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 aga
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 BONA
NAME EXTENSION (JR., SR
FIRST NAME JOJE

MIDDLE NAME SAMILLANO

3. DATE OF BIRTH
(mm/dd/yyyy) 9/24/1973 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH NABUA, CAMARINES SUR If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS 295 ZO

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
SAN E
Other/s:
Subdivision/Village Ba
NABUA CAMAR
7. HEIGHT (m) 1.82
City/Municipality Pr
8. WEIGHT (kg) 74 ZIP CODE 4434

18. PERMANENT ADDRESS 295 ZO

9. BLOOD TYPE B+
House/Block/Lot No. S
SAN E
10. GSIS ID NO. 2004606748
Subdivision/Village Ba
NABUA CAMAR
11. PAG-IBIG ID NO. 15-300019891
City/Municipality Pr

12. PHILHEALTH NO. 10-05000626974 ZIP CODE 4434

13. SSS NO. 03-3720398-8 19. TELEPHONE NO. 2881263

14. TIN NO. 901-371-697 20. MOBILE NO. 09175085100

15. AGENCY EMPLOYEE NO. 4780253 21. E-MAIL ADDRESS (if any) jojebona@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BONA 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME MARITES YURI GABRIELLE A. BONA

MIDDLE NAME ALTAMERA

OCCUPATION SENIOR BOOKKEEPER

EMPLOYER/BUSINESS NAME LA PURISIMA NATIONAL HIGH SCHOOL

BUSINESS ADDRESS LA PURISIMA, NABUA, CAMARINES SUR

TELEPHONE NO. 2443069

24. FATHER'S SURNAME BONA

NAME EXTENSION (JR., SR)
FIRST NAME JOSE SR

MIDDLE NAME DELLORO

25. MOTHER'S MAIDEN NAME

SURNAME SAMILLANO

FIRST NAME JUANA

MIDDLE NAME FOLLOSCO (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 LA CONSOLACION ACADEMY PRIMARY EDUCATION 1980 1986 N/A

SECONDARY HOLY ROSARY MINOR SEMINARY SECONDARY EDUCATION 1986 1990 N/A
VOCATIONAL /

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

TRADE BACHELOR OF SCIENCE IN AERONAUTICAL
COURSE
COLLEGE PATS COLLEGE OF AERONAUTICS ENGINEERING 1990 1994 N/A
UNIVERSITY OF NORTHEASTERN PHILIPPINES
GRADUATE STUDIES BACHELOR OF LAWS 2012 2016 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
rience 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)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship

by naturalization

Pls. indicate country:

ZONE 6
Street
SAN ESTEBAN
Barangay
CAMARINES SUR
Province
4434

ZONE 6
Street
SAN ESTEBAN
Barangay
CAMARINES SUR
Province

4434

2881263

09175085100

jojebona@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

11/10/2007

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1986 N/A

1990 N/A
 N/A N/A

1994 N/A

2016 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) LICENSE (if applicabl
DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE RATING
EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / (If Applicable) NUMBER
CONFERMENT
DRIVER'S LICENSE

CAREER SERVICE PROFESSIONAL 85.6 11/27/1994 NAGA CITY 21050778

CSC. RES.
CIVIL SERVICE ELIGIBLE N/A 10/10/2002 LEGASPI CITY
#93-366
E07-06-
PROFESSIONAL DRIVER'S LICENSE N/A 9/23/2014 LTO, IRIGA CITY
002727

(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 SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
(Write in full/Do not abbreviate) full/Do not abbreviate) INCREMENT
From To

