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 DUMAGUING
NAME EXTENSION (JR., SR)
FIRST NAME RHIANDY
MIDDLE NAME MENDOZA
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) NOV. 10 , 1985
by birth by naturalization
4. PLACE OF BIRTH STO. NIÑO TUKURAN Z.D.S. If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS QUEZON ST.

Widowed Separated House/Block/Lot No. Street

Other/s:
STO. NIÑO
Subdivision/Village Barangay
7. HEIGHT (m) 1.62 M TUKURAN , ZAMBOANGA DEL SUR
City/Municipality Province
8. WEIGHT (kg) 73 KG ZIP CODE 7019
9. BLOOD TYPE 18. PERMANENT ADDRESS MAGSAYSAY ST.
B (+) House/Block/Lot No. Street

10. GSIS ID NO. STO. NIÑO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. TUKURAN , ZAMBOANGA DEL SUR

4165-1143-0412-5745 City/Municipality Province

12. PHILHEALTH NO. 1420-0726509-2 ZIP CODE 7019

13. SSS NO. 34-3567742-9 19. TELEPHONE NO.

14. TIN NO. 721-184-172 20. MOBILE NO. 0907-511-6164

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) [email protected]
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 ETHAN O. DUMAGUING FEB. 19 , 2015
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME DUMAGUING

NAME EXTENSION (JR., SR)
FIRST NAME RAMON
MIDDLE NAME CABRALES
25. MOTHER'S MAIDEN NAME MENDOZA
SURNAME DUMAGUING
FIRST NAME ARCELI
MIDDLE NAME MENDOZA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

TUKURAN CENTRAL
ELEMENTARY
ELEMENTARY SCHOOL 1998 1999 1999
SAN CARLOS NATIONAL
SECONDARY
HIGH SCHOOL 2002 2003 2003
VOCATIONAL / Technical Education and - REF. AND AIRCONDITIONING
TRADE COURSE Skills Development Authority (TESDA) - BUILDING WIRING
2003 2004 2004
SOUTHERN MINDANAO BACHELOR OF SCIENCE IN 2009
COLLEGE
COLLEGES- PAGADIAN CITY
2008 2009
CIVIL ENGINEERING

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/23/18

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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

TECHNICAL DRAFTING NC-II 10/3-5/2013 TESDA DAO PAGADIAN CITY

(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.
INCLUSIVE DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT

9/16/13 PRESENT CIVIL ENGINEERING AIDE LOCAL GOVERTMENT UNIT 6,500 J.O.
9/24/12 7/19/13 PROJECT SUPERVISOR BUILDWELL CONTRUCTION 12,000 CONTRACTUAL

10/11/10 9/24/12 CIVIL ENGINEERING AIDE LOCAL GOVERTMENT UNIT 5,000 PLANTILLA

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/23/18

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
(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 Type of LD

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

(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)

AUTO CAD OPERATOR

DRIVING

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/23/18

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
3.5 cm. X 4.5 cm
(passport size)

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 and or photocopied picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the 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: LGUTK-180194
ID/License/Passport No.: J03-08-002474
Signature (Sign inside the box)
10/23/18
Date/Place of Issuance: 11/10/18 - PAGADIAN CITY
Date Accomplished Right Thumbmark

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

HON. MAYCHEL O. VELAYO-ROTA

Person Administering Oath

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