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 ag
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 TOLEDO
NAME EXTENSION (JR., S
FIRST NAME ROMEO
MIDDLE NAME CALACAT
3. DATE OF BIRTH
(mm/dd/yyyy) 11/4/1965 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH TAGBILARAN CITY, BOHOL If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S

Other/s:
POBL
Subdivision/Village Ba
7. HEIGHT (m) 1.73 M BILAR BO
City/Municipality Pr
8. WEIGHT (kg) 85 KG ZIP CODE 6317
18. PERMANENT ADDRESS
9. BLOOD TYPE O
House/Block/Lot No. S
POBL
10. GSIS ID NO.
Subdivision/Village Ba
BILAR BO
11. PAG-IBIG ID NO.
City/Municipality Pr
12. PHILHEALTH NO. 12-050041369-2 ZIP CODE 6317
13. SSS NO. 06-1149594-9 19. TELEPHONE NO. (038) 510-82-59
14. TIN NO. 167-162-702-000 20. MOBILE NO. 09203731623
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME TOLEDO 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR., SR) N/A KHEM N. ALVAREZ

FIRST NAME MARIA LOURDESITA
MIDDLE NAME NAVARRO KENT N. TOLEDO

OCCUPATION (NUP) NON-UNIFORMED PERSONNEL

EMPLOYER/BUSINESS NAME PHILIPPINE NATIONAL POLICE
BUSINESS ADDRESS CAMP CRAME QUEZON CITY
TELEPHONE NO.

24. FATHER'S SURNAME TOLEDO (DECEASED)

NAME EXTENSION (JR., SR) N/A
FIRST NAME ROSO
MIDDLE NAME LEPARDO
25. MOTHER'S MAIDEN NAME
 SURNAME CALACAT
FIRST NAME LOURDES
MIDDLE NAME LOMOD (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 LOBOC CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1976 1977 GRADUATED

VOCATIONAL
SECONDARY / (PMI) LOBOC ACADEMY HIGH SCHOOL 1982 1983 GRADUATED

N/A
TRADE BACHELOR OF SCIENCE IN
COURSE UNIVERSITY OF BOHOL COMMERCE MAJOR IN FINANCE
1985 1986 GRADUATED
COLLEGE

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE July 2

CS FORM
al case/s against the person

(Do not fill up. For CSC use only)

ENSION (JR., SR) N/A

zenship

by naturalization

indicate country:

Street
POBLACION
Barangay
BOHOL
Province

Street
POBLACION
Barangay
BOHOL
Province

-59
23

DATE OF BIRTH (mm/dd/yyyy)

3/8/1994

11/11/1998
et if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

N/A

N/A

N/A

July 28, 2017

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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.
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

CONTRACTUA
5/13/2014 PRESENT DRIVER LOCAL GOVERNMENT UNIT 3100.00 00-0 L
CONTRACTUA
2/30/1988 1/3/2014 STO. NINO DE CEBU FINANCE CORP LIASON OFFICER 10500.00 00-00 L
CONTRACTUA
12/1/1987 1/31/1988 LEASE FINANCE & CREDIT CORP LIASON OFFICER 10500.00 00-00 L
CONTRACTUA
6/1/1987 11/30/1987 COCA-COLA BOTTLING COMPANY PRODUCTION WORKER 10500.00 00-00 L
CONTRACTUA
12/1/1987 5/1/1987 SAN MIGUEL CORPORATION PRODUCTION WORKER 10500.00 00-00 L
MAGNOLIA ICE CREAM SAN MIGUEL CONTRACTUA
6/1/1986 11/30/1986 CORPORATION PRODUCTION WORKER 10500.00 00-00 L
 (Continue on separate sheet if necessary)

SIGNATURE DATE JULY 28, 2017

CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

eet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

N
eet 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

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

N/A
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

SINGING, WATCHING TELEVISION

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

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)

JULY 28, 2017

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
YES ✘ NO
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? ________________________________
________________________________
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
NORMAN D. PALACIO POBLACION, BILAR, BOHOL (038) 535-91-44 3.5 cm. X 4.5 cm
(passport size)
DIOSCORO D. ANCOG POBLACION, BILAR, BOHOL
With full and handwritten
name tag and signature over
GENEROSO L. ABAYA III POBLACION, BILAR, BOHOL 9502813871 printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
is not acceptable
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: VOTERS ID
ID/License/Passport No.: 1229-0039A-K0465RCT10000 Signature (Sign inside the box)
JULY 28, 2017
Date/Place of Issuance: LOBOC, BOHOL Date Accomplished Right Thumbmark

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

NORMAN D. PALACIO
Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

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