CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 FLORES

FIRST NAME CHARLES NAME EXTENSION (JR., SR)

MIDDLE NAME DECRIPITO

3. DATE OF BIRTH
(mm/dd/yyyy) 11/6/96 16. CITIZENSHIP
Filipino Dual Citizenship

by birth by naturalization
4. PLACE OF BIRTH DIGOS CITY, DAVAO DEL SUR, PHILIPPINES If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS 4946 LIM STREET
House/Block/Lot No. Street
Widowed Separated
ZONE 3
Other/s:
Subdivision/Village Barangay

7. HEIGHT (m) 1.69 DIGOS CITY DAVAO DEL SUR

City/Municipality Province
8. WEIGHT (kg) 70 ZIP CODE 8002

9. BLOOD TYPE A 18. PERMANENT ADDRESS 4946 LIM STREET

House/Block/Lot No. Street

10. GSIS ID NO. ZONE 3

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121238888876 DIGOS CITY DAVAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 010263904961 ZIP CODE

13. SSS NO. 0936087870 19. TELEPHONE NO. 227-7367

14. TIN NO. 736-735-987-000 20. MOBILE NO. 0927-1716-952

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

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME N/A N/A

MIDDLE NAME N/A N/A

OCCUPATION N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A

BUSINESS ADDRESS N/A N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME FLORES N/A

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

MIDDLE NAME BUSTAMANTE N/A

25. MOTHER'S MAIDEN NAME N/A

SURNAME FLORES N/A

FIRST NAME EVELYN N/A

MIDDLE NAME DECRIPITO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

DON MARIANO MARCOS ELEMENTARY

ELEMENTARY BASIC EDUCATION CURRICULUM 6/1/03 3/24/09 2009
SCHOOL
ENGINEERING AND SCIENCE EDUCATION
SECONDARY DIGOS CITY NATIONAL HIGH SCHOOL 6/1/09 3/24/13 2013 7th HONORS
PROGRAM
VOCATIONAL /
TRADE COURSE

MINDANAO STATE UNIVESRITY- ILIGAN BACHELORS OF SCIENCE IN MAGNA CUM

COLLEGE 6/1/13 5/26/18 2018
INSTITUTE OF TECHNOLOGY ACCOUNTANCY LAUDE
LATIN HONOR
GRADUATE STUDIES COR JESU COLLEGE JURIS DOCTOR 6/1/19 3/1/19
SCHOLARSHIP
(Continue on separate sheet if necessary)

SIGNATURE DATE October 15, 2020

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LICENSE (if applicable)
RATING DATE OF EXAMINATION /
LAWS/ CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) CONFERMENT NUMBER
ELIGIBILITY / DRIVER'S LICENSE
Validity

CERTIFIED PUBLIC ACCOUNTANT 81% 10/6/18 MANILA, PHILIPPINES 0191919 11/6/21

CERTIFIED MANAGEMENT ACCOUNTANT A 11/5/18 MAKATI, PHILIPPINES

DRIVER'S LICENSE 1/7/20 PROSPERIDAD, AGUSAN DEL SUR

(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

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

1/12/18 11/25/18 ASSOCIATE CONSULTANT PriceWaterhouseCoopers Philippines 18,000.00 Probationary N

11/25/18 4/26/19 CONSULTANT PriceWaterhouseCoopers Philippines 22,000.00 Regular N

6/7/19 Present INSTRUCTOR University of Mindanao Digos College 23,000.00 Contractual N

TECHNICAL ADVISER ON BUDGET AND
3/9/20 Present City Government of Digos 20,000.00 Contractual Y
FINANCE

(Continue on separate sheet if necessary)

SIGNATURE DATE October 15, 2020

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

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

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

UPDATES ON TRAIN LAW 12/9/19 12/9/19 2.0 TECHNICAL PriceWaterhouseCoppers Philippines

MODERN TEACHING PEDAGOGY 1/15/20 1/15/20 2.0 TECHNICAL University of Mindanao

2016 BUDGET OPERATIONS MANUAL 4/6/20 4/6/20 4.0 TECHNICAL City Government of Digos

BUDGET OPERATIONS BENCHMARKING ACTIVITY 8/7/20 8/7/20 5.0 TECHNICAL City Government of Tagum

UPDATES ON BUDGET PREPARATION (LBM NO. 80) 9/7/20 9/7/20 4.0 TECHNICAL City Government of Digos

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC

TEACHING MOST OUTSTANDING JPIA PRESIDENT
ACCOUNTANTS
PUBLIC SPEAKING MOST OUTSTANDING JPIA MEMBER INSTITUTE OF MANAGEMENT ACCOUNTANTS

MICROSOFT APPLICATIONS

(Continue on separate sheet if necessary)

SIGNATURE DATE October 15, 2020

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 by
YES NO
any court or tribunal? If YES, give details:
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, YES NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in If YES, give details:
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 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
the last 6 months
DR. POLAUS M. BARI MSU- IIT, Adress Bonifacio Street, Ilgan City 0917-714-9430 4.5 cm. X 3.5 cm
(passport size)
UM Digos College, Roxas Extension, Digos
DR. TESSIE M. MIRALLES 0910-261-0449
City Computer generated
or photocopied picture
EnP. CARMI ADELE D. ROMERO, JD City Hall of Digos, Rizal Avenue, Digos City 0919-007-2367 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 administrative/criminal case/s PHOTO
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: PROFESSIONAL IDENTIFICATION CARD

ID/License/Passport No.: 0191919 Signature (Sign inside the box)

10/15/2020
Date/Place of Issuance: 11/15/2020 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