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 (Do not fill up. For CSC use
( No. only)

I. PERSONAL INFORMATION
2. SURNAME FLORIA
NAME EXTENSION (JR., SR)
FIRST NAME STEVEN CLAUDE

MIDDLE NAME
LOPEZ
3. DATE OF BIRTH
(mm/dd/yyyy)
5/10/1999 16. CITIZENSHIP Filipino Dual Citizenship

by birth by naturalization
4. PLACE OF BIRTH TUGUEGARAO CITY If holder of dual citizenship,
Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS DAYAG ST.

6 CIVIL STATUS
House/Block/Lot No. Street
Widowed Separated CENTRO SUR
Other/s: Subdivision/Village Barangay
ALCALA CAGAYAN
7. HEIGHT (m) 176cm City/Municipality Province

8. WEIGHT (kg) 65kg ZIP CODE

18. PERMANENT ADDRESS DAYAG ST.
9. BLOOD TYPE AB House/Block/Lot No. Street
CENTRO SUR
10. GSIS ID NO. N/A Subdivision/Village Barangay
ALCALA CAGAYAN
11. PAG-IBIG ID NO. N/A City/Municipality Province

12. PHILHEALTH NO. 06-250010556-4 3507

ZIP CODE

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

14. TIN NO. 617-992-999-00000 20. MOBILE NO. 093346886

27

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) sclfloria1@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME FLORIA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME
CRYSTAL JOY SAGE LUIS R. FLORIA 8/1/2019
MIDDLE NAME RAMOS
OCCUPATION HOUSEWIFE
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. 9278719064
24. FATHER'S SURNAME FLORIA
NAME EXTENSION (JR., SR)
FIRST NAME PHILIP

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME FLORIA

FIRST NAME CHARISSA

MIDDLE NAME
LOPEZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY ALCALA EAST CENTRAL SCHOOL N/A 2006 2012 N/A 2012 N/A

SECONDARY LYCEUM OF ALCALA N/A 2012 2016 N/A 2016 N/A

VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A

BACHELOR OF SCIENCE IN HOSPITALITY

COLLEGE UNIVERSITY OF CAGAYAN VALLEY
MANAGEMENT
2018 2022 N/A N/A N/A

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF LICENSE (if applicable)
RATING
UNDER SPECIAL LAWS/ CES/ CSEE EXAMINATION PLACE OF EXAMINATION / CONFERMENT Date
(If NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Applicable) / of
CONFERMENT Validit
y
CAREEER CIVIL SERVICE PROFESSIONAL
81.8 MARCH 26, 2023 ATULAYAN, TUGUEGARAO CITY
EXAMINATION

(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
SALARY/ JOB/ PAY
28. INCLUSIVE DATES POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SERVICE
GRADE (if
(mm/dd/yyyy) MONTHL STATUS OF
(Write in (Writ applicable)& STEP
Y APPOINTMENT
full/Do e (Format "00-
From To SALARY 0")/
not abbreviate) in full/Do not abbreviate)
INCREMENT

2022 2023 ASSISTANT SUPERVISOR SABONG NETWORK COMPANY

(Continue on separate sheet if necessary)

SIGNATURE DATE
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/ NUMBER OF HOURS POSITION / NATURE OF WORK
yyyy)
Fro To
m

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMMUNICATION SKILLS

INTERPERSONAL SKILLS

DATA GATHERING

SPORTS

(Continue on separate sheet if necessary)

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, YES NO
a. within the third degree?
YES NO
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?
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
YES NO
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: YES NO
resignation, retirement, dropped from the rolls, dismissal, termination, end of term, If YES, give details:
finished contract or phased 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
YES NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period YES NO
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 YES NO
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:
YES NO
a.
Are you a member of any indigenous group? If YES, please specify:
YES NO
b.
Are you a person with disability? If YES, please specify ID No:
YES 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.

ID picture taken
within the last 6
MELISA A. MANUEL, LPT ALCALA, CAGAYAN 9088878482 months
4.5 cm. X 3.5 cm
(passport size)
MARVIN ISNEC, LPT ALCALA, CAGAYAN 9369188897

Computer
ROWELL JHAY SOLIVEN, LPT ALCALA, CAGAYAN 9272635494 generated or
photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, is not acceptable
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 PHOTO
the filingIssued
Government of administrative/criminal
ID (i.e.Passport, GSIS, SSS, PRC, case/s against
Driver's License, etc.) me.

PLEASE INDICATE ID Number and Date of

Issuance
Government Issued ID:

ID/License/Passport No.: Signature (Sign inside the box)

Date/Place of Issuance:
Date Right Thumbmark
Accomplished

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