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/
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 fi

I. PERSONAL INFORMATION
2. SURNAME TESIO
NAME EXTENSION (JR., SR)
FIRST NAME ANGELIC

MIDDLE NAME LANAJA

3. DATE OF BIRTH
(mm/dd/yyyy) 5/3/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by n
4. PLACE OF BIRTH Baroy Lanao del Norte If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS Jalalon

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
Poblacio
Other/s:
Subdivision/Village Baranga
Kapatagan Lanao del N
7. HEIGHT (m) 129
City/Municipality Province
8. WEIGHT (kg) 52 ZIP CODE 9214

18. PERMANENT ADDRESS Jalalon

9. BLOOD TYPE O
House/Block/Lot No. Street
Poblacio
10. GSIS ID NO. N/A
Subdivision/Village Baranga
Kapatagan
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 15-025461963-0 ZIP CODE

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

14. TIN NO. N/A 20. MOBILE NO. 09066965319

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
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 Tesio

NAME EXTENSION (JR., SR)
FIRST NAME Miquias
 MIDDLE NAME Rabanes

25. MOTHER'S MAIDEN NAME Lanaja

SURNAME Tesio

FIRST NAME Helen

MIDDLE NAME Rendula (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Kapatagan East Central School 6/1/2004 3/1/2009 Graduated

SECONDARY /
VOCATIONAL Kapatagan National High School 6/1/2009 3/1/2012 Graduated

TRADE
october
COURSE
COLLEGE Pilgrim Christian College BS Accountancy 6/1/2012
29,2016
Graduated

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE August 9, 2

CS FORM 212 (
AL DATA SHEET
Work Experience Sheet shall cause the filing of administrative/criminal case/s against the

T (PDS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

Jalalon
Street
Poblacion
Barangay
Lanao del Norte
Province
9214

Jalalon
Street
Poblacion
Barangay
Lanao del Norte
Province

N/A

09066965319

[email protected]

DATE OF BIRTH (mm/dd/yyyy)

 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2009 with honors

2012 with honors

2016

on separate sheet if necessary)

August 9, 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
March 12,2017
Civil Service Professional Examination 82.5 Cagayan de Oro City

Philippine Law School Admission Test 63.0 April 16,2017 Cagayan de Oro 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.
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
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
arate sheet 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 / NATURE O
From To

Radyo Natin Club Lanao del Norte Chapter 1/1/2010 1/1/2014

Christian Youth Fellowship 1/1/2010 present

(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 CONDUCTED/
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/
NUMBER OF HOURS
YSEALI University Caravan Mindanao (Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
Xavier University Gym , CDO City
From To
December 17,2014
Y
-YSEALI University Caravan Mindanao 12/17/2014
Xavier University Gym , CDO City
The Essence
December of Financial Accounting in your Business , Pilgrim Christian College
17,2014
1/15/2016 Pilgrim C

Meet with the Board of Accountancy, Lourdes College

4/17/2017 Lou

On the Job Training, Fabre Accounting Office 10/1/2015 200.0

Fabre Acc
Junior Phil
Junior Philippine Institute of Accountants 7/1/2015
Ac
Junior Phil
Junior Philippine Institute of Accountants 7/1/2016
Ac
International Reporting Standards (IFRS) : NEW REVENUE RECOGNITION FROM Phillipine In
4/1/2016
CONTRACTS Public
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Oriented in Microsoft Applications such as Junior Phili

Word, Excel, Powerpoint Acc
Christian Y
Bookkeeping
(c
Auditing
Thorough knowledge of GAAP, FASB,
pronouncements and the accounting process

Singing , Dancing

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Rev
MENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ING PROGRAMS ATTENDED
or the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in
full)

YSEALI

Pilgrim Christian college

Lourdes College

Fabre Accounting Office

Junior Philippine Institute of
Accountants
Junior Philippine Institute of
Accountants
Phillipine Institute of Certified
Public Accountants
eparate sheet if necessary)

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION

(Write in full)

Junior Philippine Institute of

Accountants
Christian Youth Fellowship
(circuit 3)

eparate sheet 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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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
Mary Arlene Carbonera Poblacion Kapatagan Lanao del Norte 3.5 cm. X 4.5 cm
(passport size)

Marites Cabigas Poblacion Kapatagan Lanao del Norte With full and handwritten
name tag and signature over
printed name
Grace Deloria Poblacion Kapatagan Lanao del Norte
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:

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

Date/Place of Issuance:
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 o

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

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