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 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 MONIS
NAME EXTENSION (JR., SR)
FIRST NAME MARC IAN JADE

MIDDLE NAME SABADO N/A

3. DATE OF BIRTH
(mm/dd/yyyy) 12/3/2002 16. CITIZENSHIP

4. PLACE OF BIRTH SUDIPEN LA, UNION If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX MALE

6 CIVIL STATUS SINGLE

17. RESIDENTIAL ADDRESS SECTOR 5 SECTOR 5
House/Block/Lot No. Street
NAGSABARAN
Subdivision/Village Barangay

7. HEIGHT (m) 5'6 BANGAR LA UNION

City/Municipality Province
8. WEIGHT (kg) 72 ZIP CODE

9. N/A
18. PERMANENT ADDRESS SECTOR 5 SECTOR 5
House/Block/Lot No. Street

10. GSIS ID NO. N/A NAGSABARAN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A BANGAR LA UNION

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 2519

05 -250613813 -2
13. SSS NO. 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09616006532

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) monisyanyan@[Link]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME
NAME EXTENSION (JR., SR)
N/A
N/A N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

CELLPHONE NO.

24. FATHER'S SURNAME MONIS

FIRST NAME LEONARDO

MIDDLE NAME LANUZA

25. MOTHER'S MAIDEN NAME

SURNAME SABADO

FIRST NAME
MARY JANE

MIDDLE NAME ARCEGA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MARIA CRISTINA ELEMENTARY SCHOOL N/A 2009 2015 N/A 2015

DOÑA FRANSISCA LACSAMA DE ORTEGA

SECONDARY MEMORIAL NATIONAL HIGH SCHOOL
N/A 2015 2021 N/A 2021
VOCATIONAL /

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

TRADE
COURSE
COLLEGE CICOSAT COLLEGES N/A 2021 2025 4TH YEAR

GRADUATE STUDIES
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE 01-12-25 CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

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

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

(Continue on separate sheet if necessary)

SIGNATURE DATE 01-12-25 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 / NATURE OF WORK
From To

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

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

DRIVING N/A N/A

SINGING N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 01-12-25 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?
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
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: yes no✓
a. Are you a member of any indigenous group?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS CELL. NO. ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
MARK AHLLEN M. RICARDE BANGAR,LA UNION 9100974572 (passport size)

With full and handwritten

CARLOS JAIRUS C. BALBIN BANGAR, LA UNION 9950976288 name tag and signature over
printed name

EDWARDSON CORDERO LUNA, LA UNION 9949512944 Computer generated

or photocopied picture
is not acceptable
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct 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 filing of administrative/criminal case/s
against me. PHOTO

Government Issued ID ([Link], GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance

Government Issued ID: DRIVER'S LICENSE

ID/License/Passport No.: A04-24-004667

Signature (Sign inside the box)
01/12/25
Date/Place of Issuance: 10-22-24
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