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 TAN-PUA

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

MIDDLE NAME GALVES

3. DATE OF BIRTH
(mm/dd/yyyy)
9/25/1985 16. CITIZENSHIP ✘ Filipino Dual Citizenship

by birth by naturalization
4. PLACE OF BIRTH TRENTO, AGUSAN DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS BLK 6A LOT 11 GATE 2
House/Block/Lot No. Street
Widowed Separated
Other/s: KALAYAAN VILLAGE BRGY 201
Subdivision/Village Barangay

7. HEIGHT (m) 1.544 PASAY CITY NCR

City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 1300
18. PERMANENT ADDRESS BLK 16 LOT 11 PHASE 2
9. BLOOD TYPE B+
House/Block/Lot No. Street
WELLSPRING HIGHLANDS CATALUNAN PEQUENO
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1880-0128-9585 DAVAO CITY DAVAO DEL SUR

City/Municipality Province
12. PHILHEALTH NO. 16-050220049-3 ZIP CODE 8000
13. SSS NO. 09-2735737-3 19. TELEPHONE NO. N/A
14. TIN NO. 306-297-240 20. MOBILE NO. 0945 306 9685
15. AGENCY EMPLOYEE NO. 200173 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) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A 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 TAN-PUA
NAME EXTENSION (JR., SR)
FIRST NAME REY N/A

MIDDLE NAME ARIÑO

25. MOTHER'S MAIDEN NAME

SURNAME ARCILLAS
FIRST NAME ARACELI
MIDDLE NAME GALVES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE UNITS
YEAR
ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full) full) (if not graduated) RECEIVED
From To
TRENTO CENTRAL
ELEMENTARY
ELEMENTARY SCHOOL ELEMENTARY 1991 1997 GRADUATED 1997 N/A
TRENTO NATIONAL HIGH
SECONDARY /
VOCATIONAL
SCHOOL HIGH SCHOOL 1997 2001 GRADUATED 2001 N/A
ST. AUGUSTINE SCHOOL OF
NURSING CAREGIVING 2014 2015 GRADUATED 2015 N/A

TRADE COURSE UNIVERSITY OF BACHELOR OF ARTS IN

COLLEGE
SOUTHEASTERN PHILIPPINES 2001 2005 GRADUATED 2005 N/A
ENGLISH
PHILIPPINE COLLEGE OF BACHELOR OF SECONDARY
GRADUATE STUDIES
TECHNOLOGY EDUCATION MAJ IN ENGLISH 2018 2018 GRADUATED 2018 N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE August 16, 2021

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF LICENSE (if applicable)
SPECIAL LAWS/ CES/ CSEE (If EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Applicable) CONFERMENT NUMBER Date of
Validity
RA 1080 (LICENSED PROFESSIONAL
TEACHER)
80.6 3/24/2019 DAVAO CITY 1791875 9/25/2022

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

BUREAU OF JAIL MANAGEMENT

11/16/2020 PRESENT JAIL OFFICER 1 29,668.00 SG-10 PERMANENT Y
AND PENOLOGY
ONLINE ENGLISH
ASIA EOE GLOBAL SERVICES
4/15/2019 7/192019 SECONDARY LANGUAGE 8500.00 N/A PART TIME N
TEACHER INC
MIRAIT PHILIPPINES INC - ENGINEERING
6/10/2015 1/5/2019 SUPERVISOR AND TELECOMMUNICATION COMPANY 12000.00 N/A PERMANENT N
CUSTOMER SERVICE
7/11/2007 5/15/2014 SM CITY DAVAO 12000.00 N/A PERMANENT N
ASSISTANT

(Continue on separate sheet if necessary)

SIGNATURE DATE August 16, 2021

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
DEPARTMENT OF SOCIAL WELFARE AND
DEVELOPMENT - ZAMBOANGA CITY
01/20/2006 05/20/2006 640 HUMAN RESOURCE ASSISTANT

