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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 cas
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.

I. PERSONAL INFORMATION
2. SURNAME Bautista

FIRST NAME Renneth

MIDDLE NAME Coton


3. DATE OF BIRTH
(mm/dd/yyyy) 5/23/1975 16. CITIZENSHIP

4. PLACE OF BIRTH Parang, Maguindanao If holder of dual citizenship,

please indicate the details.


5. SEX

17. RESIDENTIAL ADDRESS PHQ Compound


6 CIVIL STATUS
House/Block/Lot No.
Maguindanao PPO
Subdivision/Village
7. HEIGHT (m) 1.524 Shariff Aguak
City/Municipality
8. WEIGHT (kg) 60 ZIP CODE 9608

9. BLOOD TYPE A 18. PERMANENT ADDRESS PHQ Compound


House/Block/Lot No.

10. GSIS ID NO. 02038-5111-4122-020 Maguindanao PPO


Subdivision/Village
Shariff Aguak
11. PAG-IBIG ID NO.
City/Municipality

12. PHILHEALTH NO. 19-000740079-2 ZIP CODE 9608

13. SSS NO. none 19. TELEPHONE NO. none

14. TIN NO. 196-425-740 20. MOBILE NO. 09175459954

15. AGENCY EMPLOYEE NO. 20010200749 21. E-MAIL ADDRESS (if any) nup.maguindanaoppo@g
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME none 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Karl Andrea B Barnedo
FIRST NAME

MIDDLE NAME Carlos Marcelo B Barnedo

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME n/a (eligitimate)


NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME Bautista

FIRST NAME Teresita

MIDDLE NAME Coton (Continue on separate sheet if n

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE


BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
NAME OF SCHOOL
BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY Parang Central Elementary School Primary Education 1981 1987


VOCATIONAL /
SECONDARY Notre Dame of Parang High School 1987 1991

none none none none

COLLEGE TRADE Mindanao State University, Marawi City BSBA- Management 1991 1995
COURSE
GRADUATE STUDIES Cotabato City State Polytechnic College MPA 2002 2007
(Continue on separate sheet if necessary)

SIGNATURE DATE
AL DATA SHEET
ork Experience Sheet shall cause the filing of administrative/criminal case/s against the person

T (PDS) BEFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) none

Pls. indicate country:

Street
Poblacion
Barangay
Maguindanao
Province
9608

Street
Poblacion
Barangay
Maguindanao
Province

9608

none

09175459954

nup.maguindanaoppo@gmail.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

Karl Andrea B Barnedo 12/7/2003


Carlos Marcelo B Barnedo 5/17/2011

12/26/1956

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/


YEAR
UNITS ACADEMIC
GRADUATE
EARNED HONORS
D
(if not graduated) RECEIVED
HIGHEST LEVEL/ SCHOLARSHIP/
YEAR
UNITS ACADEMIC
GRADUATE
EARNED HONORS
D
(if not graduated) RECEIVED

graduated 1986 none

graduated 1991 none

none none none

graduated 1995 none

12 units n/a n/a


nue on separate sheet if necessary)

April 10, 2017

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

Career Service Professional Exam 80.27% 2/18/1996 Cotabato City n/a

(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.
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

01/01/2017 todate Statistician I Philippine National Police 20,811.00 11-6 Perm

01/01/2016 12/31/2016 Statistician I Philippine National Police 20,088.00 11-6 Perm

12/21/2015 12/31/2015 Statistician I Philippine National Police 19,925.00 11-6 Perm

12/21/2012 12/20/2015 Statistician I Philippine National Police 19,302.00 11-5 Perm

06/01/2012 12/20/2012 Statistician I Philippine National Police 19,111.00 11-4 Perm

06/01/2011 5/31/2012 Statistician I Philippine National Police 17,765.00 11-4 Perm

07/01/2010 5/31/2011 Statistician I Philippine National Police 16,419.00 11-4 Perm

