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 LAVANDERO
NAME EXTENSION (JR., SR)
FIRST NAME CHARITY CARE

MIDDLE NAME NAVALLO

3. DATE OF BIRTH
10/13/1984 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH Mangagoy, Bislig, Surigao del Sur If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS ✘ Single 17. RESIDENTIAL ADDRESS Purok 11 Domsat Road
Married
Widowe Separat Block 10, Lot 24 Sitio Mimbalot
Fil-Lux Eco Village Buruun
d ed
Other/s: Subdivision/Village Barangay
Iligan City Lanao del Norte
7. HEIGHT (m) 157.48
City/Municipality Province
8. WEIGHT (kg) 64 kg ZIP CODE 8000

18. PERMANENT ADDRESS Block 10, Lot 24 Sitio Mimbalot

9. BLOOD TYPE AB
House/Block/Lot No. Street
Fil-Lux Eco Village Buruun
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Iligan City Lanao del Norte
11. PAG-IBIG ID NO. 121174805385
City/Municipality Province

12. PHILHEALTH NO. 15-201342964-7 ZIP CODE 9200

13. SSS NO. 0111-5839473-5 19. TELEPHONE NO. N/A

14. TIN NO. 488-496-983-000 20. MOBILE NO. +639457664438

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME LAVANDERO

NAME EXTENSION (JR., SR)
FIRST NAME MAXIMO

MIDDLE NAME PETALCORIN

25. MOTHER'S MAIDEN NAME

SURNAME NAVALLO

FIRST NAME AVELINA

MIDDLE NAME MARKGRAF (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY De La Salle John Bosco College Primary Education 1994 1998 N/A 1998 N/A

SECONDARY /
VOCATIONAL De La Salle John Bosco College High School 1998 2002 N/A 2002 N/A

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

TRADE
COURSE
COLLEGE Mindanao State University Main Campus Bachelor of Arts in Political Science 2002 2011 N/A 2011 N/A

GRADUATE STUDIES Paññāsāstra University of Cambodia Masters in Applied Conflict Transformation Studies 2011 2013 N/A 2013 With Honors

GRADUATE STUDIES Mindanao State University Main Campus Juris Doctor 2013 2018 N/A 2018 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE December 3, 2018

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 Passed 10/18/2015 Region X 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/ 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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/
N)
Lanao Alliance of Human Rights
12/16/2014 7/4/2018 Paralegal Head/Project Officer 15000.00 N/A Contractual N
Advocates
Sustainable Alternatives for the
6/4/2012 12/9/2014 Project Coordinator 20000.00 N/A Contractual N
Advancement of Mindanao Incorporated
Mindanao Tri-People Youth Center
6/7/2012 4/16/2012 Executive Director 15000.00 N/A Contractual N
Incorporated

(Continue on separate sheet if necessary)

SIGNATURE DATE December 3, 2018

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 / NATURE OF WORK
From To
Ranaw Disaster Response and Rehabilitation Assistance Center Incorporated. 6th Quick Response Team Member-Relief Assistance during
East Extension, Tubod, Rosario Heights, Iligan City, Lanao del Norte
12/18/2011 3/18/2012 N/A
Typhoon Sendong
Lanao Alliance of Human Rights Advocates. Balite Drive, Santiago, Iligan City, Quick Response Team Member, Fact Finding Mission on the
10/7/2008 10/14/2008 56.0
Lanao del Norte GPH-MILF war in 2008

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

Exposure Visit to the Philippines for Joint Monitoring Committee (JMC) 5/20/2017 5/26/2017 64.0 Facilitator Center for Peace and Conflict Studies

Community Participation in the Peace Process: The Mindanao Case Study-MILF and
6/9/2014 6/10/2014 16.0 Speaker Center for Peace and Conflict Studies
other Peace Processes at Yangon, Myanmar
Medical Action Group and task Force Detainees
From Evidence to Ation: Protecting Human Rights Defenders and Fighting Impunity 5/26/2014 5/28/2014 24.0 Participant
of the Philippines

International Netwrok for Human Economy Regional Encounter, Yogyakarta, Indonesia 11/9/2011 11/11/2011 24.0 Delegate International Network Lebret-Irfed

Building Grassroots and Youth Participation (Youth Cultural Exchange 2) Paris, France 6/30/2009 10/28/2009 N/A Delegate Développement et Civilisations Lebret-IRFED (Paris)

Développement et Civilisations Lebret-IRFED

Youth Cultural Exchange Program, Tamil Nadu, India 5/18/2009 5/28/2009 N/A Delegate
(Paris)

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write
(Write in full)
in full)
Best Debater - Mindanao State University, College of Law 47th Foundation Day Debate
Public Speaking Mindanao Peoples' Peace Movement
Competition, March 7, 2015
Beta Sigma Lambda, National Exclusive Law
Writing Champion-Constitutional Law Debate Competition, February 20, 2015
Fraternity and Sorority
Singing College Service Awardee

Playing Sports College Debater Awardee

College Writer Awardee

(Continue on separate sheet if necessary)

SIGNATURE DATE December 3, 2018

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? resignation from previous
________________________________ employment
________________________________
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
Sangguniang Panglungsod, the last 6 months
Councilor Jesse Ray N. Balanay Buhanginan Hills, Pala-o, Iligan City
O9178924174 3.5 cm. X 4.5 cm
(passport size)
Mindanao State University, College of
Atty. Alizedney Ditucalan, LLM Law, Marawi City
O9177704480 With full and handwritten
name tag and signature over
Office of the Regional Legislative printed name
Assemblyman Farouk Macarambon, Jr. Assembly, ORG Compound, Cotabato O9067944698
City 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: Driver's License

ID/License/Passport No.: M02-10-002699

Signature (Sign inside the box)
December 3, 2018
Date/Place of Issuance: 12/22/2016 LTO-Iligan
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