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 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 CATAYLO
NAME EXTENSION (SR. JR.) JR.
FIRST NAME MELITO
MIDDLE NAME BARILLO
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
12/30/1989 ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH DUMAGUETE CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS 06 YAKAL
Widowed House/Block/Lot No. Street
Separate
d DARO
Other/s:
Subdivision/Village Barangay
DUMAGUETE CITY NEGROS ORIENTAL
7. HEIGHT (m) 1.69 m
City/Municipality Province
8. WEIGHT (kg) 92 kg. ZIP CODE 6200
18. PERMANENT ADDRESS 06 YAKAL
9. BLOOD TYPE O+
House/Block/Lot No. Street
DARO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
DUMAGUETE CITY NEGROS ORIENTAL
11. PAG-IBIG ID NO. 121280512965
City/Municipality Province
12. PHILHEALTH NO. 12-201784088-4 ZIP CODE 6200
13. SSS NO. 07-24-78853-0 19. TELEPHONE NO. OFFICE (035) 422-8128
14. TIN NO. 732-981-570 20. MOBILE NO. 09752538641/09129682878
15. AGENCY EMPLOYEE NO. 60085 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME CATAYLO 5/26/1962
NAME EXTENSION (JR., SR)
FIRST NAME MELITO SR
MIDDLE NAME BASISTA
25. MOTHER'S MAIDEN NAME 4/13/1962
SURNAME BARIILO
FIRST NAME ANTONIETTA
MIDDLE NAME MARZAMULO (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 CITY CENTRAL ELEM. SCHOOL PRIMARY EDUCATION 6/1/1997 3/22/2003 Graduated 2002 N/A
SECONDARY NEGROS ORIENTAL HIGH SCHOOL SECONDARY EDUCATION 6/1/2003 4/2/2009 Graduated 2009 CLASS
VOCATIONAL / HONOR
SILIMAN UNIVERSITY (SAITE) ANIMAL PRODUCTION SWINE NC II 8/1/2018 9/26/2018 Graduated 2019 NC II
HOLDER
TRADE
COURSE
COLLEGE FOUNDATION UNIVERSITY BACHELOR OF SCIENCE IN 6/1/2010 4/20/2016 Graduated 2016 DEANS
AGRICULTURE, ANS. SCI. LISTER
GRADUATE STUDIES NEGROS ORIENTAL STATE UNIVERSITY MASTER OF SCIENCE IN 2018 PRESENT 36 UNITS ON GOING N/A
AGRICULTURE, ANS. SCI.
(Continue on separate sheet if necessary)
SIGNATURE DATE November 19, 2021
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
LICENSURE EXAMINATION FOR AGRICULTURISTS 82.0 10/19-21,2016 SACRED HEART SCHOOL, GENERAL 0023859 12/30/2022
(LEA) MAXIMUM AVE.EXT.,CEBU CITY
DRVER'S LICENSE N/A N/A LTO-DUMAGUETE CITY GO2-18-000121 12/30/2022
(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 SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(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)
9/1/2017 9/30/2021 MEAT INSPECTOR I OFFICE OF THE CITY VETERINARIAN P9080 N/A JOB ORDER NO
10/1/2021 PRESENT MEAT INSPECTOR III OFFICE OF THE CITY VETERINARIAN P12600 SG11 CASUAL YES
PLANTILLA
(Continue on separate sheet if necessary)
SIGNATURE DATE NOVEMBER 19, 2021
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
NATIONAL MEAT INSPECTION SERVICE, CENTRAL
NMIS MEAT SAFETY CONSCIOUSNESS WEEK 2021: FOOD SAFETY WEBINAR 10/19/2021 10/19/2021 5 HOURS LECTURE OFFICE
INSECTICIDE RESISTANCE MANAGEMENT TO MANAGE CECID FLY IN MANGO 7/20/2021 7/22/2021 32 HOURS TRAINING AGRICULTURAL TRAINING INSTITUTE- BOHOL
BUREAU OF AGRICULTURAL AND FISHERIES
WENINAR ON FOOD SAFETY 6/20/2021 6/20/2021 3 HOURS LECTURE STANDARDS
ASSA BALITAKTAKAN 2021: A WEBINAR SERIES ON AFRICAN SWINE FEVER 4/12/2021 4/12/201 4 HOURS LECTURE MARIANO MARCOS STATE UNIVERSITY: ANIMAL
SCIENCE STUDENT ASSOCIATION
1-DAY ARTIFICIAL INSEMINATION FOR PORK PRODUCERS 3/19/2021 3.19.2021 8 HOURS TRAINING ATI-INTERNATIONAL TRAINING CENTER ON PIG
HUSBANDRY
AGRIBUSINESS INVESTMENT OPPORTUNITES ON QUAIL PRODUCTION AND 3/2/201 3/2/201 8 HOURS LECTURE DEPARTMENT OF AGRICULTURE- AGRIBUSINESS
MANAGEMENT AND MARKETING ASSISTANCE SERVICE
SMART FARMING: THE FUTURE OF AGRICULTURAL PRODUCTION 3/24/2021 3/24/2021 3 HOURS LECTURE CENTRAL LUZON STATE UNIVERSITY- UNIVERSITY
EXTENSION CENTER
1ST INTERNATIONAL VIRTUAL CONGRESS AND 2021 AGRICULTURISTS' SUMMIT WITH 2/18/2021 2/20/201 32 HOURS LECURE PHILIPPINE ASSOCIATION OF AGRICULTURISTS,
THE THEME "PREPARING TOMORROWS WORKFORCE FOR AGRICULTURE INC.
