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 only.)

I. PERSONAL INFORMATION
2. SURNAME TILLOR

FIRST NAME PERCILITO NAME EXTENSION (JR., SR) N/A

MIDDLE NAME CAAYON

3. DATE OF BIRTH 16. CITIZENSHIP √ Filipino Dual Citizenship

(mm/dd/yyyy) 04/21/1992 If holder of dual citizenship, by birth by naturalization
please indicate the details. Pls. indicate country:

MAHARAT, BUNGTOD,
4. PLACE OF BIRTH 17. RESIDENTIAL ADDRESS
BOGO, CEBU
LARAY
5. SEX √ Male Female House/Block/Lot No. Sitio

6 CIVIL STATUS √ Single Married BUNGTOD

Widowed Separated Subdivision/Village Barangay

Other/s: BOGO CITY CEBU

City/Municipality Province
7. HEIGHT (m) 5'4"

WEIGHT (kg) 60 kg ZIP CODE 6010

8.
18. PERMANENT ADDRESS LARAY
9. BLOOD TYPE B+
House/Block/Lot No. Sitio
BUNGTOD
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BOGO CITY CEBU
11. PAG-IBIG ID NO. 1210-9556-0317
City/Municipality Province

12. PHILHEALTH NO. 12-051228243-7 ZIP CODE 6010

13. SSS NO. 06-3415868-7 19. TELEPHONE NO. N/A

14. TIN NO. 315-015-613 20. MOBILE NO. 09358604284

15 AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) tillorpercilito04211992@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME OF CHILDREN (Write full name & list all) DATE OF BIRTH(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A 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 TILLOR

NAME EXTENSION (JR., SR)
FIRST NAME FRUTO SR.

MIDDLE NAME PIEGA

25. MOTHER'S MAIDEN NAME

SURNAME CAAYON

FIRST NAME LAURENCIA

MIDDLE NAME OPLAS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL BASIC EDUCATION/DEGREE/ SCHOLARSHIP/
PERIOD OF HIGHEST LEVEL/
26. COURSE YEAR ACADEMIC
LEVEL ATTENDANCE UNITS EARNED
GRADUATED HONORS
From To (If not graduated)
(Write in full) (Write in full) RECEIVED
ELEMENTARY BOGO CENTRAL SCHOOL I BASIC EDUCATION 1999 2005 N/A 2005 THIRD HONORS

ST. LOUISE DE MARILLAC

SECONDARY
VOCATIONAL / HIGH SCHOOL 2005 2009 N/A 2009 WITH HONORS
COLLEGE OF BOGO

N/A N/A N/A N/A N/A N/A N/A

TRADE COURSE ST. LOUISE DE MARILLAC BACHELOR OF SECONDARY

COLLEGE 2010 2014 N/A 2014 N/A
COLLEGE OF BOGO EDUCATION
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
CAREER SERVICE/ RA 1080 (BOARD/ BAR) LICENSE (if applicable)
27. DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE RATING
EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / (If Applicable) Date of
CONFERMENT NUMBER
DRIVER'S LICENSE Validity
PBET (PHILIPPINE BOARD EXAMINATION FOR
77% 8/17/2014 UNIVERSITY OF CEBU - LAPU - LAPU - MAMBALING CAMPUS 1378214 4/21/2025
TEACHER)

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE GOV'T
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. SERVICE
INCLUSIVE DEPARTMENT / AGENCY / OFFICE / SALARY/ JOB/ PAY
28. DATES POSITION TITLE
COMPANY MONTHLY GRADE (if applicable)& STATUS OF
(mm/dd/yyyy) (Write in full/Do not SALARY STEP (Format "00-0")/ APPOINTMENT
(Write in full/Do not abbreviate)
From To abbreviate) INCREMENT
(Y/
12/01/2020 12/31/2021 REGISTRATION OFFICER II PHILIPPINE STATISTICS AUTHORITY 20000.00 N/A CONTRACTUAL N)
Y

09/01/2020 10/25/2020 CENSUS AREA SUPERVISOR PHILIPPINE STATISTICS AUTHORITY 18000.00 N/A CONTRACTUAL Y

WESTERN MASBATE ROOSEVELT HIGH

04/08/2014 03/31/2017 HIGH SHOOL TEACHER 9, 857.00 N/A CONTRACTUAL N
SCHOOL
07/15/2013 12/29/2013 SERVICE CREW (CASHIER) JOLY BOGO, INC. 5, 000.00 N/A CONTRACTUAL N

