Editable Pds 2024 1
Editable Pds 2024 1
Editable Pds 2024 1
212
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 GARGANTA
NAME EXTENSION (JR., SR)
FIRST NAME JESSE NOEL
4. PLACE OF BIRTH LOPEZ, QUEZON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female
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) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A
OCCUPATION N/A
SURNAME GARGANTA
ELEMENTARY MAGALLANES ELEMENTARY SCHOOL ELEMENTARY 7/06/04 7/03/11 GRADUATED 2011 N/A
SECONDARY MAGALLANES NATIONAL HIGH SCHOOL SECONDARY 7/03/11 7/07/15 GRADUATED 2015 N/A
VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A
POLYTECHNIC UNIVERSTY OF THE
COLLEGE TERTIARY 1/02/15 1/02/20 GRADUATED 2020 N/A
PHILIPPINES
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE
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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity
LICENSURE EXAMINATION FOR TEACHERS 87.8 01/30/2022 LUCENA, CITY 1907417 12/14/2025
V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
INCLUSIVE DATES SALARY/ JOB/ PAY
28. GRADE (if
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY STATUS OF GOV'T SERVICE
MONTHLY SALARY applicable)& STEP
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) (Format "00-0")/
APPOINTMENT (Y/ N)
From To INCREMENT
SIGNATURE DATE
TEAM PLAYER
LEADERSHIP
COMPUTER LITERATE
SIGNATURE DATE
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:
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:
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.