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 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 TIU
NAME EXTENSION (JR., SR)
FIRST NAME ANGELICA

MIDDLE NAME ROYO

3. DATE OF BIRTH
(mm/dd/yyyy) 7/9/1994 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH TONDO MEDICAL CENTER If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
17. RESIDENTIAL ADDRESS BLOCK 26 LOT 10 LEONGSON EXT.
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separated
N/A SAN ROQUE
Other/s:
Subdivision/Village Barangay
NAVOTAS CITY MASBATE
7. HEIGHT (m) 1.6002
City/Municipality Province
8. WEIGHT (kg) 70 ZIP CODE 1485

18. PERMANENT ADDRESS BLK 36 LOT 4 LEONGSON EXT.

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A SAN ROQUE
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211-6903-7746

NAVOTAS CITY MASBATE
City/Municipality Province

12. PHILHEALTH NO. 02-026701753-1 ZIP CODE 1485

13. SSS NO. 3458896449 19. TELEPHONE NO. N/A

14. TIN NO. 485-386-203-000 20. MOBILE NO. 639513332478

15. AGENCY EMPLOYEE NO. AA116890 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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME TIU

NAME EXTENSION (JR., SR) JR.
FIRST NAME EFREN

MIDDLE NAME JAPSON

25. MOTHER'S MAIDEN NAME AIDA BLANCA ROYO

SURNAME ROYO

FIRST NAME AIDA

MIDDLE NAME BLANCA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY KAUNLARAN ELEMENTARY SCHOOL 6/1/2001 3/6/2007 GRADUATED 2007 N/A

SECONDARY
VOCATIONAL / M.B.ASISITIO UNIT I (ANNEX) 6/10/2007 4/7/2012 GRADUATED 7/4/1905 N/A

N/A

TRADE
COURSE
COLLEGE CITY OF MALABON UNIVERSITY 9/6/2012 7/6/2016 GRADUATED 7/8/1905 N/A

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 4-24-2022

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
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
BOARD LICENSURE EXAMINATION FOR
81.6 6-26-2022 PHILIPPINE COLLEGE OF CRIMINOLOGY 1936664 7/9/2025
PROFESSIONAL TEACHER

(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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
(Y/ N)

6-22-2019 6-22-2022 SENIOR HIGH SCHOOL TEACHER TOPSERVE COMPANY 13100.00 CONTRACTUAL
 (Continue on separate sheet if necessary)

SIGNATURE DATE 4-24-2023

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 OF WORK
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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

CONTACT CENTER SERVICES NC II 5-18-2021 6-18-2021 144 HOURS ICT TESDA NAVOTAS TRAINING INSTITUTE

COMPUTER SYSTEMS SERVICING NC II 10/6/2021 7-31-2021 280 HOURS ICT

ASIAN ENTREPRENEUR TECHNOLOGICAL INC

BASIC COMPUTER TROUBLESHOOTING 3-26-2021 4-22-2021 45 HOURS ICT TESDA NAVOTAS TRAINING INSTITUTE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in
full)

GRAPHIC DESIGN USING ANDROID APPS

 COMPUTER LITERATE

READING

ENGLISH COMMUNICATION SKILLS

(Continue on separate sheet if necessary)

SIGNATURE DATE 4-24-2023

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
GEN.LUNA ST. BRGY BAYAN BAYANAN the last 6 months
MARIA LOURDES G. MUDLONG MALABON CITY
932-52-09 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
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: PRC
ID/License/Passport No.: 1936664
Signature (Sign inside the box)
4-24-2023
Date/Place of Issuance: 8-25-2022
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