CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 QUISIL
NAME EXTENSION (JR., SR)
FIRST NAME REYGEN

MIDDLE NAME CLAROS

3. DATE OF BIRTH
(mm/dd/yyyy)
09/05/1985 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH DUMAGUETE CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 2446

Widowed Separated House/Block/Lot No. Street
Serafin Teves St Calindagan
Other/s:
Subdivision/Village Barangay
Dumaguete City Negros Oriental
7. HEIGHT (m) 173 m
City/Municipality Province
8. WEIGHT (kg) 90 kg ZIP CODE 6200

18. PERMANENT ADDRESS 2446

9. BLOOD TYPE B+
House/Block/Lot No. Street
Serafin Teves St Calindagan
10. GSIS ID NO. 2004563563
Subdivision/Village Barangay
Dumaguete City Negros Oriental
11. PAG-IBIG ID NO. 1210-1652-9163
City/Municipality Province

12. PHILHEALTH NO. 120505420263 ZIP CODE 6200

13. SSS NO. 19. TELEPHONE NO. (035) 422-4162

14. TIN NO. 940-423-702 20. MOBILE NO. 0916-677-7845

15. AGENCY EMPLOYEE NO. G695 21. E-MAIL ADDRESS (if any) reygen_0905@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME QUISIL 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME GLADYS MAE MARY FRANCINE YSABEL E. QUISIL 05/02/2015

MIDDLE NAME ENARIO YOANA MARY ANTONETTE E. QUISIL 05/26/2016

OCCUPATION PRIVATE EMPLOYEE

EMPLOYER/BUSINESS NAME DCCCO MULTIPURPOSE COOPERATIVE

BUSINESS ADDRESS STA. ROSA ST., DUMAGUETE CITY, NEG. OR.

TELEPHONE NO. (035) 422-4493 LOC 206

24. FATHER'S SURNAME QUISIL

NAME EXTENSION (JR., SR)
FIRST NAME RENALDO

MIDDLE NAME VILAN

25. MOTHER'S MAIDEN NAME CLAROS

SURNAME QUISIL

FIRST NAME MARIA GENEVA

MIDDLE NAME TAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUAT
HONORS
(Write in full) ED
full) (if not RECEIVED
From To graduated)

COLEGIO DE SANTA CATALINA DE ALEJANDRIA

ELEMENTARY
(COSCA)
1992 1998 1998 CLASS VALEDICTORIAN

COLEGIO DE SANTA CATALINA DE ALEJANDRIA

SECONDARY /
VOCATIONAL (COSCA)
1998 2002 2002 CLASS VALEDICTORIAN

TRADE
COLEGIO DE SANTA CATALINA DE ALEJANDRIA
COURSE
COLLEGE
(COSCA)
BS ACCOUNTANCY 2002 2006 2006 CUM LAUDE

GRADUATE STUDIES ST. PAUL UNIVERSITY - DUMAGUETE MASTER IN BUSINESS ADMINISTRATION 2015 ONGOING

(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

PD 907 (Honor Graduate Eligibility)

G02-03-
LTO Non-Professional Driver's License 9/5/2017 Dumaguete City 9/5/2022
076508

(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)
CUSTOMER SERVICE ASSOCIATE - ROVING
3/1/2019 PRESENT LAND BANK OF THE PHILIPPINES 28,447.00 PG5 PERMANENT Y
TELLER
CUSTOMER SERVICE ASSOCIATE - ATM
6/1/2018 2/28/2019 LAND BANK OF THE PHILIPPINES 19,800.00 PG5 PERMANENT Y
BOOKKEEPER
CUSTOMER SERVICE ASSOCIATE -
07/16/14 5/31/2018 LAND BANK OF THE PHILIPPINES 17,000.00 PG5 PERMANENT Y
UNIVERSAL TELLER
PHILIPPINE NATIONAL BANK (merged with
01/02/12 07/15/14 RESERVE UNIVERSAL TELLER 14,000.00 REGULAR N
ALLIED BANKING CORPORATION)
DUMAGUETE CATHEDRAL CREDIT
04/05/10 12/31/11 AUDIT STAFF 12,500.00 REGULAR N
COOPERATIVE
MARKETING AND MEMBERSHIP EXTENSION DUMAGUETE CATHEDRAL CREDIT
07/01/08 04/04/10 10,000.00 REGULAR N
SERVICE CLERK COOPERATIVE