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

UNITED NATIONS OFFICE ON

NELSON MANDELA RULES 07/19/2021 07/19/2021 8.0 TECHNICAL
DRUGS AND CRIMES
NATIONAL JAIL MANAGEMENT
JAIL BASIC RECRUIT COURSE 01/29/2021 07/15/2021 640.0 MANDATORY AND PENOLOGY TRAINING
INSTITUTE
LAS PINAS CITY JAIL FEMALE
JAIL IMMERSION PROGRAM 01/07/2021 07/15/2021 120.0 TECHNICAL DORM
NATIONAL JAIL MANAGEMENT
TACTICAL TRANSPORT TRAINING 05/22/2021 05/26/2021 32.0 TECHNICAL AND PENOLOGY TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
TACTICAL TRANSPORT TRAINING 05/18/2021 05/21/2021 32.0 TECHNICAL AND PENOLOGY TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
JAIL TACTICAL OPERATION MODULE 05/04/2021 06/13/2021 56.0 TECHNICAL AND PENOLOGY TRAINING
INSTITUTE JAIL MANAGEMENT
NATIONAL
BASIC ROPEMANSHIP AND
06/12/2021 06/13/2021 16.0 TECHNICAL AND PENOLOGY TRAINING
RAPELLING TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
FIRE SUPPRESSION TRAINING 06/03/2021 06/04/2021 16.0 TECHNICAL AND PENOLOGY TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
FIRE SUPPRESSION TRAINING 06/01/2021 06/02/2021 16.0 TECHNICAL AND PENOLOGY TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
EXPLOSIVE ORDINANCE
06/05/2021 06/08/2021 32.0 TECHNICAL AND PENOLOGY TRAINING
RECONNAISSANCE AGENT TRAINING
INSTITUTE JAIL MANAGEMENT
NATIONAL
QUICK MEDICAL RESPONSE
05/14/2021 05/17/2021 24.0 TECHNICAL AND PENOLOGY TRAINING
TRAINING
INSTITUTE JAIL MANAGEMENT
NATIONAL
QUICK MEDICAL RESPONSE
05/11/2021 05/13/2021 24.0 TECHNICAL AND PENOLOGY TRAINING
TRAINING
INSTITUTE JAIL MANAGEMENT
NATIONAL
PUMP ACTION SHOTGUN
05/07/2021 05/10/2021 24.0 TECHNICAL AND PENOLOGY TRAINING
ORIENTATION TRAINING
INSTITUTE
NATIONAL JAIL MANAGEMENT
PUMP ACTION SHOTGUN
05/04/2021 05/06/2021 24.0 TECHNICAL AND PENOLOGY TRAINING
ORIENTATION TRAINING
INSTITUTE
EMOTIONAL MASTERY 01/09/2021 01/09/2021 4.0 TECHNICAL JSSUPT BRENDAN FULGENCIO
JSSUPT BRENDAN O
MENTAL HEALTH AWARENESS 01/09/2021 01/09/2021 4.0 TECHNICAL
FULGENCIO
JSSUPT BRENDAN O
UNDERSTANDING SIX HUMAN NEEDS 01/07/2021 01/07/2021 4.0 TECHNICAL
FULGENCIO
JSSUPT BRENDAN O
FINANCIAL LITERACY 12/22/2020 12/22/2020 4.0 TECHNICAL
FULGENCIO
JSSUPT BRENDAN O
VALUES CLARIFICATION 12/10/2020 12/10/2020 4.0 TECHNICAL
FULGENCIO
ARM FORCES OF THE PHILIPPINES
PRACTICE TEACHING 09/10/2018 09/20/2018 80.0 TECHNICAL LOGISTICS COMMAND ELEMENTARY
SCHOOL
TWO-DAY ORIENTATION-SEMINAR ON
DEPARTMENT OF EDUCATION-
DEPED PROGRAMS AND PROJECTS WITH 07/20/2018 07/21/2018 16.0 TECHNICAL
TEACHER RO-11
TRANSFORMATIVE TRAINING FOR
CONTACT CENTER LEADERS
10/05/2017 10/06/2017 16.0 SUPERVISORY MIRAIT PHIIPPINES INC

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
PHILIPPINE ASSOCIATION FOR
LEADERHIP SKILLS N/A
TEACHERS AND EDUCATORS
FIRST AIDER / LICENSED CAREGIVER JBRC 2021-01 KALASAGIP CLASS
PROFICIENT IN MS, EXCEL, GOOGLE
APPLICATION
 (Continue on separate sheet if necessary)

SIGNATURE DATE August 16, 2021

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 YES ✘ NO
regulation 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 If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
RESIGNATION
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
a.
items:
Are you a member of any indigenous group? ✘ YES ✘ NO
If YES, please specify: MANOBO
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
JCINSP STEPHANNY F SALAZAR LAS PINAS CITY JAIL FD 8361-8318 3.5 cm. X 4.5 cm
(passport size)

SJO4 JOEL ESTRADA PASAY CITY 9295687870 With full and handwritten
name tag and signature over
printed name
JO1 NONICAR GUINGUE PASAY CITY 9177111310
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 PHOTO
filing of 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/License/Passport No.: 1791875 Signature (Sign inside the box)
AUGUST 16, 2021
Date/Place of Issuance: 7/4/2019 / DAVAO CITY 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