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 ag
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

I. PERSONAL INFORMATION
2. SURNAME DAWILA
NAME EXTENSION (JR., SR
FIRST NAME MOH. ZHAMIR
MIDDLE NAME ASAKIL
3. DATE OF BIRTH
(mm/dd/yyyy) 10/13/1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH ZAMBOANGA CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S

Other/s:
NEW HOUSING TUBI
Subdivision/Village Ba
7. HEIGHT (m) 5'4 cm BONGAO TAW
City/Municipality Pr
8. WEIGHT (kg) 60 KG ZIP CODE 7500
18. PERMANENT ADDRESS
9. BLOOD TYPE "O"
House/Block/Lot No. S

10. GSIS ID NO. 06-0049-9574-6 NEW HOUSING TUBI

Subdivision/Village Ba
BONGAO T
11. PAG-IBIG ID NO. 1212-210-6884
City/Municipality Pr

12. PHILHEALTH NO. 20-250753403-3 ZIP CODE 7500

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 20. MOBILE NO. 09455841865

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
PAS-18 21. E-MAIL ADDRESS (if any) ZDAWILA@YAHOO.COM
NONE 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
NONE

MIDDLE NAME NONE

OCCUPATION NONE

EMPLOYER/BUSINESS NAME NONE

BUSINESS ADDRESS NONE

TELEPHONE NO. NONE

24. FATHER'S SURNAME DAWILA

NAME EXTENSION (JR., SR)
FIRST NAME SHAFRULLA
MIDDLE NAME ISMAEL
25. MOTHER'S MAIDEN NAME

SURNAME ASAKIL
FIRST NAME ROWENA
MIDDLE NAME MUDAL (Continue on separate sheet if necessary

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
BALIWASAN CENTRAL
ELEMENTARY ELEMENTARY GRADUATE 1999 2005 GRADUATE
SCHOOL
MSU-TCTO PREPARATORY HIGH SCHOOL
SECONDARY 2005 2009 GRADUATE
HIGH SCHOOL GRADUATE
VOCATIONAL /

SENARD ITC / CADDMAX AUTOCAD 2D AND 3D

2015 2017 GRADUATE
LEARNING CENTER INC. DRAFTING / 3D MAX
TRADE
TAWI-TAWI- REGIONAL
COURSE
COLLEGE 2009 2014 GRADUATE
AGRICULTURAL COLLEGE
GRADUATE STUDIES NONE NONE NONE
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

Street
TUBIG-BOH
Barangay
TAWI-TAWI
Province
7500

Street
TUBIG-BOH
Barangay
TAWI-TAWI
Province

NONE

09455841865

ZDAWILA@YAHOO.COM

DATE OF BIRTH (mm/dd/yyyy)

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

NONE

NONE
 NONE

NONE

NONE

parate sheet if necessary)

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

NONE

(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 STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

PRESENT
TEMPORA
2017 DRAFTSMAN - I PROVINCIAL ASSESSOR'S OFFICE 12,900 SG-6
RY
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES
arate sheet if necessary)

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 /
From To

NONE

(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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
ANNUAL CONFERENCE AND GENERAL ASSEMBLY OF ALL PROVINCIAL, CITY
AND MUNICIPAL TREASURES AND ASSESSORS OF REGION IX
12/4/2017 12/7/2017 96 HRS BUREAU OF LO

FIRST QUARTER CONFERENCE CY 2018 OF PROVINCIAL AND CITY TREASURERS AND ASSESSORS,
LEAGUE PRESIDENTS, OF MUNTAP AND
1/24/2018 1/26/2018 72 HRS BUREAU OF LO

PAMAS, REGATA OFFICERS AND BOARD OF DIRECTORS AND THEIR TECHNICAL STAFF

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

AUTOCAD DRAFTING NONE

3D DRAFT RENDERING NONE

COMPUTER LITERATE NONE

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

BUREAU OF LOCAL GOVERNMENT FINANCE

BUREAU OF LOCAL GOVERNMENT FINANCE

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

NONE

NONE
 NONE

eparate sheet if necessary)

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? ________________________________
________________________________
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)

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
DATU BENNAJAR S. JULKARNAIN ACS, BONGAO TAWI-TAWI NONE 3.5 cm. X 4.5 cm
(passport size)
EMS VILLAGE, BONGAO
NUR-MAHADIL K. AHAJA NONE With full and handwritten
TAWI-TAWI name tag and signature over
TUBIG-BOH, BONGAO printed name
AL-GAFAR M. NAPII NONE
TAWI-TAWI 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: PASSPORT

ID/License/Passport No.: EC5357968 Signature (Sign inside the box)

Date/Place of Issuance: 09-16-15/DFA NCR EAS 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 o

 If YES, give details (country):

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

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