05/04/06 06/30/08 COPY EDITOR SPI TECHNOLOGIES INC. 15,000.00 REGULAR N

(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

Cathedral Parish-Parish of St. Catherine of Alexandria (Dumaguete) 2016 Present Parish Bookkeeper

(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

Counterfeit Detection Seminar 7/20/2019 7/20/2019 8 hrs Technical Land Bank of the Philippines

Seminar on ATM, Cash Management and LARS 7/13/2019 7/13/2019 8 hrs Technical Land Bank of the Philippines

Take the LEAD in Customer Service 10/6/2018 10/6/2018 8 hrs Technical Land Bank of the Philippines

Bomb Threat, Robbery & Civil Disturbance

3/17/2018 3/17/2018 8 hrs Technical Land Bank of the Philippines
Management Training

Basic Operational, Market, and Credit Risk Management 2/23/2018 2/23/2018 8 hrs Technical CHRES/Land Bank of the Philippines

Training on Medical First Responder's Course 01-13-2018 01-14-2018 16 hrs Technical BFP-Dumaguete/LBP-Dumaguete

Branch Retooling Seminar 9/10/2016 9/11/2016 16 hrs Technical Land Bank of the Philippines

Branch Operation Seminar for New Hires 5/30/2016 5/31/2016 16 hrs Technical Land Bank of the Philippines

PrImE: Professional Image Enhancement 3/12/2016 3/12/2016 8 hrs Technical Mindbroker Corporation

Seminar on AMLA Updates 2014 09/20/14 09/20/14 8 hrs Technical Land Bank of the Philippines

Bank Frauds and Forgery Detection 08/23/14 08/23/14 8 hrs Technical CHRES/Land Bank of the Philippines

Counterfeit Detection Seminar 07/30/14 07/30/14 8 hrs Technical CHRES/Land Bank of the Philippines

Universal Teller Training Program 01/24/12 02/03/12 40 hrs Technical Allied Banking Corporation

Signature Verification Seminar 02/04/12 02/04/12 8 hrs Technical Allied Banking Corporation

LANDBANK Countryside Development Foundation, Inc.

Management Development Training 05/13/11 05/14/11 16 hrs Supervisory
(LCDFI)
LANDBANK Countryside Development Foundation, Inc.
Remedial Management 02/17/11 02/18/11 16 hrs Supervisory
(LCDFI)
LANDBANK Countryside Development Foundation, Inc.
Credit/Background Investigation and Appraisal 11/11/10 11/12/10 16 hrs Technical
(LCDFI)
LANDBANK Countryside Development Foundation, Inc.
Account Management and Credit Administration 09/13/10 09/14/10 16 hrs Technical
(LCDFI)

Records Management Seminar for Coops 08/28/10 08/28/10 8 hrs Technical Cooperative and Resource Management Center, Inc.

(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 in
(Write in full)
full)

BASKETBALL 2004 Outstanding Sangguniang Kabataan Councilor of Dumaguete NONE

PAINTING 2004 Outstanding Youth Leader (Youth Agent for Development Federation – Dumaguete City)

2005 Outstanding Youth Leader of Dumaguete City (Sangguniang Kabataan Federation)

2006 Young Men’s Christian Association (YMCA) of Negros Oriental, Inc. Outstanding Student
Award

(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? voluntary resignation
________________________________
________________________________
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
DCCCO MULTIPURPOSE the last 6 months
FLORDELIZ V. BOKINGKITO COOPERATIVE
422-4493 3.5 cm. X 4.5 cm
(passport size)

MARY MAGDALENE VILLEGAS LGU SIBULAN With full and handwritten

name tag and signature over
printed name
CATHEDRAL PARISH - DIOCESE OF
MSGR. MARINO P. YBO, PC DUMAGUETE Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: LTO DRIVER'S LICENSE

ID/License/Passport No.: G02-03-076508

Signature (Sign inside the box)

Date/Place of Issuance: 09-05-17/DUMAGUETE CITY

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