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 cas
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.

I. PERSONAL INFORMATION
2. SURNAME OCRAY

FIRST NAME MARICEL

MIDDLE NAME VELARDE

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 4/15/1974 ✘ Filipino Dual Citizens

4. PLACE OF BIRTH MAKATI CITY If holder of dual citizenship,

please indicate the details.

5. SEX
Male ✘ Female

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 7775
✘ Single Married House/Block/Lot No.
Widowed Separated N/A
Other/s: Subdivision/Village
7. HEIGHT (m) 5'1 MAKATI CITY
City/Municipality
8. WEIGHT (kg) 65 KILOGRMAS ZIP CODE 1207

9. BLOOD TYPE O
18. PERMANENT ADDRESS 7775
House/Block/Lot No.

10. GSIS ID NO. N/A N/A

Subdivision/Village

11. PAG-IBIG ID NO. N/A MAKATI CITY

City/Municipality

12. PHILHEALTH NO. 19-200515413-4 ZIP CODE 1207

13. SSS NO. 33-1350819-9 19. TELEPHONE NO. 027455423

14. TIN NO. 146-284-420 20. MOBILE NO. 09278104172

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) OCRAYMARICEL@GMAIL.COM
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)

FIRST NAME N/A NAME EXTENSION (JR., SR) N/A JOHN RENZO OCRAY TORRES

MIDDLE NAME N/A JAMES CEDRIC OCRAY

OCCUPATION N/A SHEILA MARIE OCRAY

EMPLOYER/BUSINESS NAME N/A SHAINA MAE. OCRAY TORRES

BUSINESS ADDRESS N/A MIGUEL RODRIGO TORRES

TELEPHONE NO. N/A

24. FATHER'S SURNAME OCRAY

FIRST NAME MANLY NAME EXTENSION (JR., SR) N/A

MIDDLE NAME BORAGAY

25. MOTHER'S MAIDEN NAME

SURNAME VELARDE

FIRST NAME TEODORICA

MIDDLE NAME PAYUSAN (Continue on separate sheet if

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
26. NAME OF SCHOOL PERIOD OF ATTENDANCE
BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

FRANCISCO BENITEZ ELEMENTARY

ELEMENTARY PRIMARY EDUCATION 1981 1986
SCHOOL
GENERAL PIO DEL PILAR
SECONDARY /
VOCATIONAL HIGH SCHOOL 1986 1991
HIGHSCHOOL

DATAMEX COMPUTER SCHOOL COMPUTER PROGRAMMING 1991 1992

TRADE
COURSE
COLLEGE N/A N/A N/A N/A

GRADUATE STUDIES N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
AL DATA SHEET
ork Experience Sheet shall cause the filing of administrative/criminal case/s against the person

(PDS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

✘ Filipino Dual Citizenship

✘ by birth by naturalization
Pls. indicate country:

J.B. ROXAS
Street
OLYMPIA
Barangay
NATIONAL CAPITAL REGION
Province

J.B. ROXAS
Street
OLYMPIA
Barangay
NATIONAL CAPITAL REGION
Province

027455423

09278104172

OCRAYMARICEL@GMAIL.COM

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

JOHN RENZO OCRAY TORRES 3/11/1999

JAMES CEDRIC OCRAY 1/19/2001

SHEILA MARIE OCRAY 1/4/2003

SHAINA MAE. OCRAY TORRES 9/10/2008

MIGUEL RODRIGO TORRES 10/27/2016

(Continue on separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/

YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED
 HIGHEST LEVEL/ SCHOLARSHIP/
YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

N/A 2009 N/A

N/A 2013 N/A

FIRST YEAR N/A N/A

N/A N/A N/A

N/A N/A N/A

nue on separate sheet if necessary)

January 20, 2019

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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.
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

09/16/1997 07/08/2003 CASHIER CARLOS WINE CELLAR 6K N/A N/A

10/18/2013 02/16/2016 LIASON OFFICER ALFAFARA BUFFI & associates 10k N/A N/A
 (Continue on separate sheet if necessary)

SIGNATURE DATE 01/20/2019

CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N/A

N/A
arate sheet if necessary)

01/20/2019
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 POSITI
From To

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/ CONDUCT
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

PLAYING VOLLEYBALL N/A

COOKING N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
NT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

on separate sheet if necessary)

PROGRAMS ATTENDED
last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

N/A

on separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A
 N/A

on separate sheet if necessary)

01/20/2019
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
YES ✘ NO
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, YES ✘ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details: ________________________
phased out (abolition) in the public or private sector? ________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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
the last 6 mont
COUNCILOR MA. CONCEPCION YABUT MAKTI CITY HALL 8701000 3.5 cm. X 4.5 c
(passport size

KAGAWAD LYNDON GONZALES BRGY. HALL OLYMPIA 8975830 With full and handw
name tag and signatu
printed name
KAGAWAD DYOK BINAY BRGY. HALL OLYMPIA 8975830
Computer genera
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pic
is not acceptab
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: SSS
ID/License/Passport No.: 33-1350819-9 Signature (Sign inside the box)
01/20/2019
Date/Place of Issuance: QUEZON CITY Date Accomplished Right Thumbma

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

Person Administering Oath

CS FORM 212 (Revise

 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