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 aga
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

I. PERSONAL INFORMATION
2. SURNAME VALENCIA
NAME EXTENSION (JR., SR
FIRST NAME RICK ALEXANDER

MIDDLE NAME BANCORO

3. DATE OF BIRTH
(mm/dd/yyyy) 6/5/1995 16. CITIZENSHIP
Filipino Dual Citizenship
by birth b
4. PLACE OF BIRTH PAGADIAN CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS MERCED

6 CIVIL STATUS
House/Block/Lot No. S
Widowed Separated
SAN
Other/s:
Subdivision/Village Ba
PAGADIAN CITY ZAMBOAN
7. HEIGHT (m) 1.70 m
City/Municipality Pr
8. WEIGHT (kg) 55 kg ZIP CODE 7016

18. PERMANENT ADDRESS MERCED

9. BLOOD TYPE O
House/Block/Lot No. S
SAN
10. GSIS ID NO. N/A
Subdivision/Village Ba
PAGADIAN CITY ZAMBOAN
11. PAG-IBIG ID NO. 1211-6717-2799
City/Municipality Pr

12. PHILHEALTH NO. 14-250794988-5 ZIP CODE 7016

13. SSS NO. 10-1171201-4 19. TELEPHONE NO. 062-925-3136

14. TIN NO. N/A 20. MOBILE NO. 0909-649-5856

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) rickalexandervalencia@gmail.
N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME VALENCIA

NAME EXTENSION (JR., SR)
FIRST NAME RIC

MIDDLE NAME VERGARA

25. MOTHER'S MAIDEN NAME

SURNAME BANCORO

FIRST NAME MARILYN

MIDDLE NAME CANTANCIO (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SAN JOSE ELEMENTARY SCHOOL 2001 2007

SECONDARY ZAMBOANGA DEL SUR NATIONAL HIGH SCHOOL 2007 2011

VOCATIONAL /

TRADE
COURSE
COLLEGE SAINT COLUMBAN COLLEGE BACHELOR OF SCIENCE IN ACCOUNTANCY 2011 2015

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Re

L DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization
Pls. indicate country:

MERCEDES STREET
Street
SAN JOSE
Barangay
ZAMBOANGA DEL SUR
Province
7016

MERCEDES STREET
Street
SAN JOSE
Barangay
ZAMBOANGA DEL SUR
Province

7016

062-925-3136

0909-649-5856

rickalexandervalencia@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1ST
2007 HONORABLE
MENTION

4TH
2011
HONOR
 2015

parate sheet if necessary)

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

CIVIL SERVICE PROFESSIONAL 80.26% OCTOBER 2014 PAGADIAN CITY 12/9/2014

CERTIFIED PUBLIC ACCOUNTANT (RA 1080) 83.83% OCTOBER 2016 CAGAYAN DE ORO CITY 0176536 11/4/2016

(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) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
N)
CONTRACT OF SERVICES - CITY ACCOUNTANTS OFFICE - LGU
3/1/2017 PRESENT 25,000 N/A CONTRACTUAL NO
ACCOUNTANT PAGADIAN
SECURITY STAFF DIRECTOR FOR MCB PRIVATE PROTECTIVE AND
1/1/2016 2/28/2017 8,000 N/A PERMANENT NO
OPERATION DETECTIVE AGENCY

(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 / N
From To

N/A

(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 Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SP
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
ROLL-OUT OF THE BUDGET OPERATIONS MANUAL 2016 EDITION;
DEPARTMENT
MANUAL OF THE SETTING-UP AND OPERATION OF LOCAL ECONOMIC 5/24/2017 5/26/2017 24 HOURS TECHNICAL
MANAGEMEN
ENTERPRISES; AND INTERNAL AUDIT MANUAL FOR LGUs
TAX UPDATE ON THE LATEST BIR ISSUANCES AND PREPARATION OF
YEAR-END ADJUSTMENT AS REQUIRED UNDER REVENUE REGULATIONS 5/17/2017 5/17/2017 8 HOURS TECHNICAL BUREA
NO. 2-98
BSP CURRENCY FAMILIARIZATION SEMINAR AND FINANCIAL LITERACY
2/22/2014 2/22/2014 8 HOURS TECHNICAL BANGK
PROGRAM
JUNIOR PHILIP
SPLASH + PLAN + YOUTH = CHANGE SEMINAR 11/4/2013 11/6/2013 24 HOURS SUPERVISORY WEST
JUNIOR PHILIP
PARLIAMENTARY PROCEDURE SEMINAR 6/13/2013 6/13/2013 8 HOURS SUPERVISORY SAINT CO

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

PHILIPPINE
READING N/A
PUB
WATCHING MOVIES JUNIO

COMPUTER GAMES

BADMINTON

(Continue on separate sheet if necessary)

SIGNATURE DATE
EOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

te sheet if necessary)

GRAMS ATTENDED
(5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPARTMENT OF BUDGET AND

MANAGEMENT

BUREAU OF INTERNAL REVENUE

BANGKO SENTRAL NG PILIPINAS

JUNIOR PHILIPPINE INSTITUTE OF ACCOUNTANTS -

WESTERN MINDANAO COUNCIL
JUNIOR PHILIPPINE INSTITUTE OF ACCOUNTANTS -
SAINT COLUMBAN COLLEGE CHAPTER

te sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

PHILIPPINE INSTITUTE OF CERTIFIED

PUBLIC ACCOUNTANTS
 JUNIOR JAYCEES CHAMBER

te sheet if necessary)

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 NO
YES
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
PUROK SANDAYONG, SANTO NIO, the last 6 months
ISAGANI P . CALANDA PAGADIAN CITY
0998-563-7969 3.5 cm. X 4.5 cm
(passport size)
1076 PUROK PALMERA,
WILFREDO P. MONDIDO BALANGASAN, PAGADIAN CITY
0910-324-1123 With full and handwritten
name tag and signature over
PUROK PARADISE, SUMADAT, printed name
LLOYD ACE S. BAUL DUMALINAO, ZAMBOANGA DEL SUR
0946-627-1637
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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 ID

ID/License/Passport No.: 0176536

Signature (Sign inside the box)

Date/Place of Issuance: 12/5/2016 - 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

 If YES, give details (country):

, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4