Professional Documents
Culture Documents
CS Form No. 212 Revised Personal Data Sheet - New
CS Form No. 212 Revised Personal Data Sheet - New
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME DAMILES
NAME EXTENSION (JR., SR
FIRST NAME HARMONY
4. PLACE OF BIRTH DEPASE, BAYOG, ZDS If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX MALE
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS SINGLE
House/Block/Lot No. S
PUROK 1 DE
Subdivision/Village Ba
BAYOG ZAMBOA
7. HEIGHT (m) 1.64
City/Municipality Pr
8. WEIGHT (kg) 63 ZIP CODE
15. AGENCY EMPLOYEE NO. 6170749 21. E-MAIL ADDRESS (if any) monydamiles@gmail.com
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
SURNAME MAHINAY
SECONDARY /
VOCATIONAL BAYOG NATIONAL HIGH SCHOOL SECONDARY 2005 2009
TRADE
COURSE
COLLEGE JH CERILLES STATE COLLEGE BSED - ENGLISH 2010 2014
GRADUATE STUDIES
CS FORM
DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person
FILIPINO
Street
DEPASE
Barangay
ZAMBOANGA DEL SUR
Province
Street
DEPASE
Barangay
ZAMBOANGA DEL SUR
Province
09061714584
monydamiles@gmail.com
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
2005
2009
2014
Date of
Validity
7/3/2020
GOV'T
SERVICE
(Y/
N)
arate sheet if necessary)
9/11/2018
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
eparate sheet if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
9/11/2018
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)?
If YES, give details:
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
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 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
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?
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?
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:
Computer generated
ROBERT P. GOMONIT KAHAYAGAN, BAYOG ZDS 9264316777
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 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: 1317065
ID/License/Passport No.:
Signature (Sign inside the box)
SEPTEMBER 11, 2018
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.