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
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 us

I. PERSONAL INFORMATION
2. SURNAME ANDRADE
NAME EXTENSION (JR., SR)
FIRST NAME JOSIE
MIDDLE NAME ALONZO
3. DATE OF BIRTH
(mm/dd/yyyy) 12/4/1977 16. CITIZENSHIP
Filipino Dual Citizenship
by

birth by
4. PLACE OF BIRTH BUBOG, NUMANCIA, AKLAN If holder of dual citizenship, Pls. indicate coun

Female please indicate the details.

5. SEX Male

Single Married 17. RESIDENTIAL ADDRESS N/A SITIO C

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Str

Other/s: N/A BUB

Subdivision/Village Bara

7. HEIGHT (m) 1.52 NUMANCIA AKL

City/Municipality Prov
8. WEIGHT (kg) 47 ZIP CODE 5604
9. BLOOD TYPE "O+" 18. PERMANENT ADDRESS N/A SITIO C
House/Block/Lot No. Str

10. GSIS ID NO. 77120400919 N/A BUB

Subdivision/Village Bara

11. PAG-IBIG ID NO. 1210-6683-5512 NUMANCIA AKL

City/Municipality Prov

12. PHILHEALTH NO. 19-00055309-1 ZIP CODE 5604

13. SSS NO. N/A 19. TELEPHONE NO. (036) 262-3861
14. TIN NO. 918-084-680 20. MOBILE NO. 0998 860 5004
15. AGENCY EMPLOYEE NO. CSTG3-1640 21. E-MAIL ADDRESS (if any) josie_77andrade@yahoo.c
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ANDRADE 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME MELVER N/A FRANCIS DOMINIC A. ANDRADE
MIDDLE NAME DELOS SANTOS FLORENCE DANIEL A. ANDRADE

OCCUPATION PUV DRIVER FYONA DENIZ A. ANDRADE

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME ALONZO
NAME EXTENSION (JR., SR)
FIRST NAME ELLIOROSO N/A

MIDDLE NAME BAUTISTA

25. MOTHER'S MAIDEN NAME

SURNAME VILLANUEVA
FIRST NAME JULIET
MIDDLE NAME ANDRADE (Continue on separate sheet if necessa

III. EDUCATIONAL BACKGROUND

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

LAGUINBANUA ELEMENTARY SCHOOL,

ELEMENTARY PRIMARY EDUCATION 1984 1990 GRADUATED
NUMANCIA, AKLAN
ROXAS MEMORIAL COLLEGE OF ARTS AND TRADES, NOW AKLAN
SECONDARY /
VOCATIONAL STATE UNIVERSITY-INFORMATION TECHNOLOGY, KALIBO, AKLAN HIGHSCHOOL 1990 1994 GRADUATED

ROXAS MEMORIAL COLLEGE OF ARTS AND TRADES, NOW AKLAN

STATE UNIVERSITY-INFORMATION TECHNOLOGY, KALIBO, AKLAN COSMETOLOGY 1990 1994 GRADUATED

TRADE
 UNIVERSITY OF THE PHILIPPINES IN THE BACHELOR OF SCIENCE IN
COLLEGE 1995 2000 GRADUATED
VISAYAS, ILOILO CITY MANAGEMENT
AKLAN CATHOLIC COLLEGE, KALIBO, 2001 2005
GRADUATE STUDIES BACHELOR OF LAWS GRADUATED
AKLAN 2009 2012
(Continue on separate sheet if necessary)

SIGNATURE DATE 4/26/

CS FORM 21
L DATA SHEET
k Experience Sheet shall cause the filing of administrative/criminal case/s against the person

DS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship
by naturalization
Pls. indicate country:

SITIO CENTRO
Street
BUBOG
Barangay
AKLAN
Province
5604
SITIO CENTRO
Street
BUBOG
Barangay
AKLAN
Province

5604
(036) 262-3861
0998 860 5004
josie_77andrade@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

01/24/2006
01/03/2008
8/19/2014

(Continue on separate sheet if necessary)

YEAR
SCHOLARSHIP/ ACADEMIC
GRADUATE HONORS RECEIVED
D

1990 SALUTATURIAN

EIGHT HON.
1994 MENTION

1994 ARTISAN
 2000 N/A

2012 N/A

n separate sheet if necessary)

4/26/2017
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF LICENSE (if applicable)
SPECIAL LAWS/ CES/ CSEE (If EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Applicable) CONFERMENT NUMBER Date of
Validity

