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 SOLAIMAN
NAME EXTENSION (JR., SR)
FIRST NAME HAMAD

MIDDLE NAME PUASA

3. DATE OF BIRTH
(mm/dd/yyyy) 05/19/1998 16. CITIZENSHIP

4. PLACE OF BIRTH BATUAN, BALABAGAN LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS PINDOLONAN

6 CIVIL STATUS
House/Block/Lot No. Street
BUBONG PUNOD
Subdivision/Village Barangay
7. HEIGHT (INCH) 69 Inches Marawi CITY Lanao del Sur
City/Municipality Province
8. WEIGHT (kg) 56kg ZIP CODE 9700
18. PERMANENT ADDRESS BLK 12 LOT 42 TUNGA STREET
9. BLOOD TYPE B+
House/Block/Lot No. Street
ERLINDA VILLE DEL CARMEN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
ILIGAN CITY LANAO DEL NORTE
11. PAG-IBIG ID NO. N/A
City/Municipality Province

PHILHEALTH NO. N/A ZIP CODE 9200

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

14. TIN NO. N/A 20. MOBILE NO. 09512608459/09652660271

15. AGENCY EMPLOYEE NO. F-2022-32 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) N/A N/A
FIRST NAME N/A

MIDDLE NAME N/A N/A

OCCUPATION N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME SOLAIMAN N/A N/A

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

MIDDLE NAME ESMAIL N/A N/A

25. MOTHER'S MAIDEN NAME n/a N/A

SURNAME PUASA n/a N/A

FIRST NAME SAIDA n/a N/A

MIDDLE NAME MUTHO (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

BALABAGAN CENTRAL ELEMENTARY

ELEMENTARY ELEMENTARY 2006 2012 2012 DIPLOMA
SCHOOL
SECONDARY-JUNIOR
HIGH RPMD NATIONAL SCIENCE HIGH SCHOOL SECONDARY 2012 2016 2016 DIPLOMA
SECONDARY-SENIOR
HIGH
WITH
JAMIATU MUSLIM MINDANAO TVL- COMPUTER PROGRAMMING 2016 2018 2018
HONOR

COLLEGE JAMIATU MUSLIM MINDANAO BS-CRIMINOLOGY 2018 2021 2021 CUM LAUDE

GRADUATE STUDIES

SIGNATURE DATE AUGUST 7, 2023 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

CRIMINOLOGY LICENSURE EXAMINATION 78.95% JUNE 12-14, 2022 CAGAYAN DE ORO CITY 0232702 5/19/2025

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

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

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

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

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

N/A N/A N/A N/A N/A 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.
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)

08/22/2022 PRESENT COLLEGE INSTRUCTOR 7000 PART-TIME N

JAMIATU MUSLIM MINDANAO

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 7, 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

PHILIPPINE MUSLIM STUDENT ASSOCATION- JMM CHAPTER 11/16/2019 PRESENT N/A MEMBER

PROFESSIONAL CRIMINOLOGY ASSOCIATION IN THE PHILLPINES 8/31/2022 PRESENT N/A MEMBER

COMMISSION ON MORO YOUTH MOVEMENT 2016 PRESENT N/A MEMBER

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

REGIONAL ACCREDITATION COURSE FOR MBHTE TEACHER - OFFICIATING OFFICIALS OF MBHTE BUREAU OF PHYSICAL EDUCATION
THE 22 SPORTS EVENTS FOR BARMMAA MEET 2023 6/5/2023 8/5/2023 24 AND SPORTS DEVELOPMENT
MBHTE BUREAU OF PHYSICAL EDUCATION
REGIONAL REFRESHER COURSE FOR MBHTE TECHNICAL OFFICIALS 11/11/2022 11/13/2022 72 TECHNICAL
AND SPORTS DEVELOPMENT

THESIS AND RESEARCH WRITING 12/16/2020 12/16/2022 8 JAMIATU MUSLIM MINDANAO

SEMINAR WORKSHOP ON CODE OF CONDUCT AND ETHICAL STANDARDS FOR

10/6/2019 10/6/2019 8 JAMIATU MUSLIM MINDANAO
PUBLIC OFFICIALS AND EMPLOYEE, R.A. 6713
THE CURRENT STATUS OF CRIMINOLOGY EDUCATION IN THE PHILIPPINES AND
ORIENTATION ON R.A.11131 4/30/2019 4/30/2019 8 JPI - CRIMINOLOGY DEPARTMENT

VIII. OTHER INFORMATION

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

MBHTE-BARMM SEPAK TAKRAW

READING QUR-AN PALARONG BARMAA 2023 (TECHNICAL OFFICIALS)
ASSOCIATION

COMPUTER LITERATE PALARONG PANGLUNGSOD NG MARAWI CITY 2019 AND 2022 (COACH) MATAMPAY UNITED FOOTBALL CLUB

BASEBALL PALARONG PANGLUNGSOD NG MARAWI CITY 2022 (OFFICALS)

VOLLEYBALL PALARONG ARMMAA 2012-2018 PLAYER

SEPAK TAKRAW PALARONG PAMBANASA PLAYER 2014 AND 2015

PHYSICAL FITNESS

MARKMANSHIP AND COMBAT SHOOTING

SIGNATURE DATE AUGUST 7, 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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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
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,
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
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before 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?
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?
If YES, please specify: MERANAO
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ALEEM ABDULGANI A. SUMAGUINA, MAEd BALO-I LDN 0963-818-3360

ATTY. HANIMAH M. BASHER, Lpt, Sh.L (CAR) Ph.D PIAGAPO LANAO DEL SUR 0938-178-7554

ATTY. ASLIAH G. MAPANDI, Lpt, Sh.L (CAR) Ph.D LOKSADATU MC. 0936-417-8416
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 administrative/criminal case/s PHOTO
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

ID/License/Passport No.: 0232702

Signature (Sign inside the box)
08/07/2023
Date/Place of Issuance: 10/05/2022 ILIGAN 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