CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 AMUGUIS
NAME EXTENSION (JR., SR)
FIRST NAME KRISTINE JOY

MIDDLE NAME ORTEGA

3. DATE OF BIRTH
November 7, 1987 16. CITIZENSHIP
Dual
(mm/dd/yyyy) ✘ Filipino Citizenship by
✘
by naturalization
birth
4. PLACE OF BIRTH Calapan City, Oriental Mindoro If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Fem
ale
6 CIVIL STATUS ✘ Single Mar 17. RESIDENTIAL ADDRESS RTC3
Sep House/Block/Lot No. Street
Widowe ried
arat S t o. N i n o
d
Other/s ed Subdivision/Village Barangay
:
Magalang Pampanga
7. HEIGHT (m) 1.61
City/Municipality Province
8. WEIGHT (kg) 56 kgs ZIP CODE 2011

18. PERMANENT ADDRESS Wireless

9. BLOOD TYPE "B"
House/Block/Lot No. Street
Bulusan
10. GSIS ID NO. 2004227485
Subdivision/Village Barangay
Calapan City Oriental Mindoro
11. PAG-IBIG ID NO. 121066442045
City/Municipality Province

12. PHILHEALTH NO. 030002877615 ZIP CODE 5200

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

14. TIN NO. 311-641-398-000 20. MOBILE NO. 09063546306/ 09989785007

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) tintin_khix@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) N/A
FIRST NAME N/A N/A
N/A
MIDDLE NAME N/A N/A
N/A
OCCUPATION N/A N/A
N/A
EMPLOYER/BUSINESS NAM N/A N/A
N/A
BUSINESS ADDRESS N/A N/A
N/A
TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME AMUGUIS

NAME EXTENSION (JR., SR)
FIRST NAME DENNIS

MIDDLE NAME ANDAYA

25. MOTHER'S MAIDEN NAME

SURNAME ORTEGA

FIRST NAME DIONISIA

MIDDLE NAME MARAMOT (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

ELEMENTARY CALAPAN CENTRAL SCHOOL PRIMARY EDUCATION 1994 2000 N/A 2000 with honors

JOSE J. LEIDO JR. MEMORIAL

SECONDARY HIGH SCHOOL 2000 2004 N/A 2004 with honors
VOCATIONAL / NATIONAL HIGH SCHOOL

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

TRADE
COURSE DIVINE WORD COLLEGE OF BACHELOR OF ARTS MAJOR IN POLITICAL
COLLEGE SCIENCE WITH 18 UNITS OF EDUCATION 2004 2008 N/A 2008 N/A
CALAPAN

PAMPANGA STATE AGRICULTURAL MASTER IN PUBLIC

GRADUATE STUDIES 2013 2017 N/A 2017 N/A
UNIVERSITY ADMINISTRATION

GREENVILLE COLLEGES DOCTOR IN PUBLIC ADMNISTRATION 2017 present 48 units present N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE March 17, 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
LICENSURE EXAMINATION FOR
78.40% APRIL 5, 2009 ADAMSON UNIVERSITY 1024022 11/07/2019
TEACHERS (RA 7836)

(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)

DEC 28, 2018 PRESENT TRAINING SPECIALIST III REGIONAL TRAINING CENTER 3 P 40, 637 18-1 Regular YES

JULY 2015 DEC 27, 2018 TRAINING SPECIALIST II REGIONAL TRAINING CENTER 3 P 29,010 15-1 Regular YES

JUNE 2012 JULY 2015 TRAINING SPECIALIST I REGIONAL TRAINING CENTER 3 P 18, 549.00 11-1 Regular YES

JUNE 2008 JUNE 2012 CLERK NATIONAL POLICE COLLEGE/PPSC P 7,000.00 N/A CONTRACTUAL YES

(Continue on separate sheet if necessary)

SIGNATURE DATE March 17, 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

Singles for Christ 2010 present member

Association of Junior Political Thinkers 2008 present member

(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

Correspondence/Report Writing Seminar 05/17/2021 05/17/2021 8 Technical Regional Training Center 3

Human Resource and Doctrine Development Officer Course 04/19/2021 05/07/2021 15 days Supervisory HRDD/TS

Anger/Stress Management Seminar 12/28/2020 12/28/2020 8 Supervisory Regional Training Center 3

Practicing COVID 19 Preventive Measures in the Work Place 11/25/2020 11/25/2020 8 Supervisory TESDA

COVID-19 Contact Tracing 11/04/2020 11/04/2020 8 Technical Johns Hopkins University

Substance Use Disorder Training For Criminal Justice Institutions and

10/28/19 11/07/19 80 Supervisory Colombo Plan
Universities in the Philippines

Terrorist Incident First Response Awareness Course 7/9/19 7/10/19 16 Supervisory RTC 3

Orientation on Rules on Administrative Cases in the Civil Service 6/28/19 6/28/19 8 Supervisory RTC 3

RTC 3 Academic Summit 2019 4/30/19 4/30/19 8 Supervisory RTC 3

Incident Command System Executive Course 02/06/19 02/06/19 8 Supervisory RTC 3

Fire Safety Seminar 3/25/19 3/25/19 8 Technical RTC 3

Seminar on Human Rights 12/18/18 12/18/18 8 Supervisory RTC 3

Seminar on ISO 9001:2015 11/29/18 11/29/18 8 Supervisory

PPSC
Seminar on ISO 9001:2015 11/22/18 11/23/18 16 Supervisory
PPSC
Seminar on R.A. 9184 09/21/18 09/21/18 8 Technical Regional Training Center 3