CAREER SERVICE PROFESSIONAL EXAMINATION "80.81% 08/20/2000 KALIBO, AKLAN N/A N/A

CAREER SERVICE SUB-PROFESSIONAL EXAMINATION "81.97% 11/8/1998 KALIBO, AKLAN 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
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / PAY GRADE (if
(mm/dd/yyyy) COMPANY MONTHLY applicable)& STATUS OF
(Write in full/Do not (Write in SALARY STEP (Format APPOINTMENT
"00-0")/
From To abbreviate) full/Do not abbreviate) INCREMENT
(Y/ N)
REGIONAL TRIAL COURT-
08/01/2013 PRESENT COURT STENOGRAPHER III
BRANCH 6, KALIBO, AKLAN
P 21,626.00 "00-0" PERMANENT YES
1ST MUNICIPAL CIRCUIT TRIAL COURT, NEW WASHINGTON
10/26/2000 07/31/2013 COURT STENOGRAPHER III & BATAN, NEW WASHINGTON, AKLAN P 15,358.00 "00-8" PERMANENT YES

(Continue on separate sheet if necessary)

SIGNATURE DATE 04/26/2017

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) NUMBER OF HOURS POSITION / NATUR
(mm/dd/yyyy)
From To

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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To
3RD VISAYAS CONGRESS/SEMINAR AND REGIONAL ELECTION-VISAYAS OF THE COURT
STENOGRAPHERS ASSOCIATION OF THE PHILIPPINES, (COSTRAPHIL) INC.
4/23/2015 4/24/2015 48 HOURS TECHNICAL

NATIONAL COSTRAPHIL CONVENTION AND SEMINAR, GRAND MEN SENG HOTEL, DAVAO CITY 5/18/2011 5/20/2011 36 HOURS TECHNICAL

4TH COSTRAPHIL NATIONAL CONVENTION/SEMINAR OF THE COURT STENOGRAPHER

REPORTERS ASSOCIATION OF THE PHILIPPINES, CPU, ILOILO CITY
4/13/2005 4/15/2005 36 HOURS TECHNICAL

9TH REGIONAL JUDICIAL CAREER ENHANCEMENT PROGRAM, AMIGO TERRACE HOTEL, ILOILO
CITY
4/12/2002 4/13/2002 40 HOURS TECHNICAL

DISTANCE LEARNING PROGRAM (DLP) 9/1/1999 11/1/1999 40 HOURS TECHNICAL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

STENOGRAPHY N/A

COMPUTER LITERATE

VOLLEYBALL

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revis
VERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

ntinue on separate sheet if necessary)

TRAINING PROGRAMS ATTENDED
raining taken for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY

(Write in full)

COURT STENOGRAPHERS ASSOCIATION

OF THE PHILIPPINES

COURT STENOGRAPHERS ASSOCIATION OF THE

PHILIPPINES

PHILIPPINE JUDGES
ASSOCIATION

CIVIL SERVICE COMMISSION

ntinue on separate sheet if necessary)

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in
full)

COURT STENOGRAPHERS ASSOCIATION

OF THE PHILIPPINES, (COSTRAPHIL) INC.

PHILIPPINE ASSOCIATION OF COURT

EMPLOYEES (PACE), AKLAN CHAPTER

ntinue on separate sheet if necessary)

4/26/2017
 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, YES NO
dismissal, termination, end of term, finished contract or phased 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 election to YES NO
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 w
REGIONAL TRIAL COURT, BRANCH 6, the last 6 mon
HON. JEMENA L. ABELLAR-ARBIS KALIBO, AKLAN
(036) 262-3861 3.5 cm. X 4.5
(passport siz
1ST MCTC-NEW WASHINGTON &
HON. RHEA I. VIDAL BATAN, NEW WASHINGTON, AKLAN
(036) 264-3501 With full and hand
name tag and signa
AKLAN CATHOLIC COLLEGE, KALIBO, printed nam
MA. ABIGAIL C. NOLASCO AKLAN
(036) 268-4152
Computer gener
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the or photocopied p
provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency head/authorized representative to is not accepta
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: SUPREME COURT ID
ID/License/Passport No.: CSTG3-1640 Signature (Sign inside the box)
04/26/2017
Date/Place of Issuance: N/A Date Accomplished Right Thumbma

APRIL 26, 2017

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

ATTY. ARNALDO C. TEJADA, JR.

CLERK OF COURT VI
Person Administering Oath

CS FORM 212 (Revised

 If YES, give details: ________________________________
________________________________

If YES, give details: ________________________________

________________________________

If YES, give details: ________________________________

________________________________

If YES, give details: ________________________________

________________________________

If YES, give details: ________________________________

________________________________

NO

NO

NO
If YES, give details (country):

NO

NO

NO

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

, affiant exhibiting his/her validly issued government ID as indicated above.

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