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 RODRIGUEZ
NAME EXTENSION (JR., SR)
FIRST NAME RAMBELL JOHN

MIDDLE NAME ALFONSO

3. DATE OF BIRTH
(mm/dd/yyyy) 12/30/1993 16. CITIZENSHIP

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

17. RESIDENTIAL ADDRESS 909 HILERANG KAWAYAN

6 CIVIL STATUS
House/Block/Lot No. Street
LAWA
Subdivision/Village Barangay
OBANDO BULACAN
7. HEIGHT (m) 1.70 METERS
City/Municipality Province
8. WEIGHT (kg) 61KG ZIP CODE 3021

18. PERMANENT ADDRESS 909 HILERANG KAWAYAN

9. BLOOD TYPE O+
House/Block/Lot No. Street
LAWA
10. GSIS ID NO. N/A
Subdivision/Village Barangay
OBANDO BULACAN
11. PAG-IBIG ID NO. 121028421570
City/Municipality Province

12. PHILHEALTH NO. 012054196954 ZIP CODE 3021

13. SSS NO. 34-3153864-3 19. TELEPHONE NO. 82825237

14. TIN NO. 311-549-671 20. MOBILE NO. 0916 796 1423

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) rjrodriguez1230@gmail.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

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME RODRIGUEZ

NAME EXTENSION (JR., SR)
FIRST NAME ROMMUEL

MIDDLE NAME AZUELA

25. MOTHER'S MAIDEN NAME ELSA BACO ALFONSO

SURNAME RODRIGUEZ

FIRST NAME ELSA

MIDDLE NAME ALFONSO (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

HONORABLEME
ELEMENTARY LAWA ELEMENTARY SCHOOL PRIMARY 2000 2006 N/A 2006 NTION

SAINT LOUIS COLLEGE; 2006; 2008;

SECONDARY /
VOCATIONAL COLEGIO DE SAN PASCUAL BAYLON
SECONDARY
2008 2010
N/A 2010 DEPORTMENT

N/A

TRADE
UNIVERSITY OF THE CORDILLERAS; 2010; 2012;
COURSE
COLLEGE
ADAMSON UNIVERSITY
BSBA FINANCIAL MANAGEMENT
2012 2017
N/A 2017 N/A

GRADUATE STUDIES UNVERSITY OF CALOOCAN CITY MASTERS IN BUSINESS ADMINISTRATION 2018 PRESENT 15 UNITS PRESENT N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE November 2, 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
CIVIL SEVICE (PROFESSIONAL)/ SECOND LEVEL
80.7 3/1/2019 NEW ERA ELEMENTARY SCHOOL N/A N/A
ELIGIBILITY

(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)

9/2/2020 PRESENT TELETECH CUSTOMER SERVICE REPRESENTATIVE ₱ 21,000.00 N/A CONTRACTUAL N

9/9/2019 12/31/2019 ASSISTANT MANAGER ANYTIME FITNESS SKYPLAZA VICTONETA ₱ 18,000.00 N/A CONTRACTUAL N
DIVINE MERCY COLLEGE FOUNDATION
1/26/2018 8/31/2019 COLLEGE COORDINATOR ₱ 15,000.00 N/A PERMANENT N
INCORPORATED

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 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 / NATURE OF WORK
From To

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
Research Congress 2019: Advancing the Frontier of Knowledge through UNIVERSITY OF CALOOCAN CITY GRADUATE
3/24/2019 3/24/2019 8 N/A
Multidisciplinary Research SCHOOL

(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)
SINGING, DANCING AND PLAYING SOME ADAMSON UNIVERSITY - JUNIOR FINANCIAL
BOY SCOUT OF THE YEAR
SORTS OF INSTRUMENTS EXECUTIVES
INTEREST IN ARTS BEST IN CONDUCT/DEPORTMENT AWARDEE SING PHILIPPINES YOUTH CHOIR

READING BEST IN CHRISTIAN LIVING ADAMSON UNIVERSITY CHORALE

MOBILE PHOTOGRAPHY AND EDITING
GINTONG KABATAAN NG BULACAN 2014 NOMINEE (WITH ACAPELLAGO) GRAVITY S.E.T. - ADU
APPLICATIONS
SONY VEGAS

ADOBE PRODUCTS

(Continue on separate sheet if necessary)

SIGNATURE DATE November 2, 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? CO-TERMINUS
________________________________
________________________________
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
MARIE VIRNADETTE BOLOS MALABON CITY 0917 560 3872 3.5 cm. X 4.5 cm
(passport size)

CAMILLE SEBASTIAN OBANDO, BULACAN 0905 641 9598 With full and handwritten
name tag and signature over
printed name
IRASTO IGNACIO MAKATI CITY 0956 789 7989
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: PASSPORT

ID/License/Passport No.: EC3763232

Signature (Sign inside the box)
November 02, 2020
Date/Place of Issuance: DFA MANILA
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