CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 MORALES
NAME EXTENSION (JR., SR)
FIRST NAME PRINCESS JOY
MIDDLE NAME DELMONTE
3. DATE OF BIRTH
(mm/dd/yyyy)
8/31/1997 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH NAGA 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 # 74 ZONE -2 SAINT FRANCIS STREET
Widowed Separated House/Block/Lot No. Street

Other/s:
CALAUAG
Subdivision/Village Barangay

7. HEIGHT (m) 1.625 m NAGA CITY CAMARINES SUR

City/Municipality Province
8. WEIGHT (kg) 68 kls ZIP CODE

18. PERMANENT ADDRESS # 74 ZONE -2 SAINT FRANCIS STREET

9. BLOOD TYPE A+
House/Block/Lot No. Street

10. GSIS ID NO. CALAUAG

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-3802-2633 NAGA CITY CAMARINES SUR

City/Municipality Province
12. PHILHEALTH NO. 1005-0266-0300 ZIP CODE 4400
13. SSS NO. 34-7938757-1 19. TELEPHONE NO.

14. TIN NO. 719-375-908-000 20. MOBILE NO. 09461868504

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) princessjoymorales6@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME
OCCUPATION

EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.

24. FATHER'S SURNAME MORALES

NAME EXTENSION (JR., SR)
FIRST NAME ALFREDO
MIDDLE NAME LASALA
25. MOTHER'S MAIDEN NAME YOLANDA BREN DELMONTE
SURNAME MORALES
FIRST NAME YOLANDA
MIDDLE NAME DELMONTE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY NAGA CENTRAL SCHOOL II 2004 2009 2009

BICOL STATE COLLEGE OF APLLIED SCIENCES
SECONDARY AND TECHNOLOGY 2010 2014 2014
VOCATIONAL /
TRADE COURSE
BICOL STATE COLLEGE OF APLLIED SCIENCES
COLLEGE AND TECHNOLOGY 2014 2018 2018
GRADUATE STUDIES

(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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

LICENSED PROFESSIONAL TEACHER 77.2 9/30/2018 LEGAZPI CITY 1679464 8/31/2021

(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.
INCLUSIVE DATES SALARY/ JOB/
28. GOV'T
PAY GRADE (if
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
From To INCREMENT

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

PHILIPPINE REDCROSS CAMARINES SUR CHAPTER 2017 PRESENT 8 HRS RED CROSS YOUTH INSTRUCTOR

PHILIPPINE REDCROSS CAMARINES SUR CHAPTER 2017 PRESENT 8 HRS FIRST AIDER

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

BREAD AND PASTRY PRODUCTION NC II JUNE 3,2019 JULY 3,2019 141 HRS TECHNICAL KOLPING SOCIETY

BEAUTY CARE NAILCARE NC II MARCH 28,2018 APRIL 28,2018 216 HRS TECHNICAL LONDONAIRE BEAUTY SALON

RED CROSS YOUTH INSTRUCTOR MARCH 28,2017 APRIL 28,2018 224 HRS TECHNICAL RED CROSS CAMARINES SUR CHAPTER

BASIC LIFE SUPPORT TRAINING 12/16/2017 12/182017 32 HRS TECHNICAL RED CROSS CAMARINES SUR CHAPTER

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 33. ASSOCIATION/ORGANIZATION
(Write in full)
(Write in full)
PHILIPPINE RED CROSS CAMARINES
COMPUTER LITERATE
SUR CHAPTER
SINGING

DANCING

(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
chief of bureau or office or to the person who has immediate supervision over you in the
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
a. items:
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
the last 6 months
MRS. JULIETA S. ABAY STA CRUZ, NAGA CITY 9096749476 3.5 cm. X 4.5 cm
(passport size)

MRS. ERLINDA V. BAILEY BLACER ST. NAGA CITY 9154382425 With full and handwritten
name tag and signature over
printed name

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: PRC
ID/License/Passport No.: 1679464 Signature (Sign inside the box)

Date/Place of Issuance: 02/06/2019 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