(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 NUMBER OF
(Write in full) POSITION / NATURE OF WORK
(mm/dd/yyyy) HOURS
From To
PUROK RED CORAL YOUTH ORGANIZATION - PUROK RED CORAL,
11/4/2018 PRESENT N/A VICE - PRESIDENT / VOLUNTARY
LARAY, BUNGTOD, BOGO CITY, CEBU
PHILIPPINE RED CROSS - NORTHERN CEBU CHAPTER 6/10/2019 PRESENT N/A RC143 VOLUNTEER / VOLUNTARY

(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
NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS
HOURS Supervisory/ (Write in full)
(Write in full) (mm/dd/yyyy)To
From Technical/etc)
TRANSITION TO TRANSFORMATION: MAPPING THE CHANGING
05/26/2022 05/27/2022 4 HOURS TECHNICAL C & E ADAPTIVE LEARNING SOLUTIONS
RESEARCH, INFORMATION AND EDUCATION LANDSCAPE
DEPARTMENT OF INFORMATION AND
A BEGINNER'S GUIDE TO DIGITAL ILLUSTRATION: PAINT TOOL SAI 05/11/2022 05/11/2022 3 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY - R4-A
DEPARTMENT OF INFORMATION AND
VISUAL STORYTELLING 101 FOR TEACHERS 04/22/2022 04/22/2022 3 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY - R9
DEPARTMENT OF AGRICULTURE -
HIGH VALUE CROPS WEEK 2022 WEBINARS 04/13/2022 04/13/2022 4 HOURS TECHNICAL
AGRICULTURAL TRAINING INSTITUTE
DEPARTMENT OF AGRICULTURE -
HIGH VALUE CROPS WEEK 2022 WEBINARS 04/12/2022 04/12/2022 4 HOURS TECHNICAL
AGRICULTURAL TRAINING INSTITUTE
DEPARTMENT OF INFORMATION AND
DIGITAL LITERACY 04/04/2022 04/08/2022 20 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY - R7
SELF-PACED LEARNING ROLES OF TEACHERS TOWARDS THE
04/01.2022 04/01/2022 4 HOURS TECHNICAL C & E ADAPTIVE LEARNING SOLUTIONS
NEW NORMAL
FROM NEW NORMAL TO BETTER NORMAL:FINDING THE RIGHT
03/31/2022 03/31/2022 4 HOURS TECHNICAL C & E ADAPTIVE LEARNING SOLUTIONS
SOLUTIUONS TO POST-PANDEMIC LEARNING SUCCESS
DEPARTMENT OF INFORMATION AND
INTERNET MEDIA AND INFORMATION LITERACY 03/29/2022 03/29/2022 4 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY - R7
DEPARTMENT OF INFORMATION AND
BASIC GRAPHIC EDITING USING CANVA 03/03/2022 03/04/2022 8 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY
DEPARTMENT OF INFORMATION AND
MICROSOFT POWERPOINT PROFICIENCY 02/24/2022 02/25/2022 8 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY
DEPARTMENT OF INFORMATION AND
CRITICAL THINKING SKILLS IN THE AGE OF MISINFORMATION 11/25/2021 11/26/2021 8 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY VISAYAS C2
DEPARTMENT OF INFORMATION AND
EFFECTIVE COMMUNICATION IN SOCIAL MEDIA FOR TEACHERS 10/18/2021 10/22/2021 20 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY VISAYAS C1
DEPARTMENT OF INFORMATION AND
CYBERSECURITY FOR EDUCATORS 10/14/2021 10/15/2021 6 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY LC3
DEPARTMENT OF INFORMATION AND
COMPUTER FORENSICS FUNDAMENTALS FOR TEACHERS 09/13/2021 09/17/2021 20 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY LC3
OFFICE PRODUCTIVITY TOOLS: HELPFUL APPLICATIONS FOR DEPARTMENT OF INFORMATION AND
04/27/2021 04/29/2021 12 HOURS TECHNICAL
REPORTING COMMUNICATIONS TECHNOLOGY LC3
DEPARTMENT OF INFORMATION AND
DATA PRIVACY PROTECTION 03/01/2021 03/05/2021 15 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY VISAYAS C1
DEPARTMENT OF INFORMATION AND
DIGITAL TRANSFORMATION ICT PROJECT MANAGEMENT 02/15/2021 02/19/2021 15 HOURS TECHNICAL
COMMUNICATIONS TECHNOLOGY VISAYAS C1
DEPARTMENT OF INFORMATION AND
DIGITAL GOVERNANCE AND MANAGEMENT TRAINING 02/15/2021 02/19/2021 15 HOURS TECHNICAL COMMUNICATIONS TECHNOLOGY MINDANAO C1

