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 ENGGON
NAME EXTENSION (JR., SR) N/A
FIRST NAME PAUL
MIDDLE NAME MANGUNDAYA
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 8/10/1974 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH TRAN LEBAK,S.K. If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK BENEMBARAN

Widowed Separated House/Block/Lot No. Street
TAMONTAKA II
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5'5 COTABATO CITY
City/Municipality Province
8. WEIGHT (kg) 55 KG ZIP CODE 9600
18. PERMANENT ADDRESS PUROK BENEMBARAN
9. BLOOD TYPE A
House/Block/Lot No. Street
TAMONTAKA II
10. GSIS ID NO. NONE
Subdivision/Village Barangay
COTABATO CITY SPECIAL PROVINCE
11. PAG-IBIG ID NO. NONE
City/Municipality Province

12. PHILHEALTH NO. NONE ZIP CODE 9600

13. SSS NO. NONE 19. TELEPHONE NO. N/A

14. TIN NO. NONE 20. MOBILE NO. 09975960253

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) N/A
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ENGGON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A MOHALIDIN M. ENGGON
FIRST NAME TARHATA 07/24/1994

MIDDLE NAME M.

OCCUPATION HOUSEWIFE

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ENGGON

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

MIDDLE NAME M.

25. MOTHER'S MAIDEN NAME

SURNAME GANI

FIRST NAME MEDULAGA

MIDDLE NAME M. (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
From To

ELEMENTARY LEBAK ELEMENTARY SCHOOL PRIMARY EDUCATION 1986 1991 GRADUATED 1991 DIPLOMA

SECONDARY /
VOCATIONAL N/A N/A

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

TRADE
COURSE
COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 17, 2023

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

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. SALARY/ JOB/ PAY SERVICE
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
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)

January 1, 2000 PRESENT FARMER SELF EMPLOYEED N

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 17, 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

MALASAKIT TRI-PEOPLE OF KUTAWATO INCORPORATED 12/15/2022 PRESENT MEMBER

BM PATROL PRESENT MEMBER

(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

N/A
N/A

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

FARMING N/A N/A

SECURITY

DRIVER

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 17, 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 ✘ 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 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? ________________________________
Resignation
a. Have you ever been a candidate in a national or local election held within the last year (except ________________________________
38. 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 POSITION TEL. NO.

ID picture taken within
the last 6 months
AMIR '' MILKY'' P. ESMAEL CHIEF CDRRMO 3.5 cm. X 4.5 cm
(passport size)

MP SUWAIB '' GORDON'' L. ORANON MP-BARMMM With full and handwritten

name tag and signature over
printed name
ABDULSATAR S. ABAS BRGY. EXECUTIVE OFFICER-UBJP
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: NATIONALID

ID/License/Passport No.: 2601-4293-1957-3869

Signature (Sign inside the box)

Date/Place of Issuance: 23 NOV. 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