CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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* LUCERO CITEZENSHIP
NAME EXTENSION (JR., SR)
ARMAND
FIRST NAME* Please indicate country:
MIDDLE NAME* SOMERA Afghanistan
3. DATE OF BIRTH *
16. CITIZENSHIP* Albania
(mm/dd/yyyy) 07/21/1986 ✘ Filipino Dual Citizenship
by Algeria
✘ by birth
4. PLACE OF BIRTH* TAGUDIN, ILOCOS SUR If holder of dual citizenship, Pls. indicate country:naturalization Andorra
please indicate the details.
5. SEX* ✘ Male Female Angola

✘ Single Married 17. RESIDENTIAL ADDRESS 36A Antigua and Barbuda

6 CIVIL STATUS*
Widowed Separat House/Block/Lot No. Street* Argentina
Armenia
Other/s: ed DEL PILAR Aruba
Subdivision/Village* Barangay* Australia
TAGUDIN ILOCOS SUR Austria
7. HEIGHT (m)* 1.63 m
City/Municipality* Province* Azerbaijan
8. WEIGHT (kg)* 81 kg ZIP CODE* 2714 Bahamas, The
18. PERMANENT ADDRESS 36A Bahrain
9. BLOOD TYPE* B
House/Block/Lot No. Street* Bangladesh
DEL PILAR Barbados
10. GSIS ID NO.
Subdivision/Village* Barangay* Belarus
TAGUDIN ILOCOS SUR Belgium
11. PAG-IBIG ID NO.
City/Municipality* Province* Belize
12. PHILHEALTH NO. 05-050154795-3 Benin

13. SSS NO. 01-202222-7 19. TELEPHONE NO. N/A Bhutan

20. MOBILE NO.* (Ex.
14. TIN NO. 290-395-413-000
09991234567) 0918 217 1144 Bolivia

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) N/A Bosnia and Herzegovin
II. FAMILY BACKGROUND Botswana
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy) Brazil
NAME EXTENSION (JR., SR) Brunei 
FIRST NAME RALPH LAWRENCE A. LUCERO 01/05/2012
Bulgaria
MIDDLE NAME ANDREI MICHAEL A. LUCERO 12/20/2013 Burkina Faso
OCCUPATION AMANDA AMERIE A. LUCERO 06/16/2020 Burma
EMPLOYER/BUSINESS NAME Burundi
BUSINESS ADDRESS Cambodia
TELEPHONE NO. Cameroon
24. FATHER'S SURNAME* LUCERO Canada
NAME EXTENSION (JR., SR) Cape Verde
AUNARIO
FIRST NAME* Central African Republi
MIDDLE NAME* LUIS Chad
25. MOTHER'S MAIDEN NAME* Chile
SURNAME* SOMERA China
FIRST NAME* JOSEPHINE Colombia
MIDDLE NAME* LARIOZA (Continue on separate sheet if necessary) Comoros
III. EDUCATIONAL BACKGROUND Congo, Democratic Re
HIGHEST LEVEL/ SCHOLARSHIP/
Congo, Republic of the
26. NAME OF SCHOOL PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in
(Write in full) EARNED
GRADUATED
HONORS Costa Rica
full) (if not graduated) RECEIVED
From To Cote d'Ivoire
ELEMENTARY* SAINT AUGUSTINE'S SCHOOL PRIMARY GRADUATE 1999 Croatia

SECONDARY*/
VOCATIONAL SAINT AUGUSTINE'S SCHOOL HIGH SCHOOL GRADUATE 2003 Cuba

N/A N/A N/A Curacao

TRADE
COURSE
COLLEGE SAINTLOUIS COLLEGE COLLEGE GRADUATE 2012 Cyprus

GRADUATE STUDIES N/A N/A N/A Czech Republic

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

CAREER SERVICE PROFESSIONAL ELIGIBILITY 81.4 05/27/2012 SAINT LOUIS COLLEGE, SAN FERNANDO CITY, LA UNION

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY 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)
DEPARTMENT OF SOCIAL WELFARE AND CONTRACT OF
10/28/2019 12/31/2019 AREA ENUMERATOR
DEVELOPMENT- FIELD OFFICE 1 SERVICE YES

