CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the 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 up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME ABLUYEN
NAME EXTENSION (JR., SR) N/A
FIRST NAME ERNEST KARL

MIDDLE NAME BATTON

3. DATE OF BIRTH
(mm/dd/yyyy) 2/27/1991 16. CITIZENSHIP

4. PLACE OF BIRTH BANAUE,IFUGAO If holder of dual citizenship, Pls. indicate country:

please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS #14 PADILLA

6 CIVIL STATUS
House/Block/Lot No. Street
N/A ROSARIO
Subdivision/Village Barangay
SANTIAGO CITY ISABELA
7. HEIGHT (m) 1.77 m
City/Municipality Province
8. WEIGHT (kg) 85 kg ZIP CODE 3311

18. PERMANENT ADDRESS #021 ILOGUE

9. BLOOD TYPE B+
House/Block/Lot No. Street
N/A TAM-AN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BANAUE IFUGAO
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 3601

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

14. TIN NO. 472-671-196-000 20. MOBILE NO. 09270435401

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) abluyenwestley@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JANNIE DIVINE M. ABLUYEN
FIRST NAME 12/25/2017
*NOTHING FOLLOWS*
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ABLUYEN

NAME EXTENSION (JR., SR)
FIRST NAME DOMINADOR N/A

MIDDLE NAME
NABOYE
25. MOTHER'S MAIDEN NAME BATTON

SURNAME ABLUYEN

FIRST NAME KATHLEEN

MIDDLE NAME NUMBANONG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

4TH HONOR
ELEMENTARY BANAUE CENTRAL SCHOOL PRIMARY EDUCATION 2001 2007 N/A 2007
GRADE 4

SECONDARY /
VOCATIONAL IMMACULATE CONCEPTION SCHOOL HIGH SCHOOL 2007 2011 N/A 2011 N/A

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

COLLEGE TRADE
COURSE BACHELOR OF SCIENCE IN
MANUEL LUIZ QUEZON UNIVERSITY 2011 2012 N/A 2012 N/A
ACCOUNTANCY

BACHELOR OF SCIENCE IN BUSINESS

SAINT MARY'S UNIVERSITY ADMINISTRATION MAJOR IN 2012 2015 N/A 2015 N/A
FINANCIAL MANAGEMENT

BACHELOR OF SCIENCE IN
IFUGAO STATE UNIVERSITY 2015 2016 N/A 2016 N/A
EDUCATION (EARNING UNITS)

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 7/1/2019

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

BOARD FOR PROFESSIONAL TEACHERS 79.60% SEPTEMBER 25,2016 PRC, BAGUIO CITY 1506075 12/27/2019

*NOTHING FOLLOWS*

(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)
SANGGUNIANG PANLALAWIGAN
01/15/2016 12/29/2016 ADMINISTRATIVE AIDE III 8,000.00 N/A JOB ORDER Y
OFFICE
SANGGUNIANG PANLALAWIGAN
12/01/2015 12/31/2015 ADMINISTRATIVE AIDE I 7,000.00 N/A JOB ORDER Y
OFFICE
SANGGUNIANG PANLALAWIGAN
07/01/2015 11/30/2015 ADMINISTRATIVE AIDE I 7,000.00 N/A JOB ORDER Y
OFFICE
SANGGUNIANG PANLALAWIGAN
04/01/2010 05/31/2010 ADMINISTRATIVE AIDE I 7,000.00 N/A JOB ORDER Y
OFFICE
SANGGUNIANG PANLALAWIGAN
04/01/2008 05/30/2008 ADMINISTRATIVE AIDE I 7,000.00 N/A JOB ORDER Y
OFFICE
*NOTHING FOLLOWS*

(Continue on separate sheet if necessary)

SIGNATURE DATE 7/1/2019

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
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/ CONDUCTE
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
WORKSHOP AND PUBLIC MEETING ON SUSTAINABLE TOURISM AT THE WORLD 2/22/2016 2/24/2016 20 HOURS TECHNICAL UNITED NA
HERITAGE SITE OF THE RICE TERRACES OF THE PHILIPPINE CORDILLERAS AND CULT

WORK ETHICS SEMINAR FOR ON-THE-JOB TRAINEES 12/3/2014 12/3/2014 8 HOURS TECHNICAL SAINT MAR

REGIONAL CONFERENCE ON ENTERPRENEURSHIP FOR BUSINESS STUDENTS 8/16/2014 8/16/2014 8 HOURS TECHNICAL SAINT MAR
AND EDUCATORS "BUSINESS INDUSTRY AND BUSINESS SCHOOL
CONVERGENCE AS A MECHANISM FOR THE UNIVERSITY SPIN-OFFS"

RECORDS MANAGEMENT FORUM "MANAGING RECORDS: BEST PRACTICES, 2/26/2014 2/26/2014 8 HOURS TECHNICAL SAINT MAR
ISSUES AND CONCERNS" BUSINESS

ASSOCIAT
18th AME REGIONAL MARKETING MANAGEMENT EDUCATION "MARKETING
1/26/2013 1/26/2013 8 HOURS TECHNICAL OF THE PH
HAWK: CONQUERING CAREER OPPORTUNITIES AT ITS PEAK"

*NOTHING FOLLOWS*
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE N/A

RUNNING
PLAYING GUITAR AND SINGING

BASKETBALL

*NOTHING FOLLOWS*

(Continue on separate sheet if necessary)

SIGNATURE DATE
T / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

separate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

UNITED NATIONS EDUCATIONAL, SCIENTIFIC

AND CULTURAL ORGANIZATION

SAINT MARY'S UNIVERSITY

SAINT MARY'S UNIVERSITY

SAINT MARY'S UNIVERSITY SCHOOL OF

BUSINESS

ASSOCIATION OF MARKETING EDUCATORS

OF THE PHILIPPINES, INC. (AME)
separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

separate sheet if necessary)

7/1/2019
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?
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
NAMILLANGAN, ALFONSO LISTA, the last 6 mo
MR. JAKE BULAYUNGAN / (b.jake16@yahoo.com) 9776181810 3.5 cm. X 4.5
IFUGAO (passport si

DR. JOSEPH ODAN / (spjojodan@yahoo.com) ROXAS, ISABELA (078) 305-9922 With full and han
name tag and sign
printed nam
MR. KAZZY NAGULMAN / (kazzy0829@gmail.com) HINGYON, IFUGAO 9162706744
Computer gene
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied p
is not accept
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: PROFESSIONAL REGULATION COMMISSION
ID/License/Passport No.: 1506075
Signature (Sign inside the box)
7/1/2019
Date/Place of Issuance: 1-20-2017/ BAGUIO CITY
Date Accomplished Right Thumbm

Person Administering Oath

CS FORM 212 (Rev

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details (country):

ID picture taken within

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

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO
 Right Thumbmark

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