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 DECIERDO
NAME EXTENSION (JR., SR)
FIRST NAME CHARY FEL

MIDDLE NAME VEQUISO

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
10/10/1988 ✘ by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK KUMINTANG DE ORO ST.
Widowed Separated House/Block/Lot No. Street
SAN PEDRO
Other/s:
Subdivision/Village Barangay
DUMINGAG ZAMBOANGA DEL SUR
7. HEIGHT (m) 1.5748m
City/Municipality Province
8. WEIGHT (kg) 40kgs. ZIP CODE

18. PERMANENT ADDRESS PUROK KUMINTANG DE ORO ST.

9. BLOOD TYPE B
House/Block/Lot No. Street

10. GSIS ID NO.

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-2753-1884 DUMINGAG ZAMBOANGA DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 15-025319974-3 ZIP CODE

13. SSS NO. 08-1937500-7 19. TELEPHONE NO.

14. TIN NO. 311-770-588-000 20. MOBILE NO. 09075733118

15. AGENCY EMPLOYEE NO. 3060 21. E-MAIL ADDRESS (if any) charyvequiso@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME DECIERDO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) KASSANDRA JC-CLARE V. DECIERDO
FIRST NAME JEROME 4/25/2020

MIDDLE NAME DELOS REYES

OCCUPATION GOVERNMENT EMPLOYEE

EMPLOYER/BUSINESS NAME PHILIPPINE NATIONAL POLICE

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME VEQUISO

NAME EXTENSION (JR., SR)
FIRST NAME ROMEO

MIDDLE NAME BALASABAS

25. MOTHER'S MAIDEN NAME FELICITAS TAGAAN JIMOYA

SURNAME VEQUISO

FIRST NAME FELICITAS

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

ELEMENTARY CAMPO DOS ELEMENTARY SCHOOL PRIMARY EDUCATION 1995-2001 2001

SECONDARY
VOCATIONAL / SANTA TERESITA ACADEMY HIGH SCHOOL 2001-2004 2004

TRADE
COURSE
COLLEGE

BACHELOR OF SCIENCE IN BUSINESS

GRADUATE STUDIES AURORA PIONEERS MEMORIAL COLLEGE
ADMINISTRATION
2007-2011 2011
(Continue on separate sheet if necessary)

SIGNATURE DATE
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

CAREER SERVICE PROFESSIONAL 80.3 10/21/2012 ZAMBOANGA DEL SUR NATIONAL HIGH SCHOOL 08-219826

STA. MARIA DISTRICT, PAGADIAN CITY

(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)

7/1/2013 PRESENT BRANCH HEAD PALAWAN PAWNSHOP 15100.00 REGULAR

11/16/2012 6/30/2013 BRANCH CASHIER PALAWAN PAWNSHOP 13500.00 REGULAR

4/15/2012 10/15/2012 ENCODER GAISANO CAPITAL OZAMIZ 6000.00 REGUILAR

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

HAPPY TO SERVE YOU TRAINING 3/15/2018 3/15/2018 8HRS PALAWAN PAWNSHOP

BASIC MONEY CHANGING SEMINAR 12/5/2016 12/5/2016 8HRS PALAWAN PAWNSHOP

TEAM BUILDING PROGRAM 11/7/2015 11/7/2015 8HRS PALAWAN PAWNSHOP

ADVANCE JEWELRY APPRAISING 10/24/2015 10/24/2015 8HRS PALAWAN PAWNSHOP

FAST TRACK TRAINING FOR APPRAISERS 12/2/2015 12/3/2015 16HRS PALAWAN PAWNSHOP

ADVANCE JEWELRY APPRAISING 11/4/2013 11/4/2013 8HRS PALAWAN PAWNSHOP

BASIC JEWELRY APPRAISING 7/17/2013 7/17/2013 8HRS PALAWAN PAWNSHOP

APPRAISING SEMINAR 3/10/2013 3/10/2013 8HRS PALAWAN PAWNSHOP

BASIC PAWNSHOP OPERATION 11/20/2012 11/20/2012 8HRS PALAWAN PAWNSHOP

(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
 (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 ✘

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
BEBE ANN ANGANA MAHAYAG ZAMBOANGA DEL SUR 9100311877 3.5 cm. X 4.5 cm
(passport size)

GILLIAN JOYCE MONTECILLO DUMINGAG ZAMBOANGA DEL SUR 9124572472 With full and handwritten
name tag and signature over
printed name
JENNIFER PALISBO MAHAYAG ZAMBOANGA DEL SUR 9481566154
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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:
ID/License/Passport No.:
Signature (Sign inside the box)
JULY 1, 2022
Date/Place of Issuance:
Date Accomplished Right Thumbmark

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

Person Administering Oath

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