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 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 TURQUEZA
N/A
FIRST NAME EPHRAIM

MIDDLE NAME PASCUA

3. DATE OF BIRTH
(mm/dd/yyyy) 12/27/1954 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH DOLORES, ABRA If holder of dual citizenship, Pls. indicate coun
please indicate the details.
5. SEX ✘ Male Female

✘ Single ✘ Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. St
POBL
Other/s:
Subdivision/Village Bara
DOLORES AB
7. HEIGHT (m) 1.6 M
City/Municipality Pro
8. WEIGHT (kg) 60 KG ZIP CODE 2801

18. PERMANENT ADDRESS

9. BLOOD TYPE B
House/Block/Lot No. St
POBL
10. GSIS ID NO. 54122703013
Subdivision/Village Bara
DOLORES
11. PAG-IBIG ID NO. N/A
City/Municipality Pro

12. PHILHEALTH NO. N/A ZIP CODE 2801

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

14. TIN NO. 127-933-652 20. MOBILE NO. 09273766530

15. AGENCY EMPLOYEE NO. E-1649 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME TURQUEZA 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) MARIA SOPHIA FRANCESS GAIL N. TURQUEZA
FIRST NAME ROSE MARIE

MIDDLE NAME NIBATEN FERDIN LYLE N. TURQUEZA

OCCUPATION N /A FRITZ JON N. TURQUEZA
EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME TURQUEZA

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

MIDDLE NAME CLARO

25. MOTHER'S MAIDEN NAME

SURNAME PASCUA

FIRST NAME IRENE

MIDDLE NAME ASENCION (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY DOLORES CENTRAL SCHOOL PRIMARY EDUCATION 5/13/1905 5/19/1905 N/A

SECONDARY ISABELA STATE UNIVERSITY HIGH SCHOOL 5/20/1905 5/23/1905 N/A

VOCATIONAL /

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

TRADE
COURSE
COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Rev

L DATA SHEET
perience Sheet shall cause the filing of administrative/criminal case/s against the person

BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

N/A

Dual Citizenship

by naturalization

Pls. indicate country:

Street
POBLACION
Barangay
ABRA
Province
2801

Street
POBLACION
Barangay
ABRA
Province

N/A

09273766530

[email protected]

DATE OF BIRTH (mm/dd/yyyy)

9/30/1981

9/20/1983

3/24/1987

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1966 N/A

1970 N/A
 N/A N/A

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

CAREER SERVICE PROFESSIONAL 82.21% CALOOCAN CITY 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
DEPARTMENT OF THE INTERIOR AND LOCAL
1/1/18 PRESENT Local Government Operations Officer VI 58,717.00 22-1 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
01/01/2018 12/31/2017 Local Government Operations Officer VI 58,717.00 22-1 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
12/01/2017 12/31/2017 Local Government Operations Officer VI 52,783.00 22-1 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
01/01/2017 11/30/2017 Local Government Operations Officer V 47,559.00 20-8 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
1/1/2016 12/31/2016 Local Government Operations Officer V 43,300.00 20-8 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
2/3/2013 02/31/2015 Local Government Operations Officer V 39,478.00 20-8 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
6/1/2012 2/2/2013 Local Government Operations Officer V 39,048.00 20-7 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
6/1/2011 5/31/2012 Local Government Operations Officer V 35,530.00 20-7 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
6/24/2010 5/31/2011 Local Government Operations Officer V 32,012.00 20-7 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
02/032010 6/23/2010 Local Government Operations Officer V 28494.00 20-7 PERMANENT
GOVERNMENT (DILG-CAR)
DEPARTMENT OF THE INTERIOR AND LOCAL
7/1/2009 2/2/2010 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
27931.00 20-6 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

7/1/2008 6/30/2009 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
24367.00 20-6 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

7/1/2007 6/30/2008 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
22152.00 20-6 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/2007 6/30/2007 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
20138.00 20-6 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/2004 2/2/2007 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
19647.00 20-5 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

7/1/2001 2/2/2004 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
19168.00 20-4 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/2001 6/30/2001 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
18225.00 20-4 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

1/1/2000 2/2/2001 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
17809.00 20-3 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/2001 12/31/1999 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
16190.00 20-3 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

1/1/2000 2/2/1998 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
15795.00 20-2 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/1998 10/31/1997 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
13218.00 20-2 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

11/1/1997 12/31/1996 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
10640.00 20-2 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

1/1/1997 12/31/1995 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
8566.00 20-2 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

1/1/1996 2/2/1995 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
8498.00 20-1 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/1995 12/31/1994 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
7498.00 20-1 PERMANENT

DEPARTMENT OF THE INTERIOR AND LOCAL

2/3/1992 12/21/1993 Local Government Operations Officer V
GOVERNMENT (DILG-CAR)
6798.00 20-1 PERMANENT

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised 2017), Pa
 LICENSE (if applicable)

Date of
Validity

N/A

ate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

YES

ate sheet if necessary)

