. PERSONAL INFORMATION
2. SURNAME

APO S T O L

FIRST NAME

CYNTHIA

MIDDLE NAME

CATUDAY

3. NAME EXTENSION (e.g. Jr., Sr N/A

4. DATE OF BIRTH (mm/dd/yyyy)


5. PLACE OF BIRTH

04/05/1967
DOLORES, EASTERN SAMAR
Male

6. SEX
7. CIVIL STATUS

16. RESIDENTIAL ADDRESS

BLK.13,LOT 4,5&6,VILLA LOLITA SUBD.,COGON,SAN


JOSE, TACLOBAN CITY

X Fem ale
Widowed
Separated
Others, specify ___________

Single
X Married
Annulled

ZIP CODE

6500

17. TELEPHONE NO.

053 530 1814

18. PERMANENT ADDRESS

609 EMILIO ASTORGA ST., BARUGO, LEYTE

8. CITIZENSHIP

FILIPINO

9. HEIGHT (m)

1.55 (m.)

10. WEIGHT (kg)

52 (kgs.)

11. BLOOD TYPE

"A"

19. TELEPHONE NO.

N/A

12. GSIS ID NO.

CRN 006-0018-0705-7

20. E-MAIL ADDRESS (if any)

cynthiaapostol50@yahoo.com

13. PAG-IBIG ID NO.

0005-016511-09

21. CELLPHONE NO. (if any)

09173219339

14. PHILHEALTH NO.

13-000100076-5

22. AGENCY EMPLOYEE NO.

N/A

15. SSS NO.

N/A

23. TIN

926-681-751

ZIP CODE

6519

II. FAMILY BACKGROUND


24.
SPOUSE'S SURNAME

25. NAME OF CHILD (Write full name and list all)

APOSTOL

DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

EDGARDO

MIDDLE NAME

EMNAS

HARLENE DEMETRIA

02/12/1989

OCCUPATION

ELECTION OFFICER

HAROLD EDGAR

12/23/1989

EMPLOYER/BUS. NAME

COMMISSION ON ELECTION

MA. HARRIETTE

09/14/1992

BUSINESS ADDRESS

INTRAMUROS,MANILA

EDGARDO, JR.

11/27/1993

(02)521-2408

MA. HAZEL ROSARY

10/07/1995

NOTHING FOLLOWS

NOTHING FOLLOWS

TELEPHONE NO.

(Continue on separate sheet if necessary)


26.FATHER'S SURNAME

CATUDAY

FIRST NAME

AMADOR

MIDDLE NAME

BALACA

27.
MOTHER'S MAIDEN NAME
SURNAME

VILLARAZO

FIRST NAME

VIRGINIA

MIDDLE NAME

OLEGARIO

(Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


28.

YEAR
GRADUATED
NAME OF SCHOOL

LEVEL
(Write in full)

DEGREE COURSE
(Write in full)

ELEMENTARY

DOLORES ELEMENTARY SCHOOL

GRADUATED

SECONDARY
VOCATIONAL /

ASSUMPTION ACADEMY OF
SAMAR,GUIUAN EASTERN SAMAR

GRADUATED

N/A
COLLEGE
TRADE COURSE
GRADUATE STUDIES

N/A

HIGHEST
GRADE/
LEVEL/
UNITS
EARNED
(if not
(if graduated)
graduated)
1980
GRADE VI
1984

N/A

INCLUSIVE DATES OF
ATTENDANCE

FOURTH
YEAR
N/A

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

From

To

1974

1980

FIRST
HON.MENTION

1980

1984

FIRST
HON.MENTION

N/A

N/A

N/A

DIVINE WORD UNIVERSITY

BACHELOR OF ARTS
IN POLITICAL
SCIENCE

1988

GRADUATE

1984

1988

DEAN'S LISTER

SAN BEDA COLLEGE OF


LAW/ARELLANO LAW SCHOOL

BACHELOR OF LAWS

1998

GRADUATE

1988

1998

NONE

NOTHING FOLLOWS

NOTHING FOLLOWS

NOTHING FOLLOWS

NOTHING FOLLOWS

(Continue on separate sheet if necessary)

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY


29.

