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 YU
NAME EXTENSION (JR., SR)
FIRST NAME RANDY

MIDDLE NAME FLORES

3. DATE OF BIRTH
(mm/dd/yyyy)
7/11/1982 16. CITIZENSHIP

4. PLACE OF BIRTH TACLOBAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS 104 Real Street

6 CIVIL STATUS
House/Block/Lot No. Street
N?A Holy Child I
Subdivision/Village Barangay
Alangalang, Leyte Leyte
7. HEIGHT (m) 0.14224
City/Municipality Province
8. WEIGHT (kg) 60 kgs ZIP CODE 6517

18. PERMANENT ADDRESS 104 REAL STREET

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A HOLY CHILD 1
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A ALANGALANG LEYTE

City/Municipality Province

12. PHILHEALTH NO. 130501320804 ZIP CODE 6517

13. SSS NO. 06-2849657-5 19. TELEPHONE NO. N/A

14. TIN NO. 419-806-965 20. MOBILE NO. 09294876300 and '09159112653

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) yurandy_143@yahoo.com
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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME YU

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

MIDDLE NAME EMBODO

25. MOTHER'S MAIDEN NAME FLORES, EDITHA VILLA FLORES

SURNAME FLORES

FIRST NAME EDITHA

MIDDLE NAME VILLA FLORES (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY ALANGALANG I CENTRAL SCHOOL 6/6/1990 4/5/1996 1996

SECONDARY NOTRE DAME OF JARO 6/4/1996 5/6/2000 2000

 UNIC TRAINING CENTER TOURISM SECTOR 9/3/2010 1/15/2011 2011

BATCHELOR OF SCIENCE IN ACCOUNTANCY

ST. PAUL'S BUSINESS SCHOOL
(BSA)
6/6/2000 10/30/2003
COLLEGE

BATCHELOR OF SCIENCE IN MANAGEMENT

ASIAN DEVELOPMENT FOUNDATION COLLEGE
(BSC)
6/5/2005 10/22/2007 2007

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE Oct. 12, 2020

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

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

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

(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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)

05/05/2017 CURRENT Tesda Trainer/Assessor PHTTII Catbalogan Branch 30,000.00 on call trainer no
Datamex Institute of Computer Technology
01/08/2014 03/29/2016 Trainer 13,000.00 NA casual no
INC.
06/27/2011 11/08/2013 Office Staff Unic Training Center 13,000.00 NA casual no

03/05/2010 05/17/2010 Sales Associate Jonco Realty Corporation 12,000.00 NA casual no

09/09/2009 02/16/2010 Office Staff Yuson Motors Parts. Incorporation 15,000.00 NA casual no

12/5/2007 12/7/2008 Head Waiter E. Y. V Catering Services 10000.00 NA casual no

6/4/2005 11/6/2005 Food Server Jollibee Tacloban Branch 8000.00 NA casual no

5/6/2004 10/7/2004 Office Staff Great Domestic Insurance Company 10000.00 NA casual no

5/8/2002 10/10/2002 Head Waiter Terracoita Grill and Fine Dining 12000.00 NA casual no

(Continue on separate sheet if necessary)

SIGNATURE DATE Oct. 12, 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 / NATURE OF WORK
From To

(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
TECHNICAL EDUCATIONAL SKILLS
COMMERCIAL COOKING NCIII 244
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
FOOD AND BEVERAGE SERVICES NCIII 124
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
BOOKKEEPING NCIII 292
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
FOOD AND BEVERAGE SERVICES NCII 356
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
HOUSEKEEPING NCII 364
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
BARTENDING NCII 438
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
BREAD AND PASTRY PRODUCTION NCII 144
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS
COOKERY NCII 316
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATIONAL SKILLS DEVELOPMENT
MASSAGE THERAPY NCII 560.0
AUTHORITY
TECHNICAL EDUCATIONAL SKILLS DEVELOPMENT
ELECTRICAL INSTALLATION MAINTENANCE NCII 200
AUTHORITY
TECHNICAL EDUCATIONAL SKILLS DEVELOPMENT
TRINER'S METHODOLOGY LEVEL 1 246.0
AUTHORITY

(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)

• Knowledgeable in Table Skirting, Table Napkin

Folding, Table Sitting, Cocktail Mixing, Cooking, Regional Skill Competition Gold Medal Winner Restaurant Services
Bed Making, Room Services.

Knowlegeble in Microsoft Application,Exel, Word

Provencial Skills Competion 1st Placer Restaurant Services
and internt explorer

Technical Vocational and Livelihood ( TVL Week) Expertise Judge at Layte National High School

(Continue on separate sheet if necessary)

SIGNATURE DATE Oct. 12, 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?
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:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO. ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
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:

ID/License/Passport No.:
Signature (Sign inside the box)

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.

Person Administering Oath

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