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 DUMALE
NAME EXTENSION (JR., SR) N/A
FIRST NAME SHEILA MARIE

MIDDLE NAME N/A

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) 03.05.1995
by birth by naturalization
4. PLACE OF BIRTH DUMAGUETE CITY, NEGROS ORIENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS N/A PUROK SANTOL, HABITAT1
Widowed Separated House/Block/Lot No. Street

Other/s:
N/A BALUGO
Subdivision/Village Barangay

7. HEIGHT (m) 1.61m DUMAGUETE CITY NEGROS ORIENTAL

City/Municipality Province
8. WEIGHT (kg) 60kgs ZIP CODE 6200

9. BLOOD TYPE O+ 18. PERMANENT ADDRESS N/A PUROK SANTOL, HABITAT1

House/Block/Lot No. Street

10. GSIS ID NO. N/A N/A BALUGO

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211-4483-0734 DUMAGUETE CITY NEGROS ORIENTAL

City/Municipality Province

12. PHILHEALTH NO. 12-051428430-5 ZIP CODE 6200

13. SSS NO. 0111-8409342-4 19. TELEPHONE NO. N/A

14. TIN NO. 704-961-578-000 20. MOBILE NO. 0997-506-8564

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
BNI-21-D206570 21. E-MAIL ADDRESS (if any) KLEIGHSHEI10@GMAIL.COM
N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
N/A UNO EMMANUEL DUMALE PALALON 11/25/2022

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME N/A

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

MIDDLE NAME N/A

25. MOTHER'S MAIDEN NAME

SURNAME DUMALE

FIRST NAME MARIANNIE

MIDDLE NAME DEMABIBAS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

RAMON PONCE DE LEON ELEMENTARY 3RD

ELEMENTARY PRIMARY EDUCATION 2OO1 2OO7 GRADUATED 2007
SCHOOL HONORS

SECONDARY SIATON NATIONAL HIGH SCHOOL SECONDARY EDUCATION 2OO8 2O11 GRADUATED 2011 NA

VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A

COLLEGE NEGROS ORIENTAL STATE UNIVERSITY BACHELOR OF SCINCE IN NURSING 2O12 2O16 GRADUATED 2O16 N/A

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

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/20/2023

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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

RA1080 75.2 NOV 25-26, 2017 CEBU CITY 0914338 03.05.2022

(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.
INCLUSIVE DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT

BUREAU OF JAIL MANAGEMNET AND

11/16/2020 PRESENT JAIL OFFICER 1 P29,668.00 10 PERMANENT YES
PENOLOGY
SHAPER BODY CONTOURING FOR MEN AND
10.01.2018 08.10.2020 STAFF NURSE P12,150.00 N/A REGULAR NO
WOMEN

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/20/2023

CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From 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
INCLUSIVE DATES OF Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

BASIC JAIL OPERATIONS 10/22/2021 10/29/2021 4 TECHNICAL BJMPRO-VII

NATIONAL JAIL MANAGEMENT AND PENOLOGY

ROPEMANSHIP AND BASIC RAPPELING 05.11.2021 05/15/2021 N/A TECHNICAL TRAINING INSTITUTE (VISAYAS-OFF CAMPUS)

QUICK MEDICAL RESPONSE TRAINING NATIONAL JAIL MANAGEMENT AND PENOLOGY

05.11.2021 05/15/2021 N/A TECHNICAL
TRAINING INSTITUTE (VISAYAS-OFF CAMPUS)

EXPLOSIVE ORDNANCE RECONNAISSANCE AGENT (EORA) 04/26/2021 04/30/2021 N/A TECHNICAL NATIONAL JAIL MANAGEMENT AND PENOLOGY
TRAINING INSTITUTE (VISAYAS-OFF CAMPUS)

STOP THE BLEED COURSE NATIONAL JAIL MANAGEMENT AND PENOLOGY

04/20/2021 04/20/2021 N/A TECHNICAL
TRAINING INSTITUTE (VISAYAS-OFF CAMPUS)

TACTICAL TRANSPORT TRAINING NATIONAL JAIL MANAGEMENT AND PENOLOGY

04.06.2021 04/30/2021 N/A TECHNICAL
TRAINING INSTITUTE (VISAYAS-OFF CAMPUS)

JAIL TACTICAL OPERATIONS 03/29/2021 04/30/2021 N/A TECHNICAL

JAIL BASIC RECRUIT COURSE - CLASS 2021-02 03/28/2021 09.03.2021 N/A MANDATORY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

SWIMMING MEDALYA NG PAPURI BJMP MULTI-PURPOSE COOPERATIVE

ARMED FORCES AND POLICE SAVINGS AND
EXERCISING
LOAN ASSOCIATION INC.
CLEANING/ORGANIZING

COOKING

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/20/2023

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,
a. within the third degree? YES NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
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
JCINSP SAMUEL JONATHAN L TUMANENG CARCAR CITY JAIL 9171893695 4.5 cm. X 3.5 cm
(passport size)
JO2 MELUNA V VELOSO BACONG, DUMAGUETE CITY 0927-753-1580
Computer generated
or photocopied picture
FELMA D. GALLETO BACONG, DUMAGUETE CITY 0926-762-0140 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: UMID ID

ID/License/Passport No.: 0111-8409342-4

Signature (Sign inside the box)
01/20/2023
Date/Place of Issuance: N/A -DGTE CITY, NEG. OR.
Date Accomplished Right Thumbmark

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

SAMUEL JONATHAN L TUMANENG

JAIL CHIEF INSPECTOR
CARCAR CITY JAIL
Person Administering Oath

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