THIRD LEVEL TRAINING ON PHILIPPINE IDENTIFICATION SYSTEM 11/19/2020 11/21/2020 24 HOURS TECHNICAL PHILIPPINE STATISTICS AUTHORITY
THIRD LEVEL TRAINING FOR 2020 CENSUS OF POPULATION AND
08/03/2020 08/08/2020 64 HOURS TECHNICAL PHILIPPINE STATISTICS AUTHORITY
HOUSING
BARANGAY DISASTER RISK REDUCTION AND MANAGEMENT PLAN PHILIPPINE RED CROSS - NORTHERN CEBU
02/10/2020 02/12/2020 24 HOURS TECHNICAL
WRITESHOP CHAPTER
CHRISTINA R. LEPITEN - ROOSEVELT
IN-SERVICE TRAINING ON K TO 12 TEACHING AND LEARNING 10/24/2016 10/25/2016 16 HOURS TECHNICAL
SECONDARY SCHOOLS SUPERVISOR
TRAINING ON INQUIRY-BASED SCIENCE TEACHING APPROACH JOSE L. DONCILLO, CESO VI - MASBATE
11/09/2015 11/11/2015 24 HOURS TECHNICAL
AND SCIENCE INSTRUMENTATION SCHOOLS SUPERINTENDENT
IN-SERVICE TRAINING SEMINAR ON OUTCOMES-BASED JACINTO ANTONIO S. LEPITEN SR. - VICE-
10/28/2014 10/29/2014 16 HOURS TECHNICAL
EDUCATION (OBE) PRESIDENT PF ACADEMIC AFFAIRS
DIVISION ECHO LIVE OUT SEMINAR ON COACHING AND TRAINING DR. DANILO E. DESPI, CESO VI - MASBATE
09/05/2014 09/07/2014 24 HOURS TECHNICAL
IN VARIOUS SPORTS DISCIPLINE SCHOOLS DIVISION SUPERINTENDENT
DR. LEDESMA LAYON - DIRECTOR, GRADUATE
IN-SERVICE TRAINING ON OUTCOMES-BASED EDUCATION 05/23/2014 05/23/2014 8 HOURS TECHNICAL
STUDIES - CTU DAANBANTAYAN CAMPUS
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in
full)
SINGING, DANCING, ACTING PSA-PHILSYS CERTIFICATE OF RECOGNITION PUROK RED CORAL YOUTH ORGANIZATION
COMMUNITY ORGANIZING, PHILIPPINE RED CROSS - NORTHERN CEBU
PHILIPPINE RED CROSS CERTIFICATE OF APPRECIATION
VOLUNTEERISM CHAPTER
PAGEANT MANAGEMENT & HOSTING BOGO REDEEMERS SOCIETY, INC. / CERTIFICATE OF RECOGNITION
E-CLASS RECORD MAKING, BOOK
CHILDREN OF MARY - VINCENTIAN MARIAN YOUTH AWARD
MAKING, MAGAZINE MAKING
FORMAT/VIDEO/PHOTO EDITING,
SERVICE AWARD
WEBSITE DEVELOPMENT
CHOREOGRAPHY & SPORTS MOST OUTSTANDING STUDENT

(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:

If
YE
35. a. Have you ever been found guilty of any administrative offense? S, YES √ NO
giv If YES, give details:
e
det
ail
s:
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 __ YES √ NO
rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private sector? __ If YES, give details:
______________________
__
__
__
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)? __ 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 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:

c. Are you a solo parent? YES √ NO

If YES, please specify:

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

NAME ADDRESS TEL. NO.
HON. JOSE BRAINARD "DIGOY" Y. MAYOL BUNGTOD, BOGO CITY, CEBU 09177227915
EMMANUEL L. ABELLANA CEBU CITY 09338228361
ESTELA B. ROSALES CEBU CITY 09333241115
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
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: PRC

ID/License/Passport No.: 1378214

Signature (sign inside the box)

