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 Lacson
NAME EXTENSION (JR., SR
FIRST NAME Lara

MIDDLE NAME Haro

3. DATE OF BIRTH
(mm/dd/yyyy) 6/15/1984 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH Oton, Iloilo 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
San
Other/s:
Subdivision/Village Ba
Oton
7. HEIGHT (m) 5'
City/Municipality Pr
8. WEIGHT (kg) 53kg. ZIP CODE 5020

18. PERMANENT ADDRESS

9. BLOOD TYPE A+
House/Block/Lot No. S

10. GSIS ID NO.

Subdivision/Village Ba

11. PAG-IBIG ID NO.

City/Municipality Pr

12. PHILHEALTH NO. 11-050218164-5 ZIP CODE

13. SSS NO. 07-2194595-2 19. TELEPHONE NO. 033-3370773

14. TIN NO. 940-750-704 20. MOBILE NO. 09151176002

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) arallacson15@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Lacson 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Lacson, Francheska Beatriz Haro
FIRST NAME Paul James

MIDDLE NAME Barot Lacson, Isaiah Nathaniel Haro

OCCUPATION Lacson, Leeon James Haro

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO. (033) 337-0773

24. FATHER'S SURNAME Haro

NAME EXTENSION (JR., SR)
FIRST NAME Victor
 MIDDLE NAME Langusta

25. MOTHER'S MAIDEN NAME Sarroza, Nelida Bayona (DESEASED)

SURNAME Haro

FIRST NAME Nelida

MIDDLE NAME Sarozza (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

ELEMENTARY Oton Central Elementary School 1991 1997

SECONDARY /
VOCATIONAL University of San Agustin 1997 2001

TRADE
COURSE Bachelor of Science Commerce-Management
COLLEGE University of San Agustin
Accounting
2001 2005

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE (signed) DATE Septemb

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
San Antonio
Barangay
Iloilo
Province
5020

Street

Barangay

Province

033-3370773

09151176002

arallacson15@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

11/8/2011

4/23/2013

4/7/2018
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1997

2001

2005

parate sheet if necessary)

September 15, 2019

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

Career Service Professional Eligibility 80.0 10/16/2005 Jaro National High School - Pilipino

(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

6/20/2008 present General Clerk III Mercury Drug Corporation regular

6/7/2006 4/8/2008 Accounting Assistant Golden (Iloilo) Finance Corporation regular

1/5/2006 5/5/2006 Accounting Clerk Iloilo Supermart, Incorporated probationary

4/8/2005 11/8/2005 Office Clerk Equitable Card Network contractual

 (Continue on separate sheet if necessary)

SIGNATURE (signed) DATE 9/15/19

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
N

N
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

(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

3/8/2016 3/17/2016 74 hours Technical&Skills Mercur

Mercury Development Course I
Continuing Education for Cashiers Excellent Customer Service Training-Workshop 9/30/2013 10/1/2013 16 hours Skills & Quality
Mercury

Merfaco Leadership Seminar 10/9/2010 10/12/2010 24 hours Soft Skills&Team

Mercury
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Computer literate

Quick learner & Can work under pressure

Good communication skills C

Can speak English, Filipino, Hiligaynon &
Bisaya

(Continue on separate sheet if necessary)

SIGNATURE signed DATE

 PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

Mercury Drug Corporation

Mercury Drug Corporation

Mercury Drug Corporation

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

eparate sheet if necessary)

9/15/19
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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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? ________________________________
transfer to a company with good benefits
________________________________
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
DOLE - Iloilo Field Office, Jaro, Iloilo the last 6 months
Mr. William Dungog City 3.5 cm. X 4.5 cm
(passport size)
Dep-Ed Sta. Rita National High School,
Ms. Alteah Jade Minerva Sta. Rita, Oton, Iloilo
09999530217 With full and handwritten
name tag and signature over
LifeBank-A Rural Bank, Sta. Barbara, 033-5234506 loc. printed name
Ms. Opalyn Magbanua Iloilo 200 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.) signed
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID:

ID/License/Passport No.:
Signature (Sign inside the box)
9/15/19
Date/Place of Issuance:
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