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 HINOAY

N/A
FIRST NAME ARNEL

MIDDLE NAME MACALANDAG

3. DATE OF BIRTH
DECAMBER 06, 1990 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH VALENCIA CITY If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX ✘ Male Female
Single 17. RESIDENTIAL ADDRESS N/A MANANGKILA
6 CIVIL STATUS ✘ Married
House/Block/Lot No. Street
Widowed Separate N/A PUROK 11 POBLACION
Other/s: d Subdivision/Village Barangay
VALENCIA BUKIDNON
7. HEIGHT (m) 168CM
City/Municipality Province
8. WEIGHT (kg) 58KG ZIP CODE 8709

18. PERMANENT ADDRESS N/A N/A

9. BLOOD TYPE "B"
House/Block/Lot No. Street
N/A PUROK 7, SINABUAGAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
VALENCIA BUKIDNON
11. PAG-IBIG ID NO. 1211-3270-8363
City/Municipality Province

12. PHILHEALTH NO. 15-201880338-5 ZIP CODE 8709

13. SSS NO. 08-2516738-0 19. TELEPHONE NO. N/A

14. TIN NO. 487-738943 20. MOBILE NO. 09855178264 / 09656739989

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

22. SPOUSE'S SURNAME HINOAY 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

N/A AIZIN NIEL CALVO HINOAY

FIRST NAME JACKIELOU 3/29/2018

MIDDLE NAME CALVO

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME HINOAY

SR.
FIRST NAME EDDIE

MIDDLE NAME LIZARDO

25. MOTHER'S MAIDEN NAME

SURNAME MACALANDAG

FIRST NAME JULIETA

MIDDLE NAME BONGATO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SINABUAGAN ELEMENTARY SCHOOL N/A 6/9/1997 3/31/2006 N/A 2006 N/A

SECONDARY /
VOCATIONAL VALENCIA NATIONAL HIGH SCHOOL N/A 6/12/2006 3/31/2010 N/A 2010 CERTIFICATE

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

TRADE
COURSE
COLLEGE PHILIPPINE COLLEGE FOUNDATION BACHELOR OF SCIENCE IN CRIMINOLOGY 6/14/2010 3/28/2014 N/A 2014 CERTIFICATE

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 01,2023

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

REGISTERED MIDWIFE 82.8 11/1/2022 DAVAO CITY N/A N/A

(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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

12/1/2022 12/30/2022 CLINICAL INSTRUCTOR QUEZON HEALTH CENTER INFIRMARY 16000.00 N/A PART TIME N/A

10/25/2015 12/27/2017 LADY GUARD PUREGOLD VALENCIA 8000.00 N/A CONTRUCTUAL N/A

6/16/2013 09/31/2015 SALES CLERK UNISILVER JEWELRY 7000.00 N/A CONTRUCTUAL N/A

6/16/2012 5/31/2013 STORE PERSONNEL BROADWAY GEMS 7000.00 N/A CONTRUCTUAL N/A

1/16/2011 5/31/2012 SALES CLERK 77 SHOE BOUTIQUE 6500.00 N/A CONTRUCTUAL N/A

5/1/2009 12/31/2010 MERCHANDISER GAISANO VALEMNCIA 7000.00 N/A CONTRUCTUAL N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 23,2023

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION
29. NUMBER OF
(Write in full) POSITION / NATURE OF WO
HOURS
From (mm/dd/yyyy)
To

N/A N/A N/A N/A 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 NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED
PROGRAMS (Write in full) (mm/dd/yyyy) HOURS Supervisory/
From To Technical/etc)

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZ
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
(Write in
COOKING N/A N/A

GARDENING
 (Continue on separate sheet if necessary)
SIGNATURE DATE JANUARY 23,2
CS FORM 212 (Revised 20
ENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

Continue on separate sheet if necessary)

GRAMS ATTENDED
D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

N/A

Continue on separate sheet if necessary)

MEMBERSHIP IN
ASSOCIATION/ORGANIZATION

(Write in full)
N/A
Continue on separate sheet if necessary)
JANUARY 23,2023
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,
✘ NO
a. within the third degree? YES
✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES

If YES, give details:

✘ ________________________________
NO
YES
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
NO
________________________________
✘
YES
________________________________
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
✘ NODate Filed:
YES ________________________________
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? ✘ NO
YES If YES, give details:
________________________________
________________________________
✘ NO
37. Have you ever been separated from the service in any of the following modes: resignation, YES
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If✘ YES,
NO give details:
out (abolition) in the public or private sector? YES ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except ✘ NO
Barangay election)? YES
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? ✘ NO
YES
If✘ YES, give details (country):
NO
YES

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA ✘ NO
YES
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?
If YES, please specify: N/A
b. Are you a person with disability?
If YES, please specify ID No: N/A
c. Are you a solo parent?
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
CAPTAIN JIMMY E. CADUNGON SINABUAGAN , VALENCIA CITY 3.5 cm. X 4.5 cm
(passport size)

LORY JEAN MONTAJES VALENCIA CITY 9351445401 With full and handwritten
name tag and signature over
printed name
REMEDIOS HONQUILADA BATANGAN, VALENCIA CITY 9061225013
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: SOCIAL SECURITY SYSTEM

ID/License/Passport No.: 08-1752730-7

Signature (Sign inside the box)
JANUARY 23,2023
Date/Place of Issuance: 11/10/2009 VALENCIA CITY
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