CS FORM 212 (Revised 2005)

Unique Applicant Number

PERSONAL DATA SHEET T15258727

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)

I. PERSONAL INFORMATION
2. SURNAME ARRO
FIRST NAME ARLYN
MIDDLE NAME ITURRIAGA 3. NAME EXTENSION (e.g. Jr., Sr.)

16. RESIDENTIAL ADDRESS CALAPI, HINIGARAN, NEGROS OCCIDENTAL

4. DATE OF BIRTH (mm/dd/yyyy) 12 / 06 / 1990
5. PLACE OF BIRTH LA CASTELLANA
6. SEX MALE FEMALE
7. CIVIL STATUS
Single Widowed ZIP CODE 6106
Married Separated
17. TELEPHONE NO.
Annuled Others, specify
_________ 18. PERMANENT ADDRESS TALAPTAP, LA CASTELLANA, NEGROS
OCCIDENTAL
8. CITIZENDSHIP FILIPINO
9. HEIGHT (m) 157
10. WEIGHT (kg) 52 ZIP CODE 6131
11. BLOOD TYPE O+ 19. TELEPHONE NO.

12. GSIS ID NO. 20. EMAIL ADDRESS (if any) ARROARLYN06@GMAIL.COM

13. PAGIBIG ID NO. 21. CELLPHONE NO. (if any) 09484240854
14. PHILHEALTH NO. 110507457401 22. AGENCY EMPLOYEE NO.

15. SSS NO. 0725037594 23. TIN 328884857

II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUS. NAME

BUSINESS ADDRESS

TELEPHONE NO.

(Continue on separate sheet if necessary)

26. FATHER'S SURNAME ARRO

FIRST NAME NOLAN

MIDDLE NAME PANDES

27. MOTHER'S MAIDEN NAME

MOTHER'S SURNAME ITURRIAGA

FIRST NAME EDEN

MIDDLE NAME TUBONGBANUA

III. EDUCATIONAL BACKGROUND

HIGHEST
GRADE/ INCLUSIVE DATES OF
YEAR ATTENDANCE SCHOLARSHIP/
LEVEL NAME OF SCHOOL DEGREE COURSE LEVEL/ UNITS
GRADUATED ACADEMIC HONORS
(Write in full) (Write in full) EARNED
(if graduated) RECEIVED
(if not
graduated) From To

TALAPTAP ELEMENTARY
ELEMENTARY 2003 6 1996 2003
SCHOOL

LA CASTELLANA NATIONAL
SECONDARY 2007 2003 2007
HIGH SCHOOL

VOCATIONAL/ TRADE
COURSE

BACHELOR OF
COLLEGE LA CARLOTA CITY COLLEGE SECONDARY 2016 2012 2016/03/18
EDUCATION

GRADUATE STUDIES

IV. CIVIL SERVICE ELIGIBILITY

ARRO, ARLYN ITURRIAGA - T15258727 CS FORM 212 (Revised 2005), Page 1 of 3
29. LICENSE (if applicable)
DATE OF
CAREER SERVICE/ RA 1080 (BOARD/ BAR)
RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
UNDER SPECIAL LAWS/ CES/ CSEE DATE OF
CONFERMENT NUMBER
RELEASE
LET (LICENSURE EXAMINATION FOR
75 01 / 01 / 1970 BACOLOD CITY
TEACHER)

V. WORK EXPERIENCE
30. INCLUSIVE DATES SALARY
(mm/dd/yyyy) GRADE &
DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF GOV'T SERVICE
POSITION TITLE (Write in full) STEP
COMPANY (Write in full) SALARY APPOINTMENT (Yes / No)
INCREMENT
From To
(Format "00-0")

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

31. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF
POSITION / NATURE OF WORK
(Write in full) HOURS
From To

VII. TRAINING PROGRAMS (Start from the most recent training.)

32. INCLUSIVE DATES OF
ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

GRANDE COMPUTER
BASIC COMPUTER COURSE 09192017 12302017 80 OUTREACH AND TRAINING
CENTER INC.

VIII. OTHER INFORMATION

33. 34. 35. MEMBERSHIP IN ASSOCIATION /
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
SPECIAL SKILLS / HOBBIES: ORGANIZATION
(Write in full)
(Write in full)

SURF WEB,READING BOOKS AND STORIES

AND COOKING

ARRO, ARLYN ITURRIAGA - T15258727 CS FORM 212 (Revised 2005), Page 2 of 3

36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees): YES NO

appointing authority, recommending authority, chief of office/bureau/department or person who
has immediate supervision over you in the Office, Bureau or Department where you will be If YES, give details:
appointed? _____________________________________
_____________________________________
_____________________________________

b. Within the fourth degree (for Local Government Employees): YES NO

appointing authority or recommending authority where you will be appointed?
If YES, give details:
_____________________________________
_____________________________________
_____________________________________

37. a. Have you ever been formally charged? YES NO

If YES, give details:
_____________________________________
_____________________________________

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

If YES, give details:
_____________________________________
_____________________________________

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or YES NO
regulation by any court or tribunal?
If YES, give details:
_____________________________________
_____________________________________

39. 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, AWOL
or phased out, in the public or private sector? If YES, give details:
_____________________________________
_____________________________________

40. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________
_____________________________________

41. 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 differently abled? YES NO
If YES, please specify:_______________________
c. Are you a solo parent? YES NO
If YES, please specify:_______________________

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

NAME ADDRESS TEL. NO.

LUCITA L. ZAMORA BRGY.CALAPI HINIGARAN 09777968964

NIEVA PABIANIA BRGY.TALAPTAP LA CASTELLANA

TRUDY CERBO LA CARLOTA CITY

43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
X
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that
this information shall remain confidential. PHOTO

15556304

COMMUNITY TAX CERTIFICATE NO.

BACOLOD

ISSUED AT SIGNATURE (Sign inside the box)

2019-01-21 01 / 21 / 2019

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK

ARRO, ARLYN ITURRIAGA - T15258727 CS FORM 212 (Revised 2005), Page 3 of 3