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 ALCONERA
NAME EXTENSION (JR., SR) N/A
FIRST NAME DINNAH MAE

MIDDLE NAME ABREA

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
1/6/1989 by birth by naturalization
4. PLACE OF BIRTH GENERAL SANTOS CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS N/A 2ND STREET
Widowed Separated House/Block/Lot No. Street
VILLA REGINA SUBDIVISION BARANGAY SAN ISIDRO
Other/s:
Subdivision/Village Barangay
GENERAL SANTOS CITY SOCCSKSARGEN
7. HEIGHT (m) 1.55 m
City/Municipality Province
8. WEIGHT (kg) 45 kg ZIP CODE 9500

18. PERMANENT ADDRESS N/A 2ND STREET

9. BLOOD TYPE O
House/Block/Lot No. Street
VILLA REGINA SUBDIVISION BARANGAY SAN ISIDRO
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A GENERAL SANTOS CITY SOCCSKSARGEN

City/Municipality Province

12. PHILHEALTH NO. 170255167300 ZIP CODE 9500

13. SSS NO. 0939569913 19. TELEPHONE NO. N/A

14. TIN NO. 169-388-446-000 20. MOBILE NO. 09989570730

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) dmaalconera@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) N/A
FIRST NAME N/A N/A 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 ALCONERA

NAME EXTENSION (JR., SR)
FIRST NAME VIRGILIO N/A

MIDDLE NAME PAULO

25. MOTHER'S MAIDEN NAME

SURNAME ABREA

FIRST NAME LUCIA

MIDDLE NAME DAGONGDONG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

WITH
ELEMENTARY DADIANGAS WEST CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1995 2001 N/A 2001
HONORS
SALUTATOR
SECONDARY /
VOCATIONAL ALABEL NATIONAL SCIENCE HIGH SCHOOL HIGH SCHOOL 2001 2005 N/A 2005
IAN

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

TRADE
COURSE
COLLEGE UNIVERSITY OF THE PHILIPPINES BA PSYCHOLOGY 2005 2009 N/A 2009 CUM LAUDE

GRADUATE STUDIES UNIVERSITY OF THE PHILIPPINES JURIS DOCTOR 2010 2014 N/A 2014 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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
NOVEMBER 2, 6, 16,
RA 1080 (2014 BAR EXAMINATIONS) 74.2 AND 23, 2014
UNIVERSITY OF SANTO TOMAS 64187 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)

2/5/2015 PRESENT PARTNER ALCONERA & ALCONERA LAW OFFICE N/A N/A N/A NO
MINDANAO STATE UNIVERSITY- COLLEGE
2015 PRESENT PROFESSOR N/A N/A CONTRACTUAL YES
OF LAW EXTENSION
2015 2017 PROFESSOR MINDANAO STATE UNIVERSITY N/A N/A CONTRACTUAL YES

2016 2017 PROFESSOR NOTRE DAME OF DADIANGAS UNIVERSITY N/A N/A CONTRACTUAL NO

2015 2016 PROFESSOR HOLY TRINITY COLLEGE N/A N/A CONTRACTUAL 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
INTEGRATED BAR OF THE PHILIPPINES (SOUTH COTABATO AND GENERAL
2017 2019 N/A BOARD MEMBER/ LEGAL AID CHAIRMAN
SANTOS CITY CHAPTER)

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

Mandatory Continuing Legal Education 04/15/16 04/14/19 36.0 N/A Integrated Bar of the Philippines

11/28/17 11/28/17 3.0 N/A

Orientation of Law Practitioners on Judicial Dispute Resolution Philippine Judicial Academy

Mandatory Continuing Legal Education 04/15/13 04/14/16 15.0 N/A Integrated Bar of the Philippines

(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)

COMPUTER LITERATE N/A INTEGRATED BAR OF THE PHILIPPINES

UNIVERSITY OF THE PHILIPPINES ALUMNI
ASSOCIATION
UNIVERSITY OF THE PHILIPPINES
SOCCSKSARGEN

(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,
a. within the third degree? YES ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

If YES, give details:

________________________________

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
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
YES ✘ NO
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, YES ✘ NO
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
YES ✘ NO
Barangay election)?
If YES, give details:
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:
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
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? YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
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
ATTY. MICHELLE ANN VIEJO KORONADAL CITY (+63)9778314211 3.5 cm. X 4.5 cm
(passport size)

ATTY. JOY SOLLESTA KORONADAL CITY (+63)9209096211 With full and handwritten
name tag and signature over
Mindanao State University printed name
CHANCELLOR ANSHARI ALI General Santos City
(+63)9099475492
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: VIN 6303-0304I-F0189DAA20000

ID/License/Passport No.: TIN 436-581-686-000

Signature (Sign inside the box)

Date/Place of Issuance: 07/20/2016/ GENERAL SANTOS CITY

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