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 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 BLANCIA
NAME EXTENSION (JR., SR) N/A
FIRST NAME VEE JAY

MIDDLE NAME SOLOMON

3. DATE OF BIRTH
03/04/1993 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH SAN REMIGIO, ANTIQUE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A PUROK 2

Widowe Separat House/Block/Lot No. Street

N/A Sinundolan
d ed
Other/s: Subdivision/Village Barangay
San Remigio Antique
7. HEIGHT (m) 1.68
City/Municipality Province
8. WEIGHT (kg) 64 ZIP CODE 5714

18. PERMANENT ADDRESS N/A PUROK 2

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A Sinundolan
10. GSIS ID NO. N/A
Subdivision/Village Barangay
San Remigio Antique
11. PAG-IBIG ID NO. 1211-9902-3100
City/Municipality Province

12. PHILHEALTH NO. 01-052027419-2 ZIP CODE 5714

13. SSS NO. 34-5096379-4 19. TELEPHONE NO. N/A

14. TIN NO. 500-034-446 20. MOBILE NO. 0999-940-0479

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) vjblancia@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) N/A
FIRST NAME N/A 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 BLANCIA

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

MIDDLE NAME TANDAYAG

25. MOTHER'S MAIDEN NAME

SURNAME SOLOMON

FIRST NAME SARAH

MIDDLE NAME CUEVAS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SINUNDOLAN ELEMENTARY SCHOOL Primary 1999 2006 N/A 2006 Valedictorian

SECONDARY /
VOCATIONAL GIDEON M. CABIGUNDA MEMORIAL SCHOOL High School 2006 2010 N/A 2010 Valedictorian

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

TRADE Department of
COURSE Bachelor of Science in ELECTRONICS
COLLEGE UNIVERSITY OF ANTIQUE
ENGINEERING
2010 2015 N/A 2015 Science and
Technology

UNIVERSITY OF MAKATI TEACHER CERTIFICATE PROGRAM 2015 2017 N/A 2017 N/A

GRADUATE STUDIES 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 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

Civil Service Professional 81.63 03/12/2016 MANILA N/A N/A

Electronic Technician 70.00 10/21/2016 MANILA 0012304 03/04/2019

Licensure Examination for Teachers 78.40 05/22/2017 MANILA 1558012 03/04/2020

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)
06/13/2017 04/15/2018 Teacher I Ugong Pasig National High School 18, 549.00 11-1 Contractual N

04/21/2015 06/23/2017 Verification Specialist Sterling Talent Solutions 25, 392.30 N/A Permanent N

(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

PHILIPPINE I TRANSFORM! YOUNG LEADERS CONVENTION LUZON WAVE 09/18/2015 09/21/2015 96.0 JUNIOR STAFFER

6TH LEADERSHIP ENHANCEMENT AND DEVELOPMENT (LEAD) TRAINING

08/22/2014 08/24/2014 72.0 TRAINING DIRECTOR
OF THE UNIVERSITY OF ANTIQUE

UNIVERSITY OF ANTIQUE STUDENT GOVERNMENT 11/04/2014 08/04/2015 8688.0 PRESIDENT

COLLEGE OF ENGINEERING AND ARCHITECTURE - UNIVERSITY OF

06/21/2013 10/04/2014 7032.0 GOVERNOR
ANTIQUE

GAWAD KALINGA FOUNDATION - ANTIQUE CHAPTER 03/23/2013 01/04/2015 16992.0 SERVICE VOLUNTEER, SPEAKER

UNIVERSITY OF ANTIQUE STUDENT GOVERNMENT 04/13/2012 06/20/2013 10392.0 VICE PRESIDENT

(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 ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

IN - SERVICE TRAINING (INSET) FOR TEACHERS 10/23/2017 10/27/2017 40.0 Technical Department of Education

#YOUTeacHForEconDev 09/24/2017 09/24/2017 8.0 Supervisory YOUTeacH Philippines

#YOUTeacHForPeace 12/08/2017 12/08/2017 8.0 Supervisory YOUTeacH Philippines

4th Philippine I Transform! Young Leaders Convention Luzon Wave 09/18/2015 09/22/2015 40.0 Supervisory YouthLEAD Philippines

Institute of Electronics Engineers of the

Electronics in Building Construction 11/03/2015 11/03/2015 4.0 Technical
Philippines (IECEP) - Antique Chapter

Construction Management and Scheduling 04/03/2015 04/03/2015 4.0 Technical Mechanical Engineers - Antique Chapter

Philippine Institute of Civil Engineers (PICE) -

Construction Management and Safety 01/21/2015 01/21/2015 4.0 Technical
Antique Chapter

52nd Rizal Youth Leadership Institute Conference 12/21/2014 12/24/2014 32.0 Supervisory National Order of the Knights of Rizal

Institute of Electrical Engineers of the

Plumbing Design and Construction 11/28/2014 11/28/2014 4.0 Technical
Philippines (IIEE) - Antique Chapter

3rd Philippine I Transform! Young Leaders Convention Luzon Wave 09/22/2014 09/26/2014 40.0 Supervisory YouthLEAD Philippines

Seminar - Workshop on Coaching and Management of Academic, Literary and Cultural Philippine Association of States Universities and
07/15/2014 07/15/2014 8.0 Managerial
Competitions Colleges Region VI (PASUC VI) Cultural Council
Technical Seminars on Electronics Plan Preparation, Virtualization, High Performance Institute of Electronics Engineers of the
11/05/2013 11/05/2013 8.0 Technical
WiFi for the Enterprise, & Autodesk (AutoCAD) Philippines (IECEP) - Wester Visayas Chapter
Institute of Electronics Engineers of the Philippines (IECEP) - Wester Visayas Chapter Institute of Electronics Engineers of the
11/30/2012 11/30/2012 8.0 Technical
- Annual General Meeting 2012 with Technical Seminars and Oath Taking Philippines (IECEP) - Wester Visayas Chapter

(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 full)
(Write in full)

IECEP – Institute Of Electronics Engineers

Hosting N/A
Of The Philippines
Teaching

Leadership

Computer Literate

Dancing

Singing

Program / Events Director

(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 ✘ 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 ✘ NO
YES
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 phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
Resignation / Finished Contract
________________________________
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
Block 7, Lot 11, Dreamland, Hagonoy, the last 6 months
Dr. Flordelyn T. Umagat Taguig City
939-899-2083 3.5 cm. X 4.5 cm
(passport size)

Hon. Glenn V. Cabigunda Poblacion, San Remigio, Antique 917-304-7074 With full and handwritten
name tag and signature over
Dalipe, San Jose de buenavista, printed name
Engr. Mark Alester A. Lazo Antique
917-554-8788
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

ID/License/Passport No.: 0012304

Signature (Sign inside the box)

Date/Place of Issuance: Dec. 5, 2016/ PRC Manila

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