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 SUAN
NAME EXTENSION (JR., SR)
FIRST NAME RAYMUND CHRISTOPHER

MIDDLE NAME ADARLO

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 08/31/1998 ✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH TACLOBAN CITY If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
✘ Male Female
17. RESIDENTIAL ADDRESS DADISON ST.
6 CIVIL STATUS Single
✘ Married House/Block/Lot No. Street
Widowed Separate PERICOHON 56
Other/s: d Subdivision/Village Barangay
TACLOBAN CITY LEYTE
7. HEIGHT (m) 1.60 m
City/Municipality Province
8. WEIGHT (kg) 69.7 kg ZIP CODE 6500

18. PERMANENT ADDRESS DADISON ST.

9. BLOOD TYPE O-
House/Block/Lot No. Street
PERICOHON 56
10. GSIS ID NO. N/A
Subdivision/Village Barangay
TACLOBAN CITY LEYTE
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 6500

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09107971189/09459857786

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME SUAN

NAME EXTENSION (JR., SR)
FIRST NAME RENATO

MIDDLE NAME RAMIREZ

25. MOTHER'S MAIDEN NAME

SURNAME ADARLO

FIRST NAME MARCELITA

MIDDLE NAME MENDOZA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

WITH
ELEMENTARY RIZAL CENTRAL SCHOOL 6/6/2005 3/28/2011 2011
HONORS
EASTERN VISAYAS STATE UNIVERSITY -
SECONDARY /
VOCATIONAL SECONDARY LABORATORY SCHOOL
6/6/2015 4/5/2015 2015

N/A

TRADE
COURSE REDEMPTORIST
COLLEGE EASTERN VISAYAS STATE UNIVERSITY BACHELOR OF SCIENCE IN CIVIL ENGINEERING 6/15/2015 PRESENT PARISH SCHOLAR

GRADUATE STUDIES N/A

(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

BRGY. 56 SK TREASURER N/A N/A N/A N/A

LAND TRANSPORTATION OFFICE - TACLOBAN

NON-PROFESSIONAL DRIVER'S LICENSE N/A 3/8/2020 H02-20-003429 08/31/2024
CITY

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

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

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

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

N/A 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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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)
ENGINEERING MAINTENANCE AND
6/28/2019 8/5/2019 INTERN Y
SERVICES
7/7/2020 8/11/2020 CAD, Sketchup Drafter with Estimate BRGY. 60-A COUNCIL 200/day Y

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

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(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

REDEMPTORIST YOUTH MINISTRY 10/26/2015 PRESENT YOUTH MEMBER AND SCHOLAR

PHILIPPINE INSTITUTE OF CIVIL ENGINEERS - STUDENT CHAPTER 6/6/2015 PRESENT MEMBER

SK FEDERATION - TACLOBAN CITY 05/14/2018 PRESENT SK TREASURER

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

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

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

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
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
EASTERN VISAYAS STATE UNIVERSITY - C.E.
CALCULATOR TECHNIQUES SEMINAR 3/23/2017 2/23/2017 N/A N/A
DEPARTMENT
EASTERN VISAYAS STATE UNIVERSITY - C.E.
ANTI-SEXUALHARASSMENT SEMINAR 3/15/2019 3/15/2019 N/A N/A
DEPARTMENT
EASTERN VISAYAS STATE UNIVERSITY - C.E.
RESEARCH AND FEASIBILITY STUDY SEMINAR 2/23/2019 2/23/2019 N/A N/A
DEPARTMENT
EASTERN VISAYAS STATE UNIVERSITY - C.E.
ON-THE-JOB TRAINING 6/28/2019 8/5/2019 N/A N/A
DEPARTMENT
EASTERN VISAYAS STATE UNIVERSITY - C.E.
CALCULATOR TECHNIQUES SEMINAR 2/23/2019 2/23/2019 N/A N/A
DEPARTMENT

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

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

(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)

AUTOCAD DRAFTING N/A N/A

SKETCHUP DRAFTING N/A N/A

MICROSOFT OFFICE PROFICIENCY N/A N/A

ENCODING N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

(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

✘
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,
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? ________________________________
________________________________
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 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
the last 6 months
PRESCILA NOVEDA - SCHOLARSHIP COORDINATOR TACLOBAN CITY 4.5 cm. X 3.5 cm
(passport size)

HON. CEASAR ADVINCULA BRGY. 56, DADISON ST., TACLOBAN CITY 9567021708
Computer generated
or photocopied picture
is not acceptable

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 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.: H02-20-003429

Signature (Sign inside the box)

Date/Place of Issuance: AUG. 3, 2020 / LTO-TACLOBAN

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