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 BAGHARI
NAME EXTENSION (JR., SR)
FIRST NAME MICHELLE

MIDDLE NAME CADIZ

3. DATE OF BIRTH
(mm/dd/yyyy) 09/13/1980 16. CITIZENSHIP

4. PLACE OF BIRTH LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
House/Block/Lot No. Street
MARRIED EAST-LUNGSODAAN
Subdivision/Village Barangay
GARCIA-HERNANDEZ BOHOL
7. HEIGHT (m) 1.65
City/Municipality Province
8. WEIGHT (kg) 58 ZIP CODE 6307

18. PERMANENT ADDRESS

9. BLOOD TYPE O+
House/Block/Lot No. Street
EAST-LUNGSODAAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
GARCIA-HERNANDEZ BOHOL
11. PAG-IBIG ID NO. 1090-0218-7897
City/Municipality Province

12. PHILHEALTH NO. 01-025179252-1 ZIP CODE 6307

13. SSS NO. 33-74-922701 19. TELEPHONE NO. NONE

14. TIN NO. 20. MOBILE NO. 09162484226

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) michbaghari13@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME BAGHARI 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ROLANDO MICHRO ANDREI C. BAGHARI 10/19/2012

MIDDLE NAME LABIAL PRINCE MICHRO C. BAGHARI 5/3/2016

OCCUPATION N/A MICHRO ANGELO C. BAGHARI 9/5/2018

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME CADIZ

NAME EXTENSION (JR., SR)
FIRST NAME RODOLFO

MIDDLE NAME ABUCEJO

25. MOTHER'S MAIDEN NAME

SURNAME CADIZ

FIRST NAME NEOFITA

MIDDLE NAME ALAMAN (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 EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

GARCIA-HERNANDEZ CENTRAL ELEMENTARY FOURTH

ELEMENTARY
SCHOOL
PRIMARY EDUCATION 1990 1993 GRADUATED 1993 HONORS

SECONDARY /
VOCATIONAL SAINT JOHN THE BAPTIST ACADEMY HIGH SCHOOL 1993 1997 GRADUATED 1997 VALEDICTORIA
N

N/A N/A

TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE DIVINE WORD COLLEGE OF TAGBILARAN
COMMERCE(BANKING & FINANCE)
1997 2001 GRADUATED 2001 NONE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/21/2021

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

CAREER SERVICE PROFESSIONAL 81.08 Oct.20,2002 TAGBILARAN CITY

(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)

Feb.2018 Oct.8,2020 Assistant Branch Manager NATIONAL BOOK STORE SM SUCAT REGULAR

Sept 2015 Jan.2018 Junior Assistant Branch Manager NATIONAL BOOK STORE SM SUCAT REGULAR

June 2013 Feb.2015 Head Cashier NATIONAL BOOK STORE SM SUCAT REGULAR

July 2011 May 2013 Cash Custodian NATIONAL BOOK STORE SM SUCAT REGULAR

Oct.2007 July 2011 Cashier NATIONAL BOOK STORE SM SUCAT REGULAR

July 2007 Aug.15,2007 Tutorial DUZON HAN EOL EDUCATIONAL FOUNDATION SEASONAL

Mar.2004 Apr 2007 Teller VCR JR. LEGACY SEASONAL

SM MANILA (METRO MANILA SHOPPING MECCA
Nov.2001 Apr.2002 Cashier CORPORATION) SEASONAL

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/21/2021

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
NATIONAL BOOK STORE HUMAN RESOURCE
Awesome Service Training 2.0 Mar 9, 2017 Mar 9, 2017
DEVELOPMENT
NATIONAL BOOK STORE HUMAN RESOURCE
Managing to Excel Feb 29, 2016 Mar 22, 2016
DEVELOPMENT
NATIONAL BOOK STORE HUMAN RESOURCE
Awesome Service Workshop Jul 13, 2015 Jul 14, 2015
DEVELOPMENT
NATIONAL BOOK STORE - INFORMATION
Deo System Orientation 2014 Nov 14, 2014 Nov 14, 2014
TECHNOLOGY - TRAINING & DEVELOPMENT
NATIONAL BOOK STORE - INFORMATION
Deo Retail Insti Account & Roving POS Oct 1, 2013 Oct 1, 2013
TECHNOLOGY - TRAINING & DEVELOPMENT
NATIONAL BOOK STORE HUMAN RESOURCE
Employee Development Series 3 Feb 11, 2009 Feb 12, 2009
DEVELOPMENT
NATIONAL BOOK STORE HUMAN RESOURCE
Employee Development Series 2 Oct 8, 2008 Oct 9, 2008
DEVELOPMENT

(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)

READING BOOKS N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/21/2021

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:
________________________________
N/A
________________________________
35. ss
If YES, give details:
________________________________
N/A
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed: N/A
________________________________
Status of Case/s: N/A

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:
________________________________
N/A
________________________________
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? N/A
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? N/A
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: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability?
If YES, please specify ID No: N/A
c. Are you a solo parent?
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
Ms. Alice Cajaljal Branch Manager SM Muntinlupa 3.5 cm. X 4.5 cm
(passport size)

Ms. Josephine Barcas Branch Manager SM Sucat With full and handwritten
name tag and signature over
printed name
Ms. Elaine Agustin NBS HR
Computer generated
or photocopied picture
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 administrative/criminal case/s against me.

42.
is not acceptable

PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance
Government Issued ID: UNIFIED MULTI-PURPOSE ID

ID/License/Passport No.: 0033-7492270-1

Signature (Sign inside the box)
OCTOBER 21, 2021
Date/Place of Issuance: Metro 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