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 GARCIA
NAME EXTENSION (JR., SR)
FIRST NAME DAN PATRICK

MIDDLE NAME SABIO

3. DATE OF BIRTH
8/16/1986 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH LAGUINDINGAN, MIS. OR. If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS ZONE 1 MAGSAYSAY ST

6 CIVIL STATUS
House/Block/Lot No. Street
Widowed
Separated POBLACION
Other/s: Subdivision/Village Barangay
LAGUINDINGAN MISAMIS ORIENTAL
7. HEIGHT (m) 1.63
City/Municipality Province
8. WEIGHT (kg) 72 ZIP CODE

18. PERMANENT ADDRESS ZONE 1 MAGSAYSAY ST

9. BLOOD TYPE "A"
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO.
Subdivision/Village Barangay
LAGUINDINGAN MISAMIS ORIENTAL
11. PAG-IBIG ID NO.
City/Municipality Province

12. PHILHEALTH NO. 15-201332677-5 ZIP CODE 9019

13. SSS NO. 08-1728454-3 19. TELEPHONE NO. N/A

14. TIN NO. 934-402-974 20. MOBILE NO. 0917-7165-699

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) danpatzsabiogarcia@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME BAGAS 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) DJOLANTER NAZZ CANCIO BAGAS
FIRST NAME CORY FE CANDY 1/9/2019
GARCIA
MIDDLE NAME JANUBAS

OCCUPATION TEACHER I

EMPLOYER/BUSINESS NAME DEPARTMENT OF EDUCATION

BUSINESS ADDRESS SINAI ELEMENTARY SCHOOL

TELEPHONE NO. 0955-1686-915

24. FATHER'S SURNAME GARCIA

NAME EXTENSION (JR., SR)
FIRST NAME DIONISIO

MIDDLE NAME UBAUB

25. MOTHER'S MAIDEN NAME

SURNAME GARCIA

FIRST NAME MATILDE

MIDDLE NAME SABIO (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

1996 - 1999-
ELEMENTARY LAGUINDINGAN CENTRAL SCHOOL
June March
1999

1999 - 2003
SECONDARY
VOCATIONAL / LAGUINDINGAN NATIONAL HIGH SCHOOL
June March
2003

TRADE
2003 - 2007
COURSE
COLLEGE XAVIER UNIVERSITY-ATENEO DE CAGAYAN Bachelor of Science in Business Management
June March
2007

2014
GRADUATE STUDIES MINDANAO STATE UNIVERSITY Bachelor of Laws 2007 - Oct
March
2014
(Continue on separate sheet if necessary)

SIGNATURE DATE
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
UNIVERSITY OF SANTO TOMAS, ESPAÑA
PHILIPPINE BAR 78.85% 2016 NOVEMBER 66957 5/23/2017
BLVD., SAMPALOC, MANILA
LICEO DE CAGAYAN UNIVERSITY, RN
CAREER SERVICE PROFESSIONAL 83.33% 10/27/2007 PELAEZ BLVD., CARMEN CAGAYAN DE ORO 193035 1/31/2008
CITY

(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)
MERLIN P. CAIÑA AND ASSOCIATES
6/1/2017 Present ASSOCIATE LAWYER PERMANENT NO
LAW OFFICE
OFFICE OF THE SANGGUNIANG BAYAN
1/14/2017 5/31/2017 RESEARCHER 10,000.00 JOB ORDER YES
OF LAGUINDINGAN
RELOCATION AND RESETTLEMENT LOCAL GOVERNMENT UNIT OF
7/1/2016 8/31/2016 10,000.00 JOB ORDER YES
OFFICER -DESIGNATE LAGUINDINGAN

7/1/2011 5/30/2014 ATTENDANT JMG PRINTS AND COPY 3,000.00 CASUAL NO

COOPERATIVE BANK OF MISAMIS

7/8/2014 6/3/2011 SOLICITOR/COLLECTOR 8,500.00 PERMANENT NO
ORIENTAL
SANGGUNIANG KABATAAN
8/30/2002 10/31/2007 SK FEDERATION PRESIDENT 16,000.00 ELECTED YES
-LAGUINDINGAN

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

(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)
CONVERSANT WITH MICROSOFT OFFICE:
WORD, EXCEL, PUBLISHER, POWER POINT
DRIVING SKILLS

COOKING

SINGING AND DANCING

PLAYING SPORTS: BASKETBALL, SEPAK
TAKRAW, VOLLEYBALL, BASEBALL, DART
AND TABLE TENNITS

(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? 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? ________________________________
EXPIRATION OF TERM
________________________________
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
MANAGER-PIONEER INSURANCE, the last 6 months
MR. CLIFFORD JOSE G. ROA CDOC.
0917-5243-023 3.5 cm. X 4.5 cm
(passport size)
BUDGET OFFICER - LGU
MRS. BABY LESLIE P.SADLUCAP LAGUINDINGAN
0917-7938-739 With full and handwritten
name tag and signature over
printed name
MRS. NOMIE S. GRAGEDA REGISTRAR -MSU COLLEGE OF LAW 0912-2060-907
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.: K02-08-000774

Signature (Sign inside the box)

Date/Place of Issuance: 10/19/16; CDOC

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