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 Bayao
N/A
FIRST NAME Mohalidin

MIDDLE NAME Lauban

3. DATE OF BIRTH
(mm/dd/yyyy) 11/21/1978 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH Datu Odin Sinsuat, Maguindanao If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Du
Other/s:
Subdivision/Village Ba
Datu Odin Sinsuat Magu
7. HEIGHT (m) 5'4
City/Municipality Pr
8. WEIGHT (kg) 70 Kls ZIP CODE 9601

18. PERMANENT ADDRESS

9. BLOOD TYPE "B"
House/Block/Lot No. S
Du
10. GSIS ID NO. N/A
Subdivision/Village Ba
Datu Odin Sinsuat
11. PAG-IBIG ID NO. 194000307403
City/Municipality Pr

12. PHILHEALTH NO. 17-000058778-0 ZIP CODE 9601

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 946-287-566 20. MOBILE NO. 09058928336

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
170863 21. E-MAIL ADDRESS (if any) mohalidinb@yahoo.com
Bayao 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Horkyshin Oranon Bayao
Rebina

MIDDLE NAME Malasigan Aljarreau Malasigan Bayao

OCCUPATION Housewife Relidinne Malasigan Bayao

EMPLOYER/BUSINESS NAME N/A Queencess Rheial Malasigan Bayao

BUSINESS ADDRESS N/A Mohalidin Malasigan Bayao Jr

TELEPHONE NO. 9357434816

24. FATHER'S SURNAME Bayao

Sr
FIRST NAME Tato

MIDDLE NAME Abdulrahman

25. MOTHER'S MAIDEN NAME

SURNAME Lauban

FIRST NAME Nolambai

MIDDLE NAME Guiani (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 Tanuel Elementary School Primary Education 1985 1991 N/A

SECONDARY Cotabato City National High School High School 1991 1995 N/A
VOCATIONAL /

N/A

TRADE
COURSE
COLLEGE Cotabato City State Polytechnic College AB-Social Work 1995 2000 N/A

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE July 1

CS FORM
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)

N/A

Dual Citizenship

by naturalization

Pls. indicate country:

Street
Dulangan
Barangay
Maguindanao
Province
9601

Street
Dulangan
Barangay
Maguindanao
Province

N/A

09058928336

mohalidinb@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

01/06/2004

06/02/2012

05/22/2014

11/14/2015

04/09/2018

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1991 N/A

1995 N/A
 2000 N/A

parate sheet if necessary)

July 15, 2019

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

NAPOLCOM Senior Police Officer Examination 70.80% 10/25/2015 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

07/31/2017 to date Police Master Sergeant Philippine National Police 33,411.00 16 Permanent

12/31/2013 07/31/2017 Police Staff Sergeant Philippine National Police 18,665 14 Permanent

06/01/2012 12/30/2013 Police Corporal Philippine National Police 16,934.00 12 Permanent

06/01/2011 05/31/2012 Police Corporal Philippine National Police 15359.00 12 Permanent

12/31/2010 05/31/2011 Police Corporal Philippine National Police 13785.00 12 Permanent

07/01/2010 12/30/2010 Patrolman Philippine National Police 12150.00 10 Permanent

07/01/2009 06/30/2010 Patrolman Philippine National Police 10808.00 10 Permanent

7/1/2008 6/30/2009 Patrolman Philippine National Police 9466.00 10 Permanent

1/11/2008 6/30/2008 Patrolman Philippine National Police 8605.00 10 Permanent

8/28/2006 1/10/2008 Patrolman Philippine National Police 8605.00 10 Temporary

 (Continue on separate sheet if necessary)

SIGNATURE DATE July 15,2019

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

Y
arate sheet if necessary)

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 POS
From To

N/A N/A N/A 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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

PUBLIC SAFETY JUNIOR LEADERSHIP COURSE 11/12/2014 04/07/2015 720 HRS Supervisory Regional Train

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3
NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP
31. SPECIAL SKILLS and HOBBIES 32. 3
(Write in full)
.

Investigation Medalya ng Papuri-32

 Driving Medalya ng Paglilingkod s Mindanao-4

Medalya ng Kasanayan-1

Medalya ng Kagalingan-1

Medalya ng Ugnayang Pampulisya-2

Medalya ng Mabuting Asal-1

Medalya ng Paglaban sa Manliligalig-1

(Continue on separate sheet if necessary)

SIGNATURE DATE
T / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

on separate sheet if necessary)

PROGRAMS ATTENDED
ast five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Regional Training Center, ARMM

on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

Alpha Phi Omega

e on separate sheet if necessary)

July 15, 2019

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: MAGUINDANAON
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
Engr. Basit U Talib Capiton, DOS, Maguindanao 9176220560 3.5 cm. X 4.5 cm
(passport size)

Basit H. Edza Gang, SK, Maguindanao 9973085359 With full and handwritten
name tag and signature over
printed name
Monib Usman Cotabato City 9067032543
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: PNP ID

ID/License/Passport No.:
Signature (Sign inside the box)
July 15, 2019
Date/Place of Issuance: 9/17/2014,CAMP CRAME
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 o

 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