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 CASTILLO

FIRST NAME CARLOS JR.

MIDDLE NAME GAMAZON

3. DATE OF BIRTH
(mm/dd/yyyy) 10/17/1977 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by

4. PLACE OF BIRTH Domanpot, Asingan, Pangasinan If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS Sams

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Do
Other/s:
Subdivision/Village Ba
Asingan Pan
7. HEIGHT (m) 1.83
City/Municipality City/M
8. WEIGHT (kg) 74 ZIP CODE 2439

18. PERMANENT ADDRESS Sams

9. BLOOD TYPE O
House/Block/Lot No. S
Do
10. GSIS ID NO. 2003441996
Subdivision/Village Ba
Asingan Pan
11. PAG-IBIG ID NO. 1280-0006-1184
City/Municipality City/M

12. PHILHEALTH NO. 19-090295495-7 ZIP CODE 2439

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

14. TIN NO. 263-292-219-000 20. MOBILE NO. 09156363688

15. AGENCY EMPLOYEE NO. ASIN-000010 21. E-MAIL ADDRESS (if any) solrac.castillo77@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
N/A N/A
FIRST NAME N/A

MIDDLE NAME N/A N/A

OCCUPATION N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A

BUSINESS ADDRESS N/A N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME CASTILLO N/A

SR. N/A
FIRST NAME CARLOS

MIDDLE NAME MATIAS N/A

25. MOTHER'S MAIDEN NAME N/A

SURNAME GAMAZON N/A

FIRST NAME MARIA N/A

MIDDLE NAME MANUEL (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 Domanpot Community School Primary Education 1984 1990 N/A

SECONDARY /
VOCATIONAL LMMSAT High School 1994 1996 N/A

Systems Technology Institute Programming in Business Systems 1996 1998 N/A

TRADE
COURSE
COLLEGE Pangasinan State University Bachelor of Science in Industrial Education 1998 2001 N/A

GRADUATE STUDIES Lyceum Northwestern University Master in Education, TLE 2012 2014 N/A
(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)

JR.

Dual Citizenship

by naturalization

Pls. indicate country:

Samson Road
Street
Domanpot
Barangay
Pangasinan
City/Municipality
2439

Samson Road
Street
Domanpot
Barangay
Pangasinan
City/Municipality

n/a

09156363688

solrac.castillo77@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1990 with honor

 1994 N/A

1998 N/A

Proficiency
2001
Awardee

2015 N/A
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 app
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

Licensure Examination for Teachers 77.2 8/1/2001 Baguio City, Philippines 0736487

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

(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

6/15/2016 present Instructor I Pangasinan State University 20651.00 12-1 Permanent

1/1/2016 6/14/2016 Instructor I Pangasinan State University 20651.00 12-1 Temporary

6/1/2015 12/31/2015 Instructor I Pangasinan State University 19940.00 12-1 Temporary

11/14/2014 3/31/2015 Instructor I Pangasinan State University 19940.00 12-1 Contractual

6/16/2014 10/31/2014 Instructor I Pangasinan State University 19940.00 12-1 Contractual

11/4/2013 3/31/2014 Instructor I Pangasinan State University 19940.00 12-1 Contractual

6/10/2013 10/29/2013 Instructor I Pangasinan State University 19940.00 12-1 Contractual

11/5/2012 3/31/2013 Instructor I Pangasinan State University 19940.00 12-1 Contractual

6/11/2012 10/26/2012 Instructor I Pangasinan State University 19940.00 12-1 Contractual

11/9/2011 4/10/2012 Instructor I Pangasinan State University 17583.00 12-1 Contractual

8/9/2011 10/28/2011 Instructor I Pangasinan State University 17583.00 12-1 Contractual

7/1/2009 10/22/2009 Instructor I Pangasinan State University 15119.00 12-1 Contractual

6/8/2009 6/30/2009 Instructor I Pangasinan State University 13512.00 12-1 Contractual

11/3/2008 3/27/2009 Instructor I Pangasinan State University 13512.00 12-1 Contractual

7/1/2008 10/27/2008 Instructor I Pangasinan State University 13512.00 12-1 Contractual

6/16/2008 6/30/2008 Instructor I Pangasinan State University 12284.00 12-1 Contractual

11/5/2007 3/25/2008 Instructor I Pangasinan State University 11167.00 12-1 Contractual

4/1/2007 10/28/2007 Instructor I Pangasinan State University 11167.00 12-1 Contractual

11/1/2006 3/31/2007 Instructor I Pangasinan State University 11167.00 12-1 Contractual

6/13/2006 10/31/2006 Instructor I Pangasinan State University 11167.00 12-1 Contractual

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A N/A N/A

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 201
 LICENSE (if applicable)

Date of
Validity

10/17/2017

N/A

N/A

N/A

N/A

N/A

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

N/A

N/A

N/A

N/A

N/A

N/A

N/A
 N/A
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) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

N/A N/A N/A N/A 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
( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/ (Write in full)
(Write in full) (mm/dd/yyyy) Technical/etc)
From To

Seminar Workshop on Teaching for Meaning and Mastery

2017 University Wide Employees Development Seminar 07/24l2017 07/25/2017 16 hrs Academic PSU-Lingayen

Campus Research Seminar and In House Review 3/1/2017 3/1/2017 8hrs Academic PSU-Asingan

Training workshop on Patent Searching and drafting 2/21/2017 2/23/2017 24 hrs Patent PSU-Lingayen

Review of Accomplishments and Planning Workshop ### ### 16hrs Academic PSU-Asingan

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. (Write 33.
in full) (Write in full)
National Organization of Professional
Playing Basketball N/A
Teachers
Philippines Association of Industrial
Singing N/A
Technology Educators
Philippines Association of Colleges and
N/A N/A
Universities in Industrial Technology
Philippines Association of Extension
N/A N/A
Program Implementors, Inc.
N/A N/A 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 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
Brgy Captain Gilbert S. Piso Domanpot Asingan 9298427145 3.5 cm. X 4.5 cm
(passport size)

Brgy Kagawad Crisanto Balisacan Domanpot Asingan 9157981125 With full and handwritten
name tag and signature over
printed name
Vice Mayor Carlos P. Lopez Jr. Domanpot Asingan 9089612356
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: PRC ID

ID/License/Passport No.: 0736487

Signature (Sign inside the box)

Date/Place of Issuance: 11/19/01

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 (Revis
 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