CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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
CUADRA
NAME EXTENSION (JR., SR)
FIRST NAME
LEONEL
MIDDLE NAME
ROJAS
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy)
OCTOBER 20, 1994 by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
ZAMBOANGA CITY
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS ZONE 3
Widowed Separated House/Block/Lot No. Street

Other/s: TIGBALABAG
Subdivision/Village Barangay
7. HEIGHT (m) 1.6256 M ZAMBOANGA CITY
City/Municipality Province
8. WEIGHT (kg) 70 KG ZIP CODE 7000

9. BLOOD TYPE 18. PERMANENT ADDRESS ZONE 3

'B' House/Block/Lot No. Street

10. GSIS ID NO. TIGBALABAG

Subdivision/Village Barangay

11. PAG-IBIG ID NO. ZAMBOANGA CITY

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 7000

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09174793986

483753226000
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) leonelcuadra14@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
N/A
NAME EXTENSION (JR., SR)
FIRST NAME
N/A
MIDDLE NAME
N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS
N/A
TELEPHONE NO.

24. FATHER'S SURNAME

CUADRA
NAME EXTENSION (JR., SR)
FIRST NAME LEONARDO
MIDDLE NAME DE LEON
25. MOTHER'S MAIDEN NAME

SURNAME ROJAS
FIRST NAME ARLENE
MIDDLE NAME VALERIANO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

TIGBALABAG ELEMENTARY
ELEMENTARY
SCHOOL 2001 2005 2005
SECONDARY VITALI NATIONAL HIGH
SCHOOL 2006 2010 2010
VOCATIONAL /
TRADE COURSE N/A
WESTERN MINDANAO
COLLEGE STATE UNIVERSITY 2011 2019 2019

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 2, 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 applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

AUGUST 21-23,
SOCIAL WORKER LICENSURE EXAM 75.60 2019 ZAMBOANGA CITY

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

SANGGUNIANG KABATAAN DEPARTMENT OF INTERIOR & LOCAL

JUNE 2018 PRESENT KAGAWAD GOVERNMENT NONE N/A 1TERM
1 Y

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 2, 2019

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

Save the Children (Philippines) 07/19/18 12/31/19 Site Implementation Officer

DOH-Epidemiology Bureau/City Health Office-Zamboanga 05/29/15 06/15/15 IHBSS Interviewer

DOH-Epidemiology Bureau/City Health Office-Zamboanga 04/29/15 05/29/19 IHBSS Mapper

City Health Office-Reproductive Health and Wellness Center 01/02/15 PRESENT Peer Educator

UNICEF/ Human Development and Empowerment Services 09/27/14 03/31/15 Training Facilitator

(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 Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

SUGPAT YOUTH TALK Toward Crafting the Youth Code of 06/16/18 06/16/18 8 UNICEF/Ateneo Center for Culture
Zamboanga City and the Art
Save the Children (Philippines)
CBS Motivators Training 12/6/17 12/9/17 24 /HIV/AIDS Support House (HASH)
Save The Children (Philippines)
SOGIE Desensitization Training Among Healthcare Workers 10/7/17 10/7/17 8 City Health Office
Roll-Out Training for Young Key Population – YKP 11/7/16 Save The Children
11/9/16 24 City Health Office
(iLearn, iProtect, iLink)
HIV Counseling and Testing Counselor Training 04/23/16 04/25/16 DOH-NASPCP
24 Save The Children (Philippines)

Peer Educator’s Training for In-School Youth 10/26/15 10/28/15 24 Department of Health ROIX
IHP-P2-Y2 Zamboanga Roll-Out Peer Education Training on 03/23/15 03/25/15 ISEAN-HIVOS/PNGOC
Behavioral Change Communication (Bcc) And Condom Distribution 24
Roll- Out Training on Creating Connection 10/8/14 10/10/14 24 UNICEF/HDES

Training on Child Protection and Gender Based Violence 09/27/14 09/29/14 UNICEF/HDES
24

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Community Organizing

HIV Counseling & Screening

Clerical and Office Management

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 2, 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?
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
Dr. Dulce Amor Dagalea-Miravite. MPH City Health Officer-Zamboanga City 09177018205 3.5 cm. X 4.5 cm
(passport size)
Asst. City Health Officer-
Dr. Kibtiya Uddin, MPH Zamboanga City 09177083751 With full and handwritten
name tag and signature over
Medical Officer IV-RHWC, printed name
Dr. Cathy Fernandez-Garcia, MPH City Health Office, Zamboanga City 09173080439
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
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable

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:

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

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 of 4