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 aga
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

I. PERSONAL INFORMATION
2. SURNAME VALLEJOS
NAME EXTENSION (JR., SR
FIRST NAME EMMANUEL

MIDDLE NAME PELAGIO

3. DATE OF BIRTH
(mm/dd/yyyy) 04 October, 1994 16. CITIZENSHIP Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH San Juan City, Manila If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS BLG 2 4th FLR Unit 5 Tand
6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
245 INC Quarry Condominium Ne
Other/s:
Subdivision/Village Ba
QUEZON CITY
7. HEIGHT (m) 5'4''
City/Municipality Pr
8. WEIGHT (kg) 74 kgs ZIP CODE 1107
18. PERMANENT ADDRESS BLG 2 4th FLR Unit 5 Tand
9. BLOOD TYPE O
House/Block/Lot No. S
245 INC Quarry Condominium Ne
10. GSIS ID NO. N/A
Subdivision/Village Ba
QUEZON CITY
11. PAG-IBIG ID NO. N/A
City/Municipality Pr

12. PHILHEALTH NO. N/A ZIP CODE 1107

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

14. TIN NO. N/A 20. MOBILE NO. 09061710755

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME VALLEJOS

NAME EXTENSION (JR., SR)
FIRST NAME MARIO
 MIDDLE NAME RAMOS

25. MOTHER'S MAIDEN NAME

SURNAME VALLEJOS

FIRST NAME AURORA

MIDDLE NAME PELAGIO (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY New Era University N/A 2000 2006

SECONDARY /
VOCATIONAL New Era University N/A 2006 2011

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

TRADE
COURSE
COLLEGE New Era University BSBA LEGAL MANAGEMENT 2011 2015

GRADUATE STUDIES New Era University 5yr JURISDOCTOR 2015 Present

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

Tandang Sora
Street
New Era
Barangay

Province
1107
Tandang Sora
Street
New Era
Barangay

Province

1107

N/A

09061710755

ememvallejos@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2006 N/A

2011 N/A

N/A N/A

2015
N/A

parate sheet if necessary)

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

(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)
(Write in full/Do not MONTHLY SALARY applicable)& STEP
(Format "00-0")/
abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To

Belmonte, Sison, Sawali and Associates

11/7/2014 3/15/2015 INTERN N/A N/A
Law Firm
Department of Environmental and
6/13/2017 7/28/2015 INTERN N/A N/A
Natural Resources
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212
 LICENSE (if applicable)

NUMBER Date of
Validity

ue on separate sheet if necessary)

n of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
OJT

OJT
ue on separate sheet if necessary)

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 /
From To

Legal Management Organization 7/1/2014 3/1/2015 N/A 4th year

(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 NUMBER OF HOURS
( Managerial/ CONDUCTED/
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
Debater
Intercollegiate Debate 2017 - "Best
Debater" re: Income Taxes be Reduced through
Increase in Personal Exemptions ; Mandatory
ROTC be Implemented in all Colleges and
Universities in the Philippines
Computer - Microsoft Office Applications

Case Digesting

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

4th year Representative

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

eparate sheet if necessary)

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 theof bureau or office or to the person who has immediate supervision over you in the
chief
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 NO
YES
(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
BANGKO CENTRAL NG the last 6 months
ATTY. FROILAN CABARIOS PILIPINAS
995.7355445 3.5 cm. X 4.5 cm
(passport size)
PHILIPPINE STATISTICS
MR. EMILIANO QUERUBIN OFFICE
915.7724349 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 or photocopied picture
is not acceptable
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 PHOTO
filing of 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: BARANGAY ID

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

Date/Place of Issuance: June 1 2017

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