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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 CAYABYAB
NAME EXTENSION (JR., SR)
FIRST NAME JOED

MIDDLE NAME PINLAC


3. DATE OF BIRTH Dual
(mm/dd/yyyy) 10/5/1990
16. CITIZENSHIP ✘ Filipino
Citizenship
by by

birth naturalization
4. PLACE OF BIRTH BASISTA, PANGASINAN If holder of dual citizenship, Pls. indicate country:

please indicate the details.


5. SEX ✘ Male
Female
✘ Single 17. RESIDENTIAL ADDRESS #139 DON VICTOR ROAD
Married
6 CIVIL STATUS
Widowe Separa House/Block/Lot No. Street
d ted
CABELDATAN
Other/s:
Subdivision/Village Barangay

BASISTA PANGASINAN
7. HEIGHT (m) 1.76 m
City/Municipality Province

8. WEIGHT (kg) 68 Kgs ZIP CODE 2422

18. PERMANENT ADDRESS #139 DON VICTOR ROAD


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

CABELDATAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay

BASISTA PANGASINAN
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 0500022320 ZIP CODE 2422

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

14. TIN NO. 426-043-903 20. MOBILE NO. 09092880648

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) joed.cayabyab@yahoo.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 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 CAYABYAB SR
NAME EXTENSION (JR., SR)
FIRST NAME EDUARDO 11/25/1960
MIDDLE NAME QUITLONG
25. MOTHER'S MAIDEN NAME

SURNAME PINLAC 3/13/1964

FIRST NAME JULIET

MIDDLE NAME DELDIO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


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

ELEMENTARY CABELDATAN ELEMENTARY SCHOOL PRIMARY 1996 2003 2003 WITH HONORS

SECONDARY MALASIQUI CATHOLIC SCHOOL SECONDARY 2003 2007 2007 ESC SCHOLARSHIP
VOCATIONAL /

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


TRADE
COURSE PHILIPPINES COLLEGE OF SCIENCE BACHELOR OF SCIENCE OF MOST OUTSTANDING OJT & SPECIAL
COLLEGE 2007 2011 2011
AND TECHNOLOGY CRIMINOLOGY LEADERSHIP AWARD

MASTER IN DEVELOPMENT
GRADUATE STUDIES PANGASINAN STATE UNIVERSITY 12 UNITS N/A
MANAGEMENT
(Continue on separate sheet if necessary)

SIGNATURE DATE February 3, 2019


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

(R.A 6506) BOARD OF CRIMINOLOGY 80.30% 10/22/24/2011 BAGUIO CITY 0062086 10/5/2019

NAPOLCOM SENIOR POLICE OFFICER EXAMINATION 71.00% 4/24/2016 SAN FERNANDO CITY, LA UNION

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

1/1/2018 TO DATE POLICE OFFICER 1 PHIIPPINE NATIONAL POLICE P29,668 10 PERMANENT YES

11/20/2013 12/31/2017 POLICE OFFICER 1 PHIIPPINE NATIONAL POLICE P14,834 10 PERMANENT YES

7/24/2013 11/20/2013 POLICE OFFICER 1 PHIIPPINE NATIONAL POLICE P14,834 10 PERMANENT YES

6/14/2013 7/24/2013 POLICE OFFICER 1 PHIIPPINE NATIONAL POLICE P14,834 10 PERMANENT YES

7/2/2012 6/14/2013 POLICE OFFICER 1 PHIIPPINE NATIONAL POLICE P14,834 10 TEMPORARY YES

(Continue on separate sheet if necessary)

SIGNATURE DATE February 3, 2019


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

N/A N/A N/A NA 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. ( Managerial/ CONDUCTED/ SPONSORED BY
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS (Write in full) (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/ (Write in full)
Technical/etc)
From To

COMPUTER HARDWARE MAINTENANCE & TROUBLESHOOTING 9/16/2015 9/29/2015 100 HOURS TECHNICAL PANGASINAN POLICE PROVINCIAL OFFICE 1

HUMAN RIGHTS SEMINAR FOR PATROLLERS 4/3/2015 4/3/2015 7 HOURS TECHNICAL PANGASINAN POLICE PROVINCIAL OFFICE 2

POLICE REGIONAL OFFICE 1/ REGIONAL


Modified PNP SCOUT ll 12/26/2013 5/9/2014 480 HOURS TECHNICAL
SPECIAL TRAINING UNIT 1

POLICE REGIONAL OFFICE 1/ REGIONAL


PNP STANDARD HANDGUN MARKMANSHIP TRAINING PHASE 1 AND 2 5/5/2014 5/6/2014 32 HOURS TECHNICAL
SPECIAL TRAINING UNIT 1

POLICE REGIONAL OFFICE 1/ REGIONAL


PROFICIENCY TRAINING FOR GLOCK 17 GEN. 4 PISTOL 3/4/2014 3/8/2014 36 HOURS TECHNICAL
SPECIAL TRAINING UNIT 1

POLICE REGIONAL OFFICE 1/ REGIONAL


6 DAYS POLICE FUNCTIONS REFRESHER COURSE 7/29/2013 8/3/2013 60 HOURS TECHNICAL
SPECIAL TRAINING UNIT 1

CLOSE QUARTER-EDGE IMPACT WEAPON TACTICAL AND COMBAT TACTICS OF


PPSC PNPA LAKAN-KALI
7/12/2013 7/18/2013 40 HOURS TECHNICAL REGIONAL TRAINING SCHOOL 1

POLICE REGIONAL OFFICE 1/ REGIONAL


PUBLIC SAFETY FEILD TRAINING (BRC) BASISC RECRIUT COURSE 7/6/2012 7/24/2012 1920 HOURS TECHNICAL
TRAINING SCHOOL 1

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

DRIVING MEDALYA PAGLILINGKOD KAY SANTO PAPA N/A

COMPUTER LITERATE MEDALYA NG PAPURI

MEDALYA NG KASANAYAN

TSAPA NG NATATANGING YUNIT

COMMENDATION
(Continue on separate sheet if necessary)

SIGNATURE DATE February 3, 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 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

HON RENATO PINLAC MALASIQUI, PANGASINAN N/A 3.5 cm. X 4.5 cm


(passport size)

RET. PC/SUPT WENDY ROSARIO CALASIAO, PANGASINAN N/A With full and handwritten
name tag and signature over
printed name
PSSUPT BELLI TAMAYO CALASIAO, PANGASINAN N/A
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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: PNP ID

ID/License/Passport No.: 16K090009 Signature (Sign inside the box)


February 3, 2019
Date/Place of Issuance: 11/9/2016/CAMP CRAME Right Thumbmark

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

Person Administering Oath

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