RATING

DATE OF
EXAMINATION /
CONFERMENT

CAREER SERVICE SUB-PROFESSIONAL


EXAMINATION

75.24%

07/26/1987

CAREER SERVICE PROFESSIONAL


EXAMINATION

82.97%

CAREER SERVICE/ RA 1080 (BOARD/ BAR)


UNDER SPECIAL LAWS/ CES/ CSEE

08/18/1998

LICENSE (if applicable)


PLACE OF EXAMINATION / CONFERMENT

NUMBER

DATE OF
RELEASE

TACLOBAN CITY
TACLOBAN CITY

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.

INCLUSIVE DATES
(mm/dd/yyyy)

POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY


(Write in full)

(Write in full)

GOV'T
SERVICE
MONTHLY
SALARY

SALARY GRADE
& STEP
INCREMENT
(Format "00-0")

STATUS OF
APPOINTMENT

From

To

01/05/2015

PRESENT

LEGAL ASSISTANT

DENR-CENRO, Palo

19,980.00

Contractual

YES

02/2/2014

12/31/2014

LEGAL ASSISTANT

DENR-CENRO, Palo

19,980.00

Contractual

YES

03/18/2002

02/1/2014

ATTORNEY II

DEPARTMENT OF ENVIRONMENT AND


NATURAL RESOURCES,R8,TAC.CITY

31,351.00

TEMPORARY

YES

NOTHING FOLLOWS

NOTHING FOLLOWS

(Yes / No)

18

(Continue on separate sheet if necessary)


CS FORM 212 (Revised 2005), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S


31.

INCLUSIVE DATES

NAME & ADDRESS OF ORGANIZATION


(Write in full)

NUMBER OF
HOURS

(mm/dd/yyyy)
From

NONE

POSITION / NATURE OF WORK

To

N/A

N/A

N/A

N/A

VII. TRAINING PROGRAMS (Start from the most recent training.)


INCLUSIVE DATES OF ATTENDANCE
32.

TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in


full)

NUMBER OF
HOURS

(mm/dd/yyyy)

CONDUCTED/ SPONSORED BY

(Write in full)

From

To

DENR ORIENTATION & SERVICE EFFECTIVENESS SEMINAR

09/1802002

09/20/2002

24 hours

DENR REGIONAL FORUM ON PUBLIC LAND DISPOSITION AND MANAGEMENT


OF FORESHORE AREAS

10/09/2005

10/21/2005

24 HOURS

DENR-LAND MANAGEMENT BUREAU

SEMINAR ON CLEAN WATER ACT (RA 9275)

10/25/2005

10/26/2005

16 HOURS

ENVIRONMENTAL MANAGEMENT BUREAU & POLLUTION CONTROL


ASSOCIATION OF THE PHILS.(PCAP 8)

LEGAL PRACTITIONER'S ORIENTATION COURSE

11/24/2005

10/25/2005

16 HOURS

CIVIL SERVICE COMMISSION,REG.8,PALO,LEYTE

FRONTLINERS MANAGEMENT TRAINING

11/29/2005

11/30/2005

16 HOURS

DENR-LAND MANAGEMENT BUREAU

GAD PLANNING WORKSHOP

03/02/2006

03/02/2006

8 HOURS

DENR,REG.8,TACLOBAN CITY

TRAINING OF WILDLIFE ENFORCEMENT OFFICERS

05/03/2006

05/03/2006

8 HOURS

DENR,REG.8,TACLOBAN CITY

CONFERENCE OF HRM OFFICERS

11/07/2006

11/07/2006

8 HOURS

DENR,REG.8,TACLOBAN CITY

TRAINING ON STATEMENT OF ASSETS & LIABILITIES & NETWORTH

06/20/2007

06/20/2007

24 HOURS

CIVIL SERVICE COMMISSION,REG.8,PALO,LEYTE

DENR-CARP FORUM,ASSESSMENT 7 REPROGRAMMING WORKSHOP

07/13/2011

07/15/2011

16 HOURS

DENR-LAND MANAGEMENT SERVICE

FORUM ON LAND MANAGEMENT & DISPOSITION

10/27/2011

10/28/2011

16 HOURS

DENR-LAND MANAGEMENT SERVICE

PHIL.ASSOCIATION OF ASSESSING OFFICERS CONVENTION (PAAO,INC.)

