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 BALON
NAME EXTENSION (JR., SR)
FIRST NAME ALDA MILAGROS

MIDDLE NAME BALON

3. DATE OF BIRTH
(mm/dd/yyyy) 11/18/1960 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH DAET If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS 576 C. COLON ST.
Widowed Separated House/Block/Lot No. Street
III
Other/s:
Subdivision/Village Barangay
DAET CAMARINES NORTE
7. HEIGHT (m) 1.524m
City/Municipality Province
8. WEIGHT (kg) 53kg ZIP CODE 4600

18. PERMANENT ADDRESS 576 C. COLON ST.

9. BLOOD TYPE 0+
House/Block/Lot No. Street
III
10. GSIS ID NO. 000-5028-1796-6
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1530-0093-5821 DAET CAMARINES NORTE

City/Municipality Province

12. PHILHEALTH NO. 10-0500301567 ZIP CODE 4600

13. SSS NO. 05-0281796-6 19. TELEPHONE NO. N/A

14. TIN NO. 166-430-703-000 20. MOBILE NO. 09217542845

15. AGENCY EMPLOYEE NO. 3-01-001-002 21. E-MAIL ADDRESS (if any) ambb21118@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)
FIRST NAME N/A N/A
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME BALON

FIRST NAME AQUILES

MIDDLE NAME GUINTO

25. MIDDLE NAME

SURNAME BALON

FIRST NAME MILAGROS

MIDDLE NAME MOSCOSO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LA CONSOLACION SCHOOL ELEMENTARY 1969 1974 1974

SECONDARY /
VOCATIONAL LA CONSOLACION SCHOOL HIGH SCHOOL 1975 1978 1978

N/A N/A

TRADE
COURSE
COLLEGE PHIL. WOMEN'S UNIVERSITY AB COMMUNICATION ARTS 11979 1982 1982

GRADUATE STUDIES N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 29, 2022

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
SEPT.14,20
BARANGAY ELIGIBILITY N/A N/A N/A 16

(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)

6/11/2017 06/30/22 PRIVATE SECRETARY II MAYOR'S OFFICE 31587.00 15 APPOINTED 4 yrs.

1/7/2016 06/30/2019 SENIOR ADMIN. ASST.III MAYOR'S OFFICE 23573.00 15 APPOINTED 3yrs.

2014 2016 PUNONG BARANGAY BARANGAY III 7000.00 ELECTED 2 yrs.

2003 2013 BARANGAY KAGAWAD BARANGAY III 5000.00 ELECTED 10 yrs.

06/13/1988 3/6/2019 SECONDARY TEACHER CHUNG HUA HIGH SCHOOL 6000.00 PART TIME 30 yrs.

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 29, 2022

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

From To
ORIENTATION ON PROGRAM TO INSTITUTIONALIZE MERITOCRACY AND EXCELLENCE IN HUMAN
RESOURCE
2/15/2022 8 HRS. SUPERVISING HUMAN RESOURCE & MANAGEMENT OFFICE

RE-ORIENTATION TRAINING ON PEACE AND ORDER & PUBLIC SAFETY PLAN-POLICY COMPLIANCE 2/16/2022 8 HRS. TECHNICAL
DILG REGION V

CONSULTATION- DIALOGUE WITH SUPPLEMENTARY FEEDING PROGRAM IMPLEMENTERS 3/24/2021 8 HRS. TECHNICAL
MSWDO REGION V

ORIENTATION PEACE AND ORDER COUNCIL PERFORMANCE AUDIT 2/8/2021 2/10/2021 24 HRS. SUPERVISING DILG V IRTF V

NATIONAL NTF-ELCAC SUMMIT 5/2/2021 8 HRS. MANEGERIAL DILG (NATIONAL)

LOCAL GOVERNMENT, BCPC ORIENTATION AND CHILD PROTECTION LAWS, POLICIES, PROGRAMS
AND SERVICES
11/7/2021 12/7/2018 16 HRS. SUPERVISING HUMANETARIAN LEGAL ASSISTANCE FOUNDATION

12/7/2018 07/13/2018 16 HRS. MANEGERIAL HUMANETARIAN LEGAL ASSISTANCE FOUNDATION

BCPC STRATEGI PLANNING - COMPREHENSIVE LOCAL JUVENILE INTERVENTION
DEPT. OF INFORMATION & COMMUNICATION
RURAL IMPACT SEMINAR WORKSHOP PROMOTING ON LINE JOB IN THE COUNTRYSIDE 05/29/2018 8 HRS. TECHNICAL
TECHNOLOGY (DICT)
FORUM ON VOLUNTEERISM: A VISION FOR THE FUTURE AND CONTAINED SUPPORT TO PHIL. NAT'L.VOLUNTEER SERVICE COORDINATING
VOLUNTEERISM FOR DEVELOPMENT
5/10/2017 8 HRS. SUPERVISING
AGENCY

6TH REGIONAL CONVENTION ON HUMAN RESOURCE MANAGEMENT PRACTITIONER 7/28/2016 07/29/2016 16 HRS. SUPERVISING CIVIL SERVICE COMMISION REGION V

DEPT. OF EDUCATION LITERACY COORDINATING

NATIONAL LITERACY AWARDING 8/12/2016 8 HRS. SUPERVISING
COUNCIL

2016 LUZON CONVENTION OF HUMAN REAOURCE MANAGEMENT PRACTITIONERS 07/28/2016 07/29/2016 16 HRS. MANEGERIAL CIVIL SERVICE COMMISION (NATIONAL)

LGU SUMMIT ON SAFE CLOSURE AND REHABILITATION OF OPEN CONTROLLED DISPOSAL FACILITY DEPT. OF ENVIRONMENT & NATIONAL RESOURCE
AND MATERIAL RECOVERY SYSTEM(MRS) OPERATION
11/22/2016 8 HRS. TECHNICAL
(REGION V)
LGU-DAET - SB COMMITTEE ON EDUCATION, CULTURE &
CRASH REFRESHER COURSE ON BUSINESS CORRESPONDENCE 10/17/2016 4 HRS. TECHNICAL
ARTS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE 29, 2022

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
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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
KGD. JOSE VENIDA BRGY.III, DAET, CAM.NORTE 9956412975 4.5 cm. X 3.5 cm
(passport size)

DR. MANUEL OBAL SAN ROQUE MERCEDES 9186257988

Computer generated
or photocopied picture
MR. NOLY TOLEDANA GREENVIEW SUBD.DCN 9278279734 is not acceptable

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 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 PHOTO
administrative/criminal case/s 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: 3-01-001-002

ID/License/Passport No.: P0419798C

Signature (Sign inside the box)
6/29/2022
Date/Place of Issuance: JUNE 7, 2022 DFA LEGASPI
Date Accomplished Right Thumbmark

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

BENITO S. OCHOA
Person Administering Oath

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