Date/Place of Issuance: 06/19/2015

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

Attachment to CS Form No. 212
WORK EXPERIENCE SHEET
Instructions: 1. Include only the experiences relevant to the position being applied to.
2. The duration should include start and finish dates, if known, month in abbreviated form
if known, and year in full. For the current position, use the word Present, e.g., 1998 -
Present. Work experience should be listed from the most recent first.
Duration : December 1, 2020 - December 31, 2021
Position : Registration Officer II
Name of Office or Unit : Cebu Statistical Field Office
Immediate Supervisor : Emmanuel L. Abellana
Name of Agency/Office/Company : Philippine Statistics Authority
Location : 2nd Floor, A. Martina Sugbu Center, P. Burgos St., Cebu City
List of Accomplishments and Contributions (if any)
1 Developed planning on registration center structure and flow of the process.
2 Coordinated with the LGU and barangays for the on-site registration.
3 Awarded for remarkable performance in the PhilSys Registration Center.
Summary of Actual Duties
1 Comply with the directives of the focal person and submit administrative monitoring reports.
2 Supervise the performance of the PhilSys Registration Team and oversee the daily operations.
3 Approve and transmit daily captured data and override biometric exceptions of the applicants.
4 Manage and secure the assigned registration kits.
5 Provide quality customer service to all applicants and answers all the applicants' queries.
Duration : September 1, 2020 - October 5, 2020
Position : Census Area Supervisor
Name of Office or Unit : Cebu Statistical Field Office
Immediate Supervisor : Estela B. Rosales
Name of Agency/Office/Company : Philippine Statistics Authority
Location : 2nd Floor, A. Martina Sugbu Center, P. Burgos St., Cebu City
List of Accomplishments and Contributions (if any)
1 Conducted trainings to enumerators.
2 Assist and accompany enumerators in the field especially in mapping.
3 Coordinated with the LGU and barangays for the survey.
Summary of Actual Duties
1 Coordinate with the LGU and barangays for the conduct of the survey.
2 Supervise the performance of the enumerators in the field.
3 Plan for the smooth process of the survey in the assigned municipality or city.
4 Comply with the directives of the focal person and submit administrative monitoring reports.
5 Manage the distribution of forms and materials for the survey.
Duration : April 28, 2014 - March 31, 2017
Position : High School Teacher
Name of Office or Unit : Western Masbate Roosevelt High School
Immediate Supervisor : Emmanuel L. Abellana
Name of Agency/Office/Company : Cebu Roosevelt Memorial Colleges, Inc.
Location : National Road, Cawayan, Masbate
List of Accomplishments and Contributions (if any)
1 Taught Science, English and MAPEH subjects to high school students.
2 Helped on campus event organising and communal events.
3 Manage Science laboratory and coaching with sports and competitions.
Summary of Actual Duties
1 Teach high school students with knowledge that corresponds with society needs.
2 Apply good classroom management and conducive to learning.
3 Manage school's properties, events and activities.
4 Comply with the directives of the school principal and submit lesson plans and test questions.
5 Promote socio-cultural, mental, physical, environmental and spiritual well-being to students.

PERCILITO C. TILLOR
Work Experience Sheet (Signature over Printed Name of Employee/Applicant)
Page 1 of 2 Current Date: May 10, 2022
Duration : July 15, 2013 - December 29, 2013
Position : Service Crew
Name of Office or Unit : Jollibee Gaisano Center Bogo
Immediate Supervisor : Juniffer R. Mangubat
Name of Agency/Office/Company : Joly Bogo, Inc.
Location : G/F Gaisano Center, P. Rodriguez St., Bogo City, Cebu 6010
List of Accomplishments and Contributions (if any)
1 Made every customer experience quality service.
2 Cleaned and arranged eating, service, and kitchen spaces and helped kitchen staff when needed.
3 Made big orders for bigger income through marketing strategy.
Summary of Actual Duties
1 Take orders from customers and present them as requested.
2 Ensure all orders are delivered to the customers in a timely manner.
3 Accept cash and return the correct change to the customers.
4 Place food orders in the appropriate bags and boxes.
5 Respond to customer inquiries, issue receipts, and record customer suggestions.

PERCILITO C. TILLOR
Work Experience Sheet (Signature over Printed Name of Employee/Applicant)
Page 2 of 2 Current Date: May 10, 2022
/Applicant)
/Applicant)