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
LIBO-ON

FIRST NAME SUNSHINE

MIDDLE NAME ANOTDE

3. DATE OF BIRTH 12/27/1988 16. CITIZENSHIP

4. PLACE OF BIRTH ESPERANZA,SULTAN KUDARAT

5.
SEX Female
6.
CIVIL STATUS 17. RESIDENTIAL ADDRESS
Married Purok Pag-unlad / Salabaca / ESPERANZA / SULTAN
KUDARAT
7.
HEIGHT (m) 152

8.
WEIGHT (kg) 52
9.
BLOOD TYPE A 18.
PERMANENT ADDRESS

10.
GSIS ID NO.
2005185986

11. PAG-IBIG ID NO. 121249844724

12.
PHILHEALTH NO. 172514770269

13.
19.
SSS NO. TELEPHONE NO.

14.
20.
PAG-IBIG ID NO. MOBILE NO. 09067749798
15.
21.
AGENCY EMPLOYEE NO. E-MAIL ADDRESS(if any) libzy1227@gmail.com

II. FAMILY BACKGROUND

22.
SPOUSE'S SURNAME
23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME

MIDDLE NAME LIBO-ON, BRYLLE MARK ANOTDE 05/31/2012

LIBO-ON, CRYZTALLE KATE ANOTDE 01/17/2020

OCCUPATION

EMPLOYER/BUSINESS
NAME

BUSINESS ADDRESS

TELEPHONE

24.
FATHER'S SURNAME

FIRST NAME

MIDDLE NAME

25.
MOTHER'S MAIDEN
NAME
SURNAME

FIRST NAME

MIDDLE NAME

III. EDUCATIONAL BACKGROUND

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

COLLEGE UNIVERSITY OF SOUTHERN

BS NURSING 2005-2010
MINDANAO
 (Continue on separate sheet if necessary)

SINATURE DATE
IV. CIVIL SERVICE ELIGIBILITY
CAREER SERVICE/ RA 1080(BOARD/BAR) RATING DATE OF LICENSE(If applicable)
UNDER SPECIAL LAWS/CES/CSEE (If Applicable) EXAMINATION
PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY/ DRIVER'S LICENSE / NUMBER
CONFERMENT

BOARD / BOARD PASSER RA 1080 79.60% 07/03/2011 Davao City

VALIDITY

V. WORK EXPERIENCE
(Include private employment.Start from your recent) Description of duties should be indicated in the attached Work Experience Sheet.

INCLUSIVE DATES Position Title DEPARTMENT/AGENCY/OFFICE/ MONTHL SALAR STATUS OF GOV'T

(mm/dd/yyyy) COMP ANY Y Y APPOINTMEN SERVIC
SALARY GRADE T E
FROM & STEP
INCREMENT
02/01/2017 Police Officer I PHILIPPINE NATIONAL POLICE 14834 TEMPORARY

02/01/2018 Patrolman/Patrolwoman PHILIPPINE NATIONAL POLICE 29668

(Continue on separate sheet if necessary)

SINATURE DATE
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC/ NON-GOVERNMENT / PEOPLE/ VOLUNTARY ORGANIZATION/S

NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER CONDUCTED/SPONSORED BY

OF
FROM TO HOURS

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 of Division Chief/Executive/ Managerial positions)

INCLUSIVE DATES Type of I.D CONDUCTED/

TITLE OF LEARNING AND DEVELOPMENT OF NUMBER (Managerial/ SPONSORED
INTERVENTIONS/TRAINING PROGRAMS ATTENDANCES OF Supervisor/ BY
(Write in full) (mm/dd/yyyy) HOURS Technical/et (Write in Full)
c
FROM
BASIC INTERNAL SECURITY OPERATIONS COURSE 03/07/2018 06/11/2018 480 RSTU 12

PS FIELD TRAINING PROGRAM (POLICE OFFICER 1) 10/18/2017 02/17/2018 1124 RSTU 12

PS BASIC RECRUIT COURSE 02/06/2017 08/08/2017 960 RTC 12

VIII. OTHER INFORMATION

SPECIAL SKILLS/HOBBIES NON - ACADEMIC DISTINCTION / RECOGNITION MEMBERSHIP

ASSOCIATION/ORGANIZATIO
N
1 Medalya ng Kadakilaan

1 Medalya ng Kasanayan

1 Medalya ng Paglaban sa Manliligalig

1 Medalya ng Paglilingkod Laban sa Kriminalidad

1 Medalya ng Paglilingkod sa Mindanao

1 Medalya ng Pagtulong sa Nasalanta

3 Medalya ng Papuri

8 Medalya ng Papuri

1 Medalya ng Ugnayang Pampulisya

1 PNP Badge of Honor

SINATURE DATE
 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, YES NO
Bureau or Department where you will be apppointed, YES NO
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If Yes, give details:

YES NO
a. Have you ever been found guilty of any administrative offense?

If Yes, give details:

b. Have you ever been criminally changed before any court? YES NO

If Yes, give details:

Date Filed:

Status of Case/s:

Have you ever been convicted of any crime or validation of any law, decree, ordinance or requlation by any court YES NO
or tribunal?
If Yes, give details:

Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped YES NO
from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or
private sector?
If Yes, give details:

a. Have you ever been a candidate in a national or local election held within the last year (except Barangay YES NO
election)?

If Yes, give details:

b. Have you resigned from the government service during the three (3)-month period before the last election to YES NO
promote/actively campaign for a national or local candidate?

If Yes, give details:

Have you acquired the status of an immigrant or permanent resident of another country? YES NO

If Yes, give details:

Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo YES NO
Parents Welfare Act of 2000 (RA 8972), please answer the following items:
If Yes, give details:

a. Are you a member of any indigenous group? YES NO

If Yes, give details:

b. Are you a person with disability?

YES NO
If Yes, give details:
c. Are you a solo parent?

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

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 Computer generated or
of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency head/authorized representative to verify/validate the photocopied picture is not
contents stated herein. I agree that any misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s
acceptable
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: Signature (Sign inside the box)

ID/License/Passport No.:

Date Accomplished
Date/Place of Issuance:

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

Person Administering Oath