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 Ibale
NAME EXTENSION (JR., SR)
FIRST NAME Rizalito

MIDDLE NAME Guido

3. DATE OF BIRTH
12/28/1968 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH Ubay,Bohol If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS ✘ Single Married
17. RESIDENTIAL ADDRESS Block 6 / Lot 20
House/Block/Lot No. Street
Widowed Separated Modena Sub. Basak
Other/s: Subdivision/Village Barangay
Lapu-Lapu City Cebu
7. HEIGHT (m) 1.64
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 6015

18. PERMANENT ADDRESS Block 6 / Lot 20

9. BLOOD TYPE A+
House/Block/Lot No. Street
Modena Sub. Basak
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Lapu-Lapu city Cebu
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 12-0506937820 ZIP CODE 6015

13. SSS NO. 06-24865922 19. TELEPHONE NO. N/A

14. TIN NO. 250827707 20. MOBILE NO. 09432094749

15. AGENCY EMPLOYEE NO. 15D280119 21. E-MAIL ADDRESS (if any) rizalitoibale826@gmail.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) Zammantha Faith A. Ibale
FIRST NAME 8/18/2017

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Ibale 9/5/1951

NAME EXTENSION (JR., SR)
FIRST NAME Justiniano

MIDDLE NAME Cuyos

25. MOTHER'S MAIDEN NAME Autida 11/12/1961

SURNAME Ibale

FIRST NAME Avelina

MIDDLE NAME Guido (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Sentinela Elementary School Primary Education 1992 1999 Graduated 1999 N/A

SECONDARY
VOCATIONAL / Union High School High School 1999 2003 Graduated 2003 N/A

N/A

TRADE
COURSE
COLLEGE University of Cebu Lapu-Lapu and Mandaue Bachelor of science in Criminology 2004 2008 Graduated 2008 N/A

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE

CS FORM 212 (Revised 2017), Page

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

RA 6506 (Board of Criminoyly) 75.0 3/1/2012 Cebu City 001467097 12/28/2018

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF GOV'T SERVICE
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT (Y/ N)
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To

Police Officer 1
7/2/2012 Present Philippine National Police 14834.00 10-1 Permanent YES

2004 2009 Service Crew Mcdonald 6000.00 N/A Temporary No

(Continue on separate sheet if necessary)

SIGNATURE DATE
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/
NUMBER OF HOURS
Supervisory/
CONDUCTED/ SPONSORED BY (Write in full)
(Write in full) (mm/dd/yyyy)
Technical/etc)
From To

Public Safety Basic Recruite Course RTS-7 Class 2012-02 7/2/2012 7/2/2013 960.0 Regional Training School 7

Special Counter Insurgency Unit Training 1/28/2014 4/10/2014 360.0

Regional Scout Training Unit 7

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) in full)

Playing Basketball Medalya ng Kasanayan 10 N/A

Watching Movies Medalya ng Papuri 7

Medalya ng Paglaban sa Manliligalig 1

Medalya ng paglilinkod sa Visayaw 1

Letter of Commendation 18

(Continue on separate sheet if necessary)

SIGNATURE DATE
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? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
If YES, give details:

a. Have you ever been found guilty of any administrative offense?

35.
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 by any court or tribunal?
YES ✘ NO
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 out (abolition) in the public or private sector?
YES ✘ NO
If YES, give details:
________________________________
________________________________
a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)?
38.
YES ✘ NO
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 YES ✘ NO
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
If YES, please specify:
✘ NO
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
Dindo Montesclaros Police Station 2, MCPO Subangdaku Mandaue City 346-8591 3.5 cm. X 4.5 cm
(passport size)

Luciano O. Daligdigan Police Station 2, MCPO Subangdaku Mandaue City 346-8591 With full and handwritten
name tag and signature over
printed name
Hon. Effren Tanjay Ubay, Bohol 9178815628
Computer generated
42. 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 is not acceptable
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. 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: Philippine National Police

ID/License/Passport No.: 15D280119

Signature (Sign inside the box)

Date/Place of Issuance: 4/28/2015 Cebu City

Date Accomplished Right Thumbmark

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

PCINSP. GENILLO M. VERAQUE

Person Administering Oath

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