06/18/2013

06/21/2013

32 HOURS

PHILIPPINE REGULATION COMMISSION (PRC)

DENR,HUMAN RESOURCES MANAGEMENT DIVISION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


33.

SPECIAL SKILLS / HOBBIES:

COMPUTER LITERATE

34.

NON-ACADEMIC DISTINCTIONS / RECOGNITION:


(Write in full)

NONE

35.

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

EVDENREU MEMBER-REG.8 CHAPTER

(Continue on separate sheet if necessary)

CS FORM 212 (Revised 2005), Page 3 of 4

36.

Are you related by consanguinity or affinity to any of the following :

a.

Within the third degree (for National Government Employees):


appointing authority, recommending authority, chief of office/bureau/department or person who has
immediate supervision over you in the Office, Bureau or Department where you will be appointed?

YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

b.

Within the fourth degree (for Local Government Employees):


appointing authority or recommending authority where you will be appointed?

YES
NO
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37

a. Have you ever been formally charged?

YES

NO

If YES, give details:


________________________________
________________________________
YES

b. Have you ever been guilty of any administrative offense?

NO

If YES, give details:


________________________________
________________________________
38.

Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
by any court or tribunal?

39.

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, AWOL or
phased out, in the public or private sector?

40.

Have you ever been a candidate in a national or local election (except Barangay election)?

YES
NO
If YES, give details:
________________________________
________________________________
YES

NO

If YES, give details:


________________________________
________________________________
YES

NO

If YES, give details:


________________________________
________________________________
41.

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?

b.

Are you differently abled?

c.

Are you a solo parent?

YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________
YES
NO
If YES, please specify: ____________________

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)


NAME

ADDRESS

ESMERAL B. ORTEGA

DAGAMI. LEYTE

ATTY. EDGAR T. OCTA

ATTY. III, DENR, LEGAL DIV.

ATTY. ANTONIO PAGATPAT


43.

TEL. NO.

9173241447

NATIONAL BUREAU OF
INVESTIGATION

ID picture taken within


the last 6 months
3.5 cm. X 4.5 cm
(passport size)

325-2255
9196119889

Computer generated
or xerox copy of picture
is not acceptable

I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this
information shall remain confidential.

PHOTO

COMMUNITY TAX CERTIFICATE NO.

ISSUED AT

SIGNATURE (Sign inside the box)

ISSUED ON (mm/dd/yyyy)

DATE ACCOMPLISHED

02/09/2015
RIGHT THUMBMARK

CS FORM 212 (Revised 2005), Page 4 of 4

continuation from V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.

INCLUSIVE DATES
(mm/dd/yyyy)
From

To

POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY


(Write in full)

(Write in full)

MONTHLY
SALARY

SALARY GRADE
& STEP
INCREMENT
(Format "00-0")

GOV'T
SERVICE
STATUS OF
APPOINTMENT
(Yes / No)

GOV'T
SERVICE

POSITION TITLE
From

To

02-25-92

PRESENT

DEPARTMENT / AGENCY / OFFICE / COMPANY


(Write in full)

(Write in full)

MONTHLY
SALARY

SALARY GRADE
& STEP
INCREMENT
(Format "00-0")

STATUS OF
APPOINTMENT
(Yes / No)

ELECTION OFFICER II
NOTHING FOLLOWS

COMMISSION ON ELECTION
NOTHING FOLLOWS

P 17,391

15

PERM.

YES

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