DEPARTMENT OF EDUCATION -
5/24/2017 PRESENT ADMINISTRATIVE OFFICER II 20,754.00 11 PERMANENT
SALVACION NATIONAL HIGH SCHOOL
DEPARTMENT OF EDUCATION -
9/8/2014 5/23/2017 DISBURSING OFFICER II 15,818.00 8 PERMANENT
SALVACION NATIONAL HIGH SCHOOL
ACTING PERSONNEL CAMARINES SUR III ELECTRIC
7/1/2014 9/5/2014 20,929.52 6 REGULAR
SUPERVISOR COOPERATIVE, INC.
CAMARINES SUR III ELECTRIC
9/30/2010 9/5/2014 WESM COMPLIANCE OFFICER 18,420.66 6 REGULAR
COOPERATIVE, INC.
REGULATORY COMPLIANCE CAMARINES SUR III ELECTRIC
8/12/2008 9/5/2014 18,420.66 6 REGULAR
OFFICER COOPERATIVE, INC.
CAMARINES SUR III ELECTRIC
7/16/2002 8/11/2008 COMPUTER OPERATOR 8,998.00 6 REGULAR
COOPERATIVE, INC.

(Continue on separate sheet if necessary)

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

Date of
Validity

4/11/1995

10/10/2002

9/24/2012

eparate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
Y

eparate 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) (mm/dd/yyyy) NUMBER OF HOURS POSITION /
From To

CASURECO III EMPLOYEES UNION 11/16/1997 9/5/2014 N/A SECRETARY

KABALIKAT CIVICOM 2007 PRESENT N/A MEMBER

CFC SINGLES FOR CHRIST 2002 2006 N/A MEMBER

(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 INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
2-day LIVE-IN WORKSHOP ON PREPARATION OF FINANCIAL REPORTS AND
COORDINATION METTING WITH ACCOUNTANTS, BOOKKEEPERS, AND 4/10/2018 5/10/2018 16.0 TECHNICAL DEPED DIVI
ADMINISTRATIVE OFFICERS OF AUTONOMOUS SCHOOLS
REGIONAL SEMINAR WORKSHOP IN PREPARATION FOR CY 2018 MID-YEAR DEPED REG
11/7/2018 7/13/2018 24.0 TECHNICAL
FINANCIAL REPORTING

BUDGET PREPARATION WORKSHOP FOR CY 2019 BUDGET PROPOSAL 1/25/2018 1/26/2018 40.0 TECHNICAL DEPED REG

SEMINAR ON CASH MANAGEMENT AND CONTROL SYSTEM 8/3/2016 8/5/2016 24.0 TECHNICAL COMMISSIO

3 DAY INTERNATIONAL SEMINAR-WORKSHOP ON BEST MANAGERS FOR BEST HOLISTIC EN

7/22/2016 7/24/2016 24.0 SUPERVISORY PROFESSIO
RESULT. THEME: MANAGING CONFLICT AND RESISTANCE
TRAINING/WORKSHOP FOR NEWLY-HIRED FINANCIAL STAFF ON FINANCIAL
9/14/2015 9/18/2015 40.0 TECHNICAL DEPED REG
MANAGEMENT SYSTEM

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

COMPUTER LITERATE (WINDOWS, MS

N/A ASSOCIATI
OFFICE)
AND CAS
 ASSOCIATI
AND CAS

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

SECRETARY

MEMBER

MEMBER

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

DEPED DIVISION OF CAMARINES SUR

DEPED REGIONAL OFFICE V

DEPED REGIONAL OFFICE V

COMMISSION ON AUDIT, CENTRAL OFFICE

HOLISTIC ENHANCEMENT CENTER FOR

PROFESSIONAL

DEPED REGIONAL OFFICE V

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

ASSOCIATION OF DISBURSING OFFICERS

AND CASHIERS OF CAMARINES SUR
 KABALIKAT CIVICOM

eparate sheet if necessary)

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
ATTY. JOSELITO F. FIGURACION NABUA, CAMARINES SUR 9209817790 3.5 cm. X 4.5 cm
(passport size)

NOEL P. FUCIO FRANCIA, IRIGA CITY 9214834455 With full and handwritten
name tag and signature over
printed name
JESSE ARNEL O DURAN NABUA, CAMARINES SUR 9069211521
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: DRIVER LICENSE

ID/License/Passport No.: EO7-06-002727

Signature (Sign inside the box)

Date/Place of Issuance: IRIGA CITY

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 o

 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