CS FORM 212 (Revised 2017), Page 2 of 4
p
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / N
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 NUMBER OF HOURS
( Managerial/ CONDUCTED/ SP
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To
Training on Assessing the Gender Responsiveness of Bottom-up Budegting to Departm
Disadvantaged Municipalities Local Government Units Funded Projects 10/27/2017 11/29/2018 16 Technical
Departm
Training for capacity enhancement of the Peolpes Law Enforcement Boards 11/15/2017 11/17/2017 16 Technical
Capacity Building for Mamamayan Ayaw sa Anomalya sa Iligal na droga Steering Departm
10/12/2017 11/13/2017 16 Technical
Committee and Technical working Group
Departm
Provincial Strategic Direction Setting Conference Workshop 08/31/2017 09/01/2017 16 Technical
Training on on Community Based Monitoring System Accelerated Poverty Profiling Departm
12/2/2016 24 Technical
Module1.
Provincial Orientation on Community Mobilization to Complement the National Departm
03/24/2017 03/24/2017 8.0 Technical
Governments Efforts to Eradicate Criminality, Corruption and Illigal Drugs
Departm
Orientation on the Revised Business Permits and Licensing System Standards 03/20/2017 03/20/2017 8.0 Technical

Departm
Training on Ealry Detection and Intervention on Drugs Use Disorder 03/14/2017 03/16/2017 24.0 Technical

Departm
Roll out Orientation on the Social Protection Handbook 02/20/2017 02/24/2017 40.0 Technical

Training on Formulation of Local Climate Change Action Plan for LGUs 12/1/2016 12/2/2016 16.0 Technical Departmen

Departm
Training Workshop pn the Peace and Order and Public Safety Planning Process 11/15/2016 11/6/2016 16.0 Technical

Advocay on Mainstreaming Climate Change Adopted-disaster Risk Reductions in Local Development Planning Departm
and Climate Change and Expenditure Tagging Cum Training on Climate and Disaster Risk Assessment Process 11/10/2016 11/12/1026 16.0 Technical
Departm
Seminar Workshop on Contact Management and Engineering 10/27/2015 10/30/2015 32.0 Technical
Training on Gender Responsive Child-friendly and Culture-Sensitive Katarungang Departm
9/29/2015 10/2/2015 32.0 Technical
Pambarangay
Departm
Orientation on Senior Citizens Benefits 9/9/2015 9/9/2015 8.0 Technical

Departm
Department of the Interior and Local Government-abra gender sensitivity Training 6/8/2015 6/8/2015 8.0 Technical

Departm
Enhanced Training on Gender and Development for DILG Personnel 5/13/2015 5/15/2015 24.0 Technical

Philippine Na
Enhanced Crime Prevention Illegal Drugs and Other 3/25/2015 3/25/2015 4.0 Technical
E
Departm
Orientation on Oplan Listo and Ugnayan ng Barangay at Simabahan 3/24/2015 3/24/2015 8.0 Technical

Departm
Barangay Newly Elected Officials Training 2014 Child Friendy Barangay Governance 11/25/2014 11/25/2014 8.0 Technical

Orientation on Grassroots Participatory Budgeting Process 2016 for Local Poverty Departm
11/11/2014 11/11/2014 8.0 Technical
Reduction Action Team
Departm
Advocay Training on Human Rights-Based Local Water and Sanitation Governance 11/25/2014 11/25/2014 8.0 Technical

Departm
Consultative Meeting and Institutionalization of the Local Blood Council-Batch 2 8/13/2014 8/13/2014 8.0 Technical
Departm
Understanding Multi Harzard Maps 8/13/2013 8/14/2013 16.0 Technical
Departm
Orientation on Business Permit and Licensing System 4/25/2013 4/26/2013 8.0 Technical

Departm
4/15/2013 4/17/2013 24.0 Technical
Bottom-up Budgeting Project Monitoring and Evaluation
Departm
1/11/2013 24.0 Technical
Skills Enhancement on Procurement of Water Projects 1/9/2013
separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
 POSITION / NATURE OF WORK

heet if necessary)

AMS ATTENDED

years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Department of the Interior and Local

Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government

Department of Sciences and Technology

Department of the Interior and Local

Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Philippine National Police and Philippine Drug
Enforcement Agency
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
Department of the Interior and Local
Government
 MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

heet 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 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? ________________________________
________________________________
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
MR. VALENTINO TENEZA Poblacion, Dolores, Abra 9164468420 3.5 cm. X 4.5 cm
(passport size)

ATTY. MATERNO MARCOS MA. G. CARINO Poblacion, Dolores, Abra 9158373957 With full and handwritten
name tag and signature over
printed name
MS. MARQUITA Z. GUZMAN Poblacion, Dolores, Abra 9086850880
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: DRIVER'S LICENSE

ID/License/Passport No.: A08-11-000730

Signature (Sign inside the box)
January 4, 2018
Date/Place of Issuance: APRIL 5, 2017
Date Accomplished Right Thumbmark

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

MILLICENT B. CARIÑO
Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of
 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