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 ANDAN

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

MIDDLE NAME MAUNGAT

3. DATE OF BIRTH NOVEMBER 16, 1995 16. CITIZENSHIP

(mm/dd/yyyy) Filipino Dual Citizenship

by birth by naturalization
MATI CITY
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 PRK MASAGANA-2

House/Block/Lot Street
Widowed Separated No.
Other/s: COMMON LAW INTERCO DRIVE, BARANGAY MATIAO
Subdivision/ Baranga
Village y
7. HEIGHT (m) 1.55 CITY OF MATI, DAVAO ORIENTAL
City/Municipality Province
8. WEIGHT (kg) 60 KG ZIP CODE 8200
O 18. PERMANENT ADDRESS PRK MASAGANA-2
9. BLOOD TYPE
House/Block/Lot Street
No.
10. GSIS ID NO. NONE INTERCO DRIVE, BARANGAY MATIAO
Subdivision/ Baranga
Village y
11. PAG-IBIG ID NO. 121204296376 CITY OF MATI, DAVAO ORIENTAL
City/Municipality Province
12. PHILHEALTH NO. 162516962453 ZIP CODE 8200

13. SSS NO. 0942772739 19. TELEPHONE NO. N/A

14. TIN NO. 339880550 20. MOBILE NO. 09169484516

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) JAYANDAN20@GMAIL.COM

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME FABRO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
JANICA NAME EXTENSION (JR., SR) KYRIE LEIGH FABRO 07/30/2017
FIRST NAME

MIDDLE NAME MANGALAO KIARRA LEIGH FABRO 11/26/2021

OCCUPATION NONE

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ANDAN

ERWIN NAME EXTENSION (JR., SR) SR

FIRST NAME

MIDDLE NAME RULETE

25. MOTHER'S MAIDEN NAME

SURNAME MAUNGAT

FIRST NAME GLORIFE

MIDDLE NAME TINGGOY (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY
RABAT ROCAMORA MATI 2