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 CABATO
NAME EXTENSION (JR., SR) N/A
FIRST NAME REDEN
MIDDLE NAME SERAPON
3. DATE OF BIRTH
(mm/dd/yyyy) 10/29/2000 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH CITY OF ILAGAN If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
✘ Male
17. RESIDENTIAL ADDRESS N/A N/A
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separate
N/A VILLA IMELDA
Other/s: d
Subdivision/Village Barangay
CITY OF ILAGAN ISABELA
7. HEIGHT (m) 5'2
City/Municipality Province
8. WEIGHT (kg) 47 ZIP CODE 3300
18. PERMANENT ADDRESS N/A N/A
9. BLOOD TYPE N/A
House/Block/Lot No. Street
N/A VILLA IMELDA
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CITY OF ILAGAN ISABELA
11. PAG-IBIG ID NO. 1213-3141-5235
City/Municipality Province
12. PHILHEALTH NO. 06-025446503-0 ZIP CODE 3300
13. SSS NO. 01-3162731-0 19. TELEPHONE NO. N/A
14. TIN NO. 635-340-920 20. MOBILE NO. 09972932807
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
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)
FIRST NAME N/A 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 CABATO
NAME EXTENSION (JR., SR) N/A
FIRST NAME LITO
MIDDLE NAME CALANTOC
25. MOTHER'S MAIDEN NAME
SURNAME SERAPON
FIRST NAME LITA
MIDDLE NAME NADUA (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 SINDUN MARIDE ELEMENTARY SCHOOL ELEMENTARY 2007 2013 2013 VALEDICTO
RIAN
SECONDARY ISABELA NATIONAL HIGH SCHOOL-SENIOR HIGH SENIOR HIGH SCHOOL 2017 2019 2019 WITH
VOCATIONAL / SCHOOL HONORS
SAN RAFAEL NATIONAL AND VOCATIONAL HIGH JUNIOR HIGH SCHOOL 2013 2017 2017 WITH
SCHOOL HONORS
TRADE
COURSE
COLLEGE ISABELA STATE UNIVERSITY-ILAGAN CAMPUS BACHELOR OF SECONDARY EDUCATION 2019 2023 2023 N/A
GRADUATE STUDIES N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE MARCH 22, 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
(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/ PAY SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if 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)
11/15/2023 02/15/2024 GOVERNMENT INTERNSHIP PROGRAM ISABELA STATE UNIVERSITY-ILAGAN 8700.00 N/A COS N
CAMPUS
(Continue on separate sheet if necessary)
SIGNATURE DATE MARCH 22, 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
PHILIPPINE RED CROSS YOUTH-ISABELA CHAPTER 09/19/2022 PRESENT 3 HOURS AUDITOR
(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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
Leadership Development Program 10/14/2023 10/14/2023 8.0 TRAINER RED CROSS
Red Cross Youth Formation Course 4/10/2023 4/10/2023 8.0 FACILITATOR RED CROSS
Youth Volunteer Formation Course 07/20/2023 07/22/2023 24.0 TRAINEE RED CROSS
PROJECT PAGBASA; Patibayin ang Galing at BAyanihan ng SAmbayanan 2.0 04/26/2023 06/30/2023 24.0 FACILITATOR ISABELA STATE UNIVERSITY-ILAGAN CAMPUS
PROJECT WARMTH: A Learning Flight Towards a Learner's Holistic Development 04/26/2023 06/30/2023 24.0 FACILITATOR ISABELA STATE UNIVERSITY-ILAGAN CAMPUS
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write in
full)
DANCING ACTIVE COLLEGE RED CROSS YOUTH VOLUNTEER PHILIPPINE RED CROSS-ISABELA CHAPTER
COOKING ILAGAN CITY RIVER WARRIORS
(Continue on separate sheet if necessary)
SIGNATURE DATE MARCH 22, 2024
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 ✘
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘
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
by any court or tribunal? YES ✘ NO
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 YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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
MAXVEL B. BENZAL VILLA IMELDA, CITY OF ILAGAN, the last 6 months
ISABELA 9975490466 3.5 cm. X 4.5 cm
(passport size)
MARINES S. ZILABBO SAN VICENTE, CITY OF ILAGAN,
ISABELA 9169481226 With full and handwritten
name tag and signature over
printed name
MARIA KRISTEL L. PASCUAL ALIBAGU, CITY OF ILAGAN 9058194461
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 (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: NATIONAL ID
ID/License/Passport No.: 8520-5614-0754-1506
Signature (Sign inside the box)
MARCH 22, 2024
Date/Place of Issuance: FEBRUARY 20, 2023
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