12/21/2009 6/30/2010 Statistician I Philippine National Police 15,072.00 11-4 Perm

07/01/2009 12/20/2009 Statistician I Philippine National Police 14,775.00 11-3 Perm

07/01/2008 6/30/2009 Statistician I Philippine National Police 13,392.00 11-3 Perm

07/01/2007 6/30/2008 Statistician I Philippine National Police 12,175.00 11-3 Perm

12/21/2006 12/20/2009 Statistician I Philippine National Police 11,068.00 11-3 Perm

12/21/2003 12/20/2006 Statistician I Philippine National Police 10,798.00 11-2 Perm

07/01/2001 12/20/2003 Statistician I Philippine National Police 10,535.00 11-1 Perm

02/21/2000 6/30/2001 Statistician I Philippine National Police 10,033.00 11-1 Perm

06/16/1999 2/19/2000 Computer Encoder Department of Agrarian Reform XII 4,000.00 n/a Casual

07/06/1998 11/7/1998 Log Pond Analyst Eversun Development Ltd 4,134.00 n/a Regular

07/01/1997 7/5/1998 Log Pond Analyst Eversun Development Ltd 3,900.00 n/a Regular

01/06/1997 30/06/1997 Log Pond Analyst Eversun Development Ltd 3,406.00 n/a Probationary
(Continue on separate sheet if necessary)
SIGNATURE DATE 10 April 2017
CS FORM 212 (Revised 20
LICENSE (if applicable)

Date of
Validity

n/a

parate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No
arate sheet if necessary)
10 April 2017
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 / NA
From To

none

(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

3-day Training on PAIS & RR Writer Software 6/9/2010 6/11/2011 24 Technical PRO IX/ C, RMD

3-day Training on PAIS & RR Writer Software 12/2/2009 12/4/2005 24 Technical PRO XII/ C, RM

First Aid Training 9/12/2008 9/12/2008 8 Technical PRO ARMM

Integrated Training Program (Phase II) 9/8/2008 9/17/2008 54 Technical PRO ARMM

Integrated Training Program (Phase I) 6/20/2006 6/29/2006 60 Technical Civil Service Co

Play Production Workshop 9/27/1999 9/28/1999 16 Technical Department of A

Job Placement Seminar 2/27/1992 2/28/1992 16 Technical Office of Alumni

Computer Literacy Training Program 8/21/1995 10/6/1995 70 Technical Cotabato Techn

Management Technology & Company Orientation 7/28/1996 8/4/1996 100 Technical Eversun Develo

On-the-Job Training 10/5/1996 1/5/1997 498 Technical Eversun Develo

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

Computer Literate none

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

parate sheet if necessary)


ROGRAMS ATTENDED
t five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

PRO IX/ C, RMD, DPRM

PRO XII/ C, RMD, DPRM

PRO ARMM

PRO ARMM

Civil Service Commission ARMM

Department of Agrarian Reform XII

Office of Alumni Relations MSU - Marawi City

Cotabato Technology System

Eversun Development Limited

Eversun Development Limited

parate sheet if necessary)


MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

none

parate sheet if necessary)

10 April 2017
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
NUP Natividad C Magpali Davao City 09176425606 3.5 cm. X 4.5 cm
(passport size)
PHQ, Maguindanao PPO,
SPO4 Amelito A Acuzar Shariff Aguak, Maguindanao With full and handwritten
name tag and signature over
printed name
PSINSP JOBERT G CALDEA Sto. Niṅo, South Cotabato
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: Philippine National Police

ID/License/Passport No.: 17A200111


Signature (Sign inside the box)
10 April 2017
Date/Place of Issuance: Jan 20, 2017/Camp Crame, QC
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 28th of April 2017 , affiant exhibiting his/her validly issued government ID as indicated above.

PSINSP JOBERT G CALDEA


Person Administering Oath

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

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