Seminar on Records Management and Document Security 06/28/18 06/28/18 8 Technical REGIONAL TRAINING CENTER 3

RTC 3 Academic Summit 05/25/18 05/25/18 8 Technical Regional Training Center 3

Seminar on Case Base Scenario 05/9/18 05/11/18 24 Technical Hanz Seidel Foundation

Seminar on ISO 9001:2015 04/25/18 04/27/18 24 Technical PHILIPPINE PUBLIC SAFETY COLLEGE

Operations and Plans Budget Seminar 01/14/18 01/16/18 24 Technical PHILIPPINE PUBLIC SAFETY COLLEGE

Seminar on RA 9262 Anti Violence Against Women and their Children 01/13/18 01/13/18 8 Supervisory RTC 3

Case Base Scenario Seminar 9/21/2017 9/22/17 16 Supervisory HANS SEIDEL FOUNDATION/PPSC

Seminar on Document Security 9/28/17 9/28/17 8 Supervisory RTC 3

Academic Summit 08/12/17 08/12/17 8 Supervisory RTC 3

Seminar on Work Ethics and Productivity 05/20/17 05/20/17 8 Supervisory Civil Service Commission

SEMINAR ON RA 9184, ITS REVISED IMPLEMENTING RULES &

04/05/17 04/07/17 24 Technical PHILIPPINE PUBLIC SAFETY COLLEGE
REGULATION)
PHILIPPINE GOVERNMENT ELECTRONIC
PHILGEPS SEMINAR WORKSHOP 03/16/17 03/17/17 16 Technical
PROCUREMENT SYSTEM
NATIONAL CAPITAL REGION TRAINING
ACADEMIC SUMMIT 2017 (RTC 3) 08/09/16 08/10/16 16 Supervisory
CENTER

PLANNING & BUDGETING SEMINAR WORKSHOP 01/09/17 01/12/17 32 Supervisory PHILIPPINE PUBLIC SAFETY COLLEGE

TRAINING OF TRAINERS (CASE BASED SCENARIOS) 12/01/16 12/02/16 16 Supervisory HANS SEIDEL FOUNDATION/PPSC

NATIONAL CAPITAL REGION TRAINING

ACADEMIC SUMMIT 2016 (NCRTC) 08/09/16 08/10/16 16 Supervisory
CENTER
TRAINING OF TRAINERS FOR PPSC PERSONNEL IN HUMAN RIGHTS-IHL
03/23/15 03/25/15 24 Supervisory COMMISSION ON HUMAN RIGHTS
EDUCATION

GENDER SENSITIVITY TRAINING 08/28/13 08/30/13 24 Supervisory PHILIPPINE PUBLIC SAFETY COLLEGE

TEST CONSRUCTION & DEVELOPMENT SEMINAR 10/17/13 10/17/13 8 Supervisory REGIONAL TRAINING CENTER 3

SEMINAR WORKSHOP ON TEST CONSTRUCTION & DEVELOPMENT 01/31/13 02/01/13 8 Supervisory PHILIPPINE PUBLIC SAFETY COLLEGE
INTERNATIONAL CRIMINAL
INSTRUCTORS DEVELOPMENT COURSE (IDC) 11/19/12 11/30/12 80 Supervisory INVESTIGATIVE TRAINING ASSISTANT
PROGRAM (ICITAP)
NATIONAL COMPUTER CENTER (UP
PPSC WEBSITE DEVELOPMENT WORKSHOP 11/22/11 11/26/11 40 Technical
DILIMAN)
FIVE PILLARS OF CRIMINAL JUSTICE SYSTEM (CONFERENCE
11/16/11 11/18/11 24 Supervisory PHILIPPINE PUBLIC SAFETY COLLEGE
WORKSHOP)
PERSONNEL ASSOCIATION OFFICERS
MANAGING WORKPLACE ATTITUDE 09/06/11 09/09/11 32 Supervisory
OF THE PHILIPPINES (POAP)
GOOD GOVRNANCE & ACCOUNTABILITY IN PUBLIC (GOVERNANCE MASTER IN PUBLIC ADMINISTRATION
11/12/11 11/12/11 8 Supervisory
FORUM) STUDENT SOCIETY
NATIONAL ARCHIVES OF THE
SEMINAR ON MANAGEMENT & ELECTRONIC RECORD 07/17/10 07/19/10 24 Technical
PHILIPPINES

EXECUTIVE COURSE ON MONEY LAUNDERING & TERRORISM FINANCE 03/03/09 03/06/09 32 Supervisory ANTI-MONEY LAUNDERING COUNCIL

PHILIPPINE EXCHANGE TRAINING (PET) 01/20/09 01/20/09 8 Supervisory SAN FRANCISCO POLICE DEPARTMENT

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write
(Write in full)
in full)
COMPUTER LITERATE (WORD, EXCEL,
N/A N/A
POWERPOINT)
DRIVING N/A N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE March 17, 2021 CS FORM 212 (Revised)
 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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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
PLTCOL MARLON VENTURA RUFO RTC 3 9279382002 3.5 cm. X 4.5 cm
(passport size)

PLTCOL ADRIAN R ANTONIO RTC 3 9454623820 With full and handwritten

name tag and signature over
printed name
PCPT MARIA ADELAIDA DOMINGO RTC 3 9561429950
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 PHOTO
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: PRC ID

ID/License/Passport No.: 1024022

Signature (Sign inside the box)
March 17, 2021
Date/Place of Issuance: Manila Philippines
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this March 17, 2021 affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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