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 MENESES
NAME EXTENSION (JR., SR)
FIRST NAME GALILEO
MIDDLE NAME RUIZ
3. DATE OF BIRTH
(mm/dd/yyyy) 4-12-1990 16. CITIZENSHIP
4. PLACE OF BIRTH CAGAYAN DE ORO CITY, MISAMIS ORIENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLK.1 LOT.22
House/Block/Lot No. Street
SHANGRILA 3 VILLA KANANGA
Subdivision/Village Barangay
7. HEIGHT (m) 1.72 BUTUAN CITY AGUSAN DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 74 ZIP CODE 8600
9. BLOOD TYPE O+
18. PERMANENT ADDRESS BLK.1 LOT.22 P-MOLAVE
House/Block/Lot No. Street
10. GSIS ID NO. SHANGRILA 3 VILLA KANANGA
11. PAG-IBIG ID NO. 1211-9807-5523 BUTUAN CITY AGUSAN DEL NORTE
City/Municipality Province
12. PHILHEALTH NO. 18-025165579-9 ZIP CODE 8600
13. SSS NO. 08-1778612-2 19. TELEPHONE NO. N/A
14. TIN NO. 286-920-583-000 20. MOBILE NO. 09154747987
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) galilmeneses90@[Link]
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)
FIRST NAME N/A
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME MENESES
NAME EXTENSION (JR., SR)
FIRST NAME GEORGE
MIDDLE NAME BUTALID
25. MOTHER'S MAIDEN NAME
SURNAME RUIZ
FIRST NAME SONIA
MIDDLE NAME CABALLERO (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
HIGHEST LEVEL/ SCHOLARSHIP/
NAME OF SCHOOL YEAR
LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE
(Write in full)
UNITS
GRADUATED
ACADEMIC
HONORS
full) EARNED
(if not graduated) RECEIVED
From To
ELEMENTARY WEST CENTRAL ELEM SCHOOL PRIMARY EDUCATION 1997 2003 N/A 2003 N/A
SECONDARY AGUSAN NATIONAL HIGH SCHOOL HIGH SCHOOL 2003 2008 N/A 2008 N/A
VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE
COURSE
BACHELOR OF SCIENCE IN BUSINESS
COLLEGE FATHER SATURNINO URIOS UNIVERSITY ADMINISTRATION MAJOR IN MARKETING 2008 2010 N/A N/A N/A
MANAGEMENT
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE September 13, 2024
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
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
(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
28. INCLUSIVE DATES SALARY/ JOB/ SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY PAY GRADE (if
(Write in full/Do SALARY
applicable)& STEP STATUS OF APPOINTMENT
not abbreviate) (Write in full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/ N)
04/17/2018 06/01/2023 PRE-DELIVERY INSPECTOR HYUNDAI BUTUAN 12,000.00 N/A REGULAR N
02/10/2016 03/18/2018 BARISTA BO'S COFFEE ROBINSONS 12,000.00 N/A REGULAR N
(Continue on separate sheet if necessary)
SIGNATURE DATE September 13, 2024
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
(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 CONDUCTED/
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Type of LD SPONSORED BY
( Managerial/
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/
Technical/etc) (Write
in full)
From To
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION MEMBERSHIP
IN
ASSOCIATIO
N/ORGANIZA
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. TION
COMPUTER LITERACY(MICROSOFT,OFFICE
WORD,POWER POINT, & EXCEL) (Write in full)
INTERPERSONAL SKILLS(WORKING WITH OR
MOTIVATING OTHERS,FLEXIBILITY) N/A
SKILLED AUTOMOTIVE MECHANIC
(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 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? ________________________________
END OF CONTRACT
________________________________
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
MARK YU BUTUAN CITY 3.5 cm. X 4.5 cm
(passport size)
MARIA THERESA FRANCISCO BUTUAN CITY 9177751883 With full and handwritten
name tag and signature over
printed name
MANUELITO SUAN BUTUAN CITY 9070881247
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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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
administrative/criminal case/s against me. PHOTO
Government Issued ID ([Link], GSIS, SSS, PRC,
Driver's License, etc.) PLEASE INDICATE ID
Number and Date of Issuance
Government Issued ID: DRIVER'S LISENCE
ID/License/Passport No.: K02-10-003087
Signature (Sign inside the box)
9/13/2024
Date/Place of Issuance: 04/12/2022
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
