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/crimina
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.

I. PERSONAL INFORMATION
2. SURNAME SANTICAN

FIRST NAME AL AIN

MIDDLE NAME AMINODEN

3. DATE OF BIRTH
(mm/dd/yyyy)
1/1/1997 16. CITIZENSHIP
✘ Filipino Dual Citiz

4. PLACE OF BIRTH MALABANG, LANAO DEL SUR If holder of dual citizenship,

please indicate the details.

5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A

House/Block/Lot No.
Widowed Separated
TUBOD CELDRAN
Other/s:
Subdivision/Village
ILIGAN CITY
7. HEIGHT (m) 1.7018 M
City/Municipality
8. WEIGHT (kg) 99 KG ZIP CODE 9200

18. PERMANENT ADDRESS N/A

9. BLOOD TYPE TYPE O
House/Block/Lot No.
N/A
10. GSIS ID NO. N/A
Subdivision/Village
MALABANG
11. PAG-IBIG ID NO. N/A
City/Municipality

12. PHILHEALTH NO. N/A ZIP CODE 9300

13. SSS NO. 094407226-2 19. TELEPHONE NO. N/A

14. TIN NO. 720555876000 20. MOBILE NO. 09382054292

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) alainhadjisatar@g
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME SANTICAN

NAME EXTENSION (JR., SR)
FIRST NAME HADJI SATAR

MIDDLE NAME GAOS

25. MOTHER'S MAIDEN NAME DAMIANO

 SURNAME SANTICAN

FIRST NAME NORON

MIDDLE NAME AMINODEN (Continue on separate shee

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY LANAO EDUCATIONAL INSTITUTE ELEMENTARY 2003 2009

SECONDARY /
VOCATIONAL OUR LADY OF PEACE HIGH SCHOOL SECONDARY 2009 2013

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

TRADE
COURSE Bachelor of Science in Customs
COLLEGE LYCEUM OF ILIGAN FOUNDATION 2013 2017
Administration

GRADUATE STUDIES N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
rative/criminal case/s against the person

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship
✘ by birth by naturalization
Pls. indicate country:

BOULEVARD
Street
OXFORD STREET
Barangay
LANAO DEL NORTE
Province
9200

N/A
Street
CURAHAB
Barangay
LANAO DEL SUR
Province

9300

N/A

09382054292

djisatar@gmail.com

e and list all) DATE OF BIRTH (mm/dd/yyyy)

n separate sheet if necessary)

HIGHEST LEVEL/ SCHOLARSHIP/

YEAR
UNITS ACADEMIC
GRADUATED
EARNED HONORS
(if not graduated) RECEIVED

GRADUATE 2009 DIPLOMA

GRADUATE 2013 DIPLOMA

N/A N/A N/A

GRADUATE 2017 DIPLOMA

N/A N/A N/A

February 13, 2020

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

Customs Broker Licensure Examination 78.5 11/22/2017 METRO MANILA

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

01/15/18 06/18/19 CUSTOMS BROKER/PROCESSOR AAH BROKERAGE P17,000 SG - 8

 (Continue on separate sheet if necessary)

SIGNATURE DATE 13 02 2020

CS FORM 2
 LICENSE (if applicable)

NUMBER Date of
Validity

0010558 1/11/2018

rate sheet if necessary)

es should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
CUSTOMS
PROCESSOR N/A
rate sheet if necessary)

13 02 2020

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

MUSLIM SCHOOL ORGANIZATION 7/16/2015 10/3/2016 1yr ORGANIZER

ON THE JOB TRAINING (OJT) - AMS LOGISTICS 4/27/2016 5/27/2016 300HRS CUSTOMS BROKERAGE P

(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) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

EXTEMPORANEOUS SPEECH CONTEST ( 3RD RUNNER UP). 3/1/2015 3/1/2015 8HRS N/A CHERADEL SU

STUDENT LEADERS TRAINING. 8/21/2015 8/22/2015 16HRS N/A

LYCEUM OF
EXCISE TAXES ON ALCOHOL PRODUCTS,TOBACCO PRODUCTS, CIGAR AND
2/27/2016 2/27/2016 8HRS N/A
CIGARETTES-SEMINAR LYCEUM OF

CUSTOMS MODERNIZATION AND TARIFF ACT (CMTA) SEMINAR. 2/25/2017 2/25/2017 8HRS N/A
LYCEUM OF
PROMOTING DIGITAL LITERACY THROUGH LANGUAGE AND ARTS- SEMINAR. 10/23/2014 10/23/2014 8HRS N/A
CORPUS CH

BRAIN BEE CONTEST 2/16/2014 2/16/2014 8HRS

PLAZA HOTE
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Reading informative books N/A

Cooking N/A

Surfing and browsing the internet N/A

PLAYING BALL GAMES N/A

FAST LEARNER N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

ORGANIZER

CUSTOMS BROKERAGE PROCESSOR

eparate sheet if necessary)

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

CONDUCTED/ SPONSORED BY
(Write in full)

CHERADEL SUITES DOME

LYCEUM OF ILIGAN FOUNDATION

LYCEUM OF ILIGAN FOUNDATION

LYCEUM OF ILIGAN FOUNDATION

CORPUS CHRISTI TUBOD

PLAZA HOTEL ALEMANIA

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

N/A

N/A

N/A

N/A

N/A

eparate sheet if necessary)

13 02 2020
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:

________________________________

a. Have you ever been found guilty of any administrative offense? YES ✘ NO
35.

If YES, give details:

________________________________
________________________________
YES ✘ NO
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
YES ✘ NO
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:
________________________________
YES ✘ NO
________________________________
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? ________________________________
YES ✘ NO
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES If YES, give details:
✘ NO

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? YES If YES, give details:
✘ NO

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 ✘ YES NO
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: MARANAO
b. Are you a person with disability? YES ✘ NO
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 TEL. NO. ID picture taken within

the last 6 months
Camp Abubakar As-Siddique 3.5 cm. X 4.5 cm
COM. MOHAMMAD NASIF "PHA" AL-HADJ 9052176933 (passport size)

PC HILL COTABATO CITY, LANAO DEL With full and handwritten

INS TADI S. DIPANGAMPONG SUL name tag and signature over
printed name
J/SINSP. ALI P. MACATANONG, CE MALABANG, LANAO DEL SUR 9128340761
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: PRC

ID/License/Passport No.: 0010558

Signature (Sign inside the box)
13 02 2020
Date/Place of Issuance: 01/11/2018, PRC CAGAYAN DE ORO
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