DAIRY BUFFALO FARMING WEBINAR 12/2/2020 12/2/2020 3 HOURS LECTURE CENTRAL LUZON STATE UNIVERSITY- TRAINING
OFFICE
AGRIBUSINESS INVESTMENT OPPORTUNITES IN NATIVE CHICKEN 11/17/2020 11/17/2020 8 HOURS LECTURE DEPARTMENT OF AGRICULTURE- AGRIBUSINESS
AND MARKETING ASSISTANCE SERVICE
2020 PSAS LECTURE SERIES WITH THE THEME: TRANSCENDING BOUNDARIES
TOWARDS FOOD SECURITY AND SAFETY THROUGH SCIENCE AND TECHNOLOGY 11/11/2020 11/18/202 16 HOURS LECTURE THE PHILIPPINE SOCIETY OF ANIMAL SCIENCE
INNOVATION IN ANIMAL PRODUCTION
NATIONAL CERTIFICATE IN ANIMAL PRODUCTION (POULTRY-CHICKEN) 8/1/2020 9/18/2020 266 HOURS TRAINING SAITE(SCHOOL OF AGRO-INDUSTRIAL AND
TECHNICAL EDUCATION) SILIMAN UNIVERSITY
NATIONAL CERTIFICATE IN ANIMAL HEALTH CARE AND MANAGEMENT N/A N/A 208 HOURS TRAINING LAZI TECHNICAL INSTITUTE (LTI) LAZI, SIQUIJOR
TRAINERS METHODOLOGY LEVEL 1 (TM1) COURSE SWINE PRODUCTION 5/4/2019 6/7/2019 264 HOURS TRAINING TEAMSKILLS SCHOOL FOR CULINARY ARTS AND
HOSPITALITY MANAGEMENT
NATIONAL CERTIFICATE IN ANIMAL PRODUCTION (SWINE) 8/1/2018 9/26/2018 309 HOURS TRAINING SAITE(SCHOOL OF AGRO-INDUSTRIAL AND
TECHNICAL EDUCATION) SILIMAN UNIVERSITY
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write in
full)
BASIC VETERINARY SERVICES, MEAT N/A PHILIPPINE ASSOCIATION OF
INSPECTION AGRICULTURISTS, INC. (PAA)
CROP ESTABLISHMENT
BASKETBALL, SOCCER, BADMINTON
COOKING/CULINARY
CARPENTRY
(Continue on separate sheet if necessary)
SIGNATURE DATE NOVEMBER 19,2021
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
by any court or tribunal? YES ✘ NO
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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
ENG. ERLINDA M. MAMHOT BATINGUEL, DUMAGUETE CITY 9169056127 3.5 cm. X 4.5 cm
(passport size)
JOBERT KLEIN R. KOERKAMP, MPsc FOUNDATION UNIVERSITY (035) 422-9167 With full and handwritten
name tag and signature over
printed name
MARK MILROE E. REYES BAJUMPANDAN, DUMAGUETE CITY 9752691624
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
administrative/criminal case/s against me. PHOTO
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.: 0023859
Signature (Sign inside the box)
NOVEMBER 19, 2021
Date/Place of Issuance: 11/10/2016/ PRC- CEBU
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