11/1/2018 10/27/2019 CREDITOR/ VENDOR/BUY AND SELL N/A N/A NO

10/1/2017 10/31/2018 CONSTRUCTION SUPERVISOR N/A N/A NO

07/22/2015 09/30/2017 CARPENTER/VENDOR/CREDITOR N/A N/A NO

DEPARTMENT OF FOREIGN AFFAIRS- REGIONAL CONTRACT OF
7/11/2015 07/21/2015 OUTSOURCED ENCODER
CONSULAR OFFICE 1 SERVICE YES
DEPARTMENT OF SOCIAL WELFARE AND CONTRACT OF
5/4/2015 7/10/2015 AREA ENUMERATOR
DEVELOPMENT- FIELD OFFICE 1 SERVICE YES

01/27/2015 5/3/2015 CONSTRUCTION SUPERVISOR N/A N/A NO

12/5/2012 01/26/2015 CARPENTER/VENDOR/CREDITOR N/A N/A NO

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT-
TRAINING OF AREA SUPERVIOSR AND ENUMERATORS FOR THE EFFECTIVE CONDUCT OF
10/7/2019 10/12/2019 NATIONAL HOUSEHOLD TARGETING SYSTEM FOR
LISTAHANAN 3RD ROUND OF HOUSEHOLD ASSESSMENT
POVERTY REDUCTION
DEPARTMENT OF SOCIAL WELFARE AND DEVELOPMENT-
TRAINING OF AREA SUPERVIOSR AND ENUMERATORS FOR THE EFFECTIVE CONDUCT OF
LISTAHANAN 2ND ROUND OF HOUSEHOLD ASSESSMENT
04/27/2015 5/2/2015 NATIONAL HOUSEHOLD TARGETING SYSTEM FOR
POVERTY REDUCTION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

PROFICIENT IN COMPUTER APPLICATION N/A N/A

BASIC ELECTRICAL WIRING, WELDING, AND CARPENTRY

READING

PLAYING SPORTS

DRAWING

(Continue on separate sheet if necessary)

SIGNATURE DATE
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, Yes
a. within the third degree?* ✘ YES ✘ No
b. within the fourth degree (for Local Government Unit - Career Employees)?* YES ✘

If YES, give details: Yes

________________________________ No

35. a. Have you ever been found guilty of any administrative offense?*
YES ✘ NO
If YES, give details: Yes
________________________________ No
________________________________
b. Have you been criminally charged before any court?* YES ✘ NO
If YES, give details: Yes
________________________________
Date Filed: No
________________________________
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: Yes
________________________________
No
________________________________
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: Yes
out (abolition) in the public or private sector?* ________________________________ No
________________________________
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: Yes
No
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: Yes
No
39. Have you acquired the status of an immigrant or permanent resident of another country?* YES ✘ NO
If YES, give details (country):
Yes
No
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: Yes
b. Are you a person with disability?* YES ✘ NO No
If YES, please specify ID No:
c. Are you a solo parent?* Yes
YES ✘ NO
If YES, please specify ID No: 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
MR. ROGELIO LORENZANA TAGUDIN, ILOCOS SUR 3.5 cm. X 4.5 cm
(passport size)

MR. ALEJANDRINO VILLANUEVA TAGUDIN, ILOCOS SUR With full and handwritten
name tag and signature over
printed name
MR. FRANCISCO CORPUZ TAGUDIN, ILOCOS SUR
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: * TIN ID

ID/License/Passport No.: * 290-395-413-000

Signature (Sign inside the box)

Date/Place of Issuance:* 03/03/2010-VIGAN CITY, ILOCOS SUR

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