CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s agai
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

I. PERSONAL INFORMATION
2. SURNAME DADUYA
NAME EXTENSION (JR., SR)
FIRST NAME FEVY

MIDDLE NAME ODAVAR

3. DATE OF BIRTH
(mm/dd/yyyy) 5/18/1999 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalizat
4. PLACE OF BIRTH BULA CAMARINES SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS 126

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
STO. DOMINGO
Other/s:
Subdivision/Village Barangay
BULA CAMARINES SUR
7. HEIGHT (m) 4'9
City/Municipality Province
8. WEIGHT (kg) 38 ZIP CODE 4430
18. PERMANENT ADDRESS 126
9. BLOOD TYPE O
House/Block/Lot No. Street
STO. DOMINGO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BULA CAMARINES SUR
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. N/A ZIP CODE 4430

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

14. TIN NO. N/A 20. MOBILE NO. 09388714208

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) pengdaduya18@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/d
NAME EXTENSION (JR., SR)
FIRST NAME NA

MIDDLE NAME NA

OCCUPATION NA

EMPLOYER/BUSINESS NAME NA

BUSINESS ADDRESS NA

TELEPHONE NO. NA

24. FATHER'S SURNAME DADUYA

NAME EXTENSION (JR., SR)
FIRST NAME WALTER

MIDDLE NAME BALLON

25. MOTHER'S MAIDEN NAME ESTOY

SURNAME DADUYA

FIRST NAME DAISY

MIDDLE NAME ODAVAR (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE LEVEL/
26. PERIOD OF ATTENDANCE YEAR
UNITS
LEVEL (Write in full) EARNED
GRADUATED
(Write in full) (if not
From To
graduated)
STO. DOMINGO ELEMENTARY
ELEMENTARY
SCHOOL
PRIMARY EDUCATION 6/6/2005 3/20/2011 GRADE 6 2011
VOCATIONAL /
SECONDARY PILI NATIONAL HIGH SCHOOL HIGH SCHOOL 6/5/2011 3/29/2015 4TH YEAR HS 2015

NA NA NA NA NA NA
CENTRAL BICOL STATE BACHELOR OF SECONDARY EDUCATION-
COLLEGE TRADE 6/18/2015 4/26/2019 2019
COURSE UNIVERSITY OF AGRICULTURE MAJOR IN EMT
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), P
e/s against the

For CSC use only)

turalization

ry:

GO

SUR

GO

ES SUR

RTH (mm/dd/yyyy)

SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED
3RD
HONORAB
LE
WITH
HONOR

CHED
ed 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicabl
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE EXAMINATION FOR TEACHERS 79.8 9/29/2019 RAWIS,LEGAZPI 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.
28. INCLUSIVE DATES SALARY/ JOB/
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To

N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Pa
 LICENSE (if applicable)

Date of
Validity

n separate sheet if necessary)

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

SERVICE

(Y/
N)

n separate 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
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. (Write in
full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

M
E
M
B
E
R
S
H
I
P

I
N

A
S
(Continue on separate sheet if necessary) S
O
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED C
(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) I
INCLUSIVE DATES OF A
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD T
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS I
Supervisory/ (Write in full)
(Write in full) (mm/dd/yyyy) O
From To Technical/etc)
N
/
COMPUTER SYSTEM SERVICING NCII 1/1/2020 2/1/2020 100 HRS LOGICZ TRAINING INSTITUTE
O
R
G
A
N
I
Z
A
T
I
O
N

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE

TEACHING

ONLINE SELLING

DRAWING

(Continue on separate sheet if necessary)

SIGNATURE DATE
 34. Are you related by consanguinity or affinity to the appointing or recommending authority, or
to theof bureau or office or to the person who has immediate supervision over you in the
chief
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
YES ✘ NO
regulation 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 If YES, give details:
phased 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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
the last 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
a.
items:
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
FERDINAND BRAZIL BULA, CAM.SUR 3.5 cm. X 4.5 cm
(passport size)

NEDY VILLAMER BULA, CAM.SUR With full and handwritten

name tag and signature over
printed name
ANNAMAE BALDERRAMA BULA, CAM.SUR
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct or photocopied picture
is not acceptable
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 PHOTO
filing of 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