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 a
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

I. PERSONAL INFORMATION
2. SURNAME ELEAZAR
NAME EXTENSION (JR., SR)
FIRST NAME VICENTE

MIDDLE NAME ARZAGA

3. DATE OF BIRTH
(mm/dd/yyyy) 8/31/1970 16. CITIZENSHIP
✘ Filipino Dual Citizenship

✘ by birth by natural
4. PLACE OF BIRTH PUERTO PRINCESA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

17. RESIDENTIAL ADDRESS BLOCK 14 / LOT 15 N/A

6 CIVIL STATUS Single ✘ Married
House/Block/Lot No. Street
Widowed Separated
SAINT MARY VILLAGE BARANGAY
Other/s:
Subdivision/Village Barangay
PUERTO PRINCESA CITY PALAWAN
7. HEIGHT (m) 5'5''
City/Municipality Province
8. WEIGHT (kg) 50 KG ZIP CODE 5300
18. PERMANENT ADDRESS N/A N/A
9. BLOOD TYPE "A"
House/Block/Lot No. Street

10. GSIS ID NO. N/A

Subdivision/Village Barangay
BROOKE'S POINT PALAWAN
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 09-025265918-0 ZIP CODE N/A

13. SSS NO. 04-0355198-3 19. TELEPHONE NO. N/A

14. TIN NO. 188-383-270 20. MOBILE NO. 0907 978 2821

15. AGENCY EMPLOYEE NO. PGCJE05-00390 21. E-MAIL ADDRESS (if any) N/A

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME GABO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIR
NAME EXTENSION (JR., SR)
FIRST NAME ANITA MA. CHRISTINE G. ELEAZAR 7/20

MIDDLE NAME GABUCO MARK ANTHONY G. ELEAZAR 5/9

OCCUPATION GOVERNMENT EMPLOYEE NOTHING FOLLOWS

EMPLOYER/BUSINESS NAME PRIVINCIAL GOVERNMEENT OF PALAWAN

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ELEAZAR

NAME EXTENSION (JR., SR)
FIRST NAME JOSE (DECEASED)

MIDDLE NAME CABRESTANTE

25. MOTHER'S MAIDEN NAME

SURNAME ARZAGA

FIRST NAME NATIVIDAD (DECEASED)

MIDDLE NAME GABUCO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/
26. PERIOD OF ATTENDANCE YEAR
UNITS
LEVEL (Write in full) EARNED
GRADUATED
(Write in full) (if not
From To
graduated)
ELEMENTARY TAGPIRARA ELEMENTARY SCHOOL PRIMARY 1977 1983 GRADUATED 1983
VOCATIONAL / PNAC SAMARIÑANA BAYANIHAN
SECONDARY
HIGH SCHOOL
HIGH SCHOOL 1988 1991 GRADUATED 1991

N/A N/A N/A N/A N/A N/A

GENERAL RADIO COMMUNICATION 1ST
COLLEGE TRADE HOLY TRINITY COLLEGE 2004 2005 N/A
COURSE OPERATOR YEAR
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (R
case/s against the

Do not fill up. For CSC use only)

R)

naturalization
untry:

N/A
Street
ARANGAY
Barangay
ALAWAN
Province

N/A
Street

Barangay
ALAWAN
Province

E OF BIRTH (mm/dd/yyyy)

7/20/2004

5/9/2006
y)

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

N/A

N/A

N/A

N/A

N/A

RM 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

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N.A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A 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. GOV'T
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To (Y/
N)
COTACT OF
1/3/2018 PRESENT PARK ATTENDANT II GENERAL SERVICE 9,536.00 N/A SERVICE
YES
COTACT OF
1/4/2016 12/31/2017 ADMINISTRATIVE AIDE I GENERAL SERVICE 8,189.00 N/A SERVICE
YES
COTACT OF
1/5/2015 12/31/2015 ADMINISTRATIVE AIDE I GENERAL SERVICE 7,575.00 N/A SERVICE
YES
COTACT OF
1/2/2014 12/31/2014 ADMINISTRATIVE AIDE I GENERAL SERVICE 6,000.00 N/A SERVICE
YES
COTACT OF
1/17/2011 12/31/2013 ADMINISTRATIVE AIDE I GENERAL SERVICE 5,000.00 N/A SERVICE
YES
COTACT OF
1/4/2010 12/31/2010 ADMINISTRATIVE AIDE I GENERAL SERVICE 5,000.00 N/A SERVICE
YES
COTACT OF
9/1/2008 12/31/2009 ADMINISTRATIVE AIDE GENERAL SERVICE 5,000.00 N/A SERVICE
YES
COTACT OF
1/2/2006 11/30/2007 ADMINISTRATIVE AIDE GENERAL SERVICE 4,500.00 N/A SERVICE
YES
150.00/D
7/1/2000 12/31/2005 UTILITY AIDE GENERAL SERVICE AY N/A JOB ORDER YES
90.00/DA
2/1/1992 8/31/1992 UTILITY AIDE PROVINCIAL GOVERNOR'S OFFICE Y N/A CASUAL YES
60.00/DA
7/1/1991 12/31/1991 UTILITY AIDE PROVINCIAL GOVERNOR'S OFFICE Y N/A CASUAL YES

NOTHING FOLLOWS

(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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A 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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) From To Technical/etc)

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full)
(Write in full)
N/
SINGING N/A
A
N/
NOTHING FOLLOWS N/A
A
N/
N/A
A
N/
N/A
A
N/
N/A
A
N/
N/A
A
N/
N/A
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 theof bureau or office or to the person who has immediate supervision over you in the
chief
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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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
YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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
a.
items:
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
SOCRATES ROAD, SAN the last 6 months
VICTORINO DENNIS M. SOCRATES MIGUEL, PPC
433-8661 3.5 cm. X 4.5 cm
(passport size)

LEONILA R. BAGA BARANAY MAUNLAD With full and handwritten

name tag and signature over
printed name
ENGR. SAYLITO M. PURISIMA BANCAO BANCAO ROAD
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
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 PHOTO
filing of 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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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