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 aga
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. (D

I. PERSONAL INFORMATION
2. SURNAME Bravo
NAME EXTENSION (JR., SR)
FIRST NAME Abigail Ann

MIDDLE NAME Macandili

3. DATE OF BIRTH
(mm/dd/yyyy) 7/21/1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH San Pablo City, Laguna If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS 485

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
Sto
Other/s:
Subdivision/Village Ba
7. HEIGHT (m) 1.63 San Pablo L
City/Municipality P
8. WEIGHT (kg) 53 ZIP CODE 4019

9. BLOOD TYPE A 18. PERMANENT ADDRESS 485

House/Block/Lot No.

10. GSIS ID NO. N/A Sto

Subdivision/Village Ba

11. PAG-IBIG ID NO.

121030540997 San Pablo L
City/Municipality P

12. PHILHEALTH NO. 080253964182 ZIP CODE 4000

13. SSS NO. 0422161381 19. TELEPHONE NO. N/A

14. TIN NO. 294496223 20. MOBILE NO. 09166265529

15. AGENCY EMPLOYEE NO. B18068 21. E-MAIL ADDRESS (if any) bravoabigail.ann@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)

NAME EXTENSION (JR., SR) N/A

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

MIDDLE NAME Exconde

25. MOTHER'S MAIDEN NAME

 SURNAME Macandili

FIRST NAME Rufina

MIDDLE NAME Hernandez (Continue on separate sheet if necessar

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Sto. Angel Elementary School Primary Education 1998 2004 Graduated

SECONDARY /
VOCATIONAL Santa Maria Academy High School 2004 2008 Graduated

N/A N/A

TRADE
Bachelor of Science in Hotel and Restaurant
COURSE
COLLEGE Laguna State Polytechnic University
Management
2008 2012 Graduated

GRADUATE STUDIES N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE Ma
BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FOR
 DATA SHEET
rience Sheet shall cause the filing of administrative/criminal case/s against the person

FORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship

by naturalization

Pls. indicate country:

Street
Sto. Angel
Barangay
Laguna
Province
4019

Street
Sto. Angel
Barangay
Laguna
Province

N/A

09166265529

bravoabigail.ann@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED

3rd Honorable
2004 Mention

2008 None

2012 None

parate sheet if necessary)

May 9, 2019

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

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

CSC-PPT-PROFESSIONAL 80.50% 3/18/2018 Sta. Cruz, Laguna

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
Fire Officer 1/Fire Code Fees Collecting Agent/Radio
Department of the Interior and Local Government/
3/1/2018 PRESENT Operator/Public Information Officer/IPCR Focal
Bureau of Protection/Siniloan Fire Station-Laguna
29,668.00 10
Person

3/12/2018 2/1/2019 Fire Officer 1 /On-The-Job Training Cabuyao City Fire Station 29,668.00 10
R4-A Regional Headquarters, Camp Vicente Lim,
1/10/2018 2/12/2018 Fire Officer 1 /On-The-Job Training
Calamba City
29,668.00 10

01/20/2014 09/28/2018 Field Representative Meralco Industrial Engineering Services Corporation 11,050.00 N/A

9/5/2012 9/2/2013 Cashier/Receptionist Classic Savory Fastfood Incorporated 9,000.00 N/A

 (Continue on separate sheet if necessary)

SIGNATURE DATE May 9, 2019

BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FORM 212 (R

 LICENSE (if applicable)

NUMBER Date of
Validity

N/A 05/16/2018

e on separate sheet if necessary)

of duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)

Permanent Yes

Permanent Yes

Permanent Yes
Regular
No
Project-Hired
Contructual No
e on separate sheet if necessary)

May 9, 2019

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 / N
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/ S
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
Bureau
Refresher Course in the Assessment and Collection of Fire Code Fees 4/24/2019 4/24/2019 8.0 Technical
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

Computer Literate N/A

Driving

(Continue on separate sheet if necessary)

SIGNATURE DATE
BFP-QSF-HRMD-018 Rev. ØØ (05.04.18)
PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

arate sheet if necessary)

OGRAMS ATTENDED
ve (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Bureau Of Fire Protection Regional

Headquarters 4A
arate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

arate sheet if necessary)

May 19, 2019

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? I resigned from my previous job
________________________________
________________________________
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)

ID picture taken with
NAME ADDRESS TEL. NO. the last 6 months
3.5 cm. X 4.5 cm
(passport size)
Brgy. Sta. Maria Magdalena, San Pablo
Senen Becina City,Laguna
09994468035 With full and handwri
name tag and signature
printed name

Bernice Kaye Eballa Sta. Monica, San Pablo City, Laguna 09270357992 Computer generate
or photocopied pictu
is not acceptable
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 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: Driver's License

ID/License/Passport No.: D14-14-001037

Signature (Sign inside the box)
May 9, 2019
Date/Place of Issuance: 01/05/2017 LTO San Pablo, Laguna
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 9th day of May 2019 , affiant exhibiting his/her validly issued government ID as indicated ab

SFO4 Luis P Andaya

Officer-In-Charge
Person Administering Oath

BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FORM 212 (Revised

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

I resigned from my previous job
________________________________
________________________________
✘ NO

✘ NO

✘ NO
If YES, give details (country):

✘ NO

✘ NO

✘ NO

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO
 Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

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