PERSONAL DATA SHEET

WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal
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.
I. PERSONAL INFORMATION
2. SURNAME PAUL

FIRST NAME KHALID

MIDDLE NAME SAUDE

3. DATE OF BIRTH
(mm/dd/yyyy) 9/23/1989 16. CITIZENSHIP FILIPI

4. PLACE OF BIRTH BANGKAW-BANGKAW, NAGA, ZAMBOANGA DEL SUR If holder of dual citizenship,

please indicate the details.

5. SEX MALE

17. RESIDENTIAL ADDRESS HOUSE NUMBER 02

6 CIVIL STATUS MARRIED
House/Block/Lot No.

Subdivision/Village
KABASALAN
7. HEIGHT (m) 180.34
City/Municipality

8. WEIGHT (kg) 93 ZIP CODE

18. PERMANENT ADDRESS HOUSE NUMBER 02

9. BLOOD TYPE O
House/Block/Lot No.

10. GSIS ID NO.

Subdivision/Village
KABASALAN
11. PAG-IBIG ID NO.
City/Municipality

12. PHILHEALTH NO. ZIP CODE 7005

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09161622016

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) khalidpauls@gmail

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) FREYA DESTEEN BENITEZ PAUL
FIRST NAME RENDREN

MIDDLE NAME BENITEZ KENDREI KAWHI BENITEZ PAUL

KHAILY ABRAHAM BENITEZ PAUL
OCCUPATION TRAINER

EMPLOYER/BUSINESS NAME STII

BUSINESS ADDRESS LOWER TAWAY, IPIL, ZAMBOANGA SIBUGAY

TELEPHONE NO.

24. FATHER'S SURNAME BENITEZ

HEET
e the filing of administrative/criminal case/s against the person

NG THE PDS FORM.

1. CS ID No. (Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

FILIPINO

Pls. indicate country:

OUSE NUMBER 02 PRK SAMPAGUITA

House/Block/Lot No. Street
POBLACION
Subdivision/Village Barangay
KABASALAN ZAMBOANGA SIBUGAY
City/Municipality Province

OUSE NUMBER 02 PRK SAMPAGUITA

House/Block/Lot No. Street
POBLACION
Subdivision/Village Barangay
KABASALAN ZAMBOANGA SIBUGAY
City/Municipality Province

7005

09161622016

khalidpauls@gmail.com

CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

ESTEEN BENITEZ PAUL 07/06/2016

KAWHI BENITEZ PAUL 05/26/2017
KHAILY ABRAHAM BENITEZ PAUL
09/15/2018
 NAME EXTENSION (JR., SR)
FIRST NAME RAMIL

MIDDLE NAME HONRADE

25. MOTHER'S MAIDEN NAME

SURNAME MORDEN

FIRST NAME ANALIE

MIDDLE NAME APAO (Continue on separate sheet if

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE

LEVEL
(Write in full) (Write in full)
From

ELEMENTARY NAGA CENTRAL ELEMENTARY SCHOOL

SECONDARY NAGA NATIONAL HIGH SCHOOL

VOCATIONAL /
CONSTRUCTION
TRADE COURSE

ZAMBOANGA CITY STATE POLYTECHNIC BACHELOR OF TECHNICAL TEACHER

COLLEGE
COLLEGE EDUCATION

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
 (Continue on separate sheet if necessary)

HIGHEST SCHOLARSHIP/
PERIOD OF ATTENDANCE LEVEL/ YEAR
ACADEMIC
GRADUATE
UNITS EARNED HONORS
D
(if not graduated) RECEIVED
To
Congo,
2002 Republic of
the
2006

2013

2016

12 UNITS

DATE 03/29/2022
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
RATIN
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER G DATE OF
SPECIAL LAWS/ CES/ CSEE (If EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE Applica CONFERMENT
ble)

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
(mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / GRADE (if
POSITION TITLE MONTHLY
COMPANY SALARY
applicable)& STEP
(Write in full/Do not abbreviate) (Format "00-0")/
(Write in full/Do not abbreviate) INCREMENT
From To

8/10/2017 08/23/2018 SHS/COLLEGE INSTRUCTOR 10000.00)

 LICENSE (if applicable)

NUMBER Date of
Validity

n the attached Work Experience sheet.

GOV'T
STATUS OF
SERVICE
APPOINTMENT
(Y/ N)

CONTRACTUAL
 (Continue on separate sheet if necessary)

SIGNATURE DATE 3/09/2022

CS FORM 212 (Revised 2017), Page 2 of 4
3/09/2022
CS FORM 212 (Revised 2017), Page 2 of 4
 VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

NAME & INCLUSIVE DATES

29.ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

(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 Type of LD

30. ATTENDANCE
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING CONDUCTED/
( Managerial/ SPONSORED BY
(mm/dd/yyyy) NUMBER OF HOURS
PROGRAMS (Write in full) Supervisory/ (Write in full)
Technical/etc)
From To

TRAINING OF TRAINERS 8/3/2022 03/19/2022 ATI

GANIZATION/S

POSITION / NATURE OF WORK

Executive/Managerial positions)

NDUCTED/ SPONSORED BY
(Write in full)

ATI
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION

31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

ELECTRICAL HOUSE WIRING

PLUMBING

MASON

(Continue on separate sheet if necessary)

SIGNATURE DATE 03/29/2021

CS FORM 212 (Revised 2017), P
 MEMBERSHIP IN
ASSOCIATION/ORGANIZATIO
N
(Write in full)

03/29/2021
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:
________________________________
________________________________

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? ________________________________
________________________________

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:
 ils:
_________________
_________________

ils:
_________________
_________________

ils:
_________________
_________________

ils:
_________________
_________________

ils:
_________________
_________________

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

NAME ADDRESS TEL. NO.

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the pr

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:

ID/License/Passport No.: J1319006140

Signature (Sign inside the box)

Date/Place of Issuance: 03/23/2019

Date Accomplished Right Thumbmark

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

Person Administering Oath

CS FORM 212 (Revised 20

 PHOTO

Right Thumbmark

ed government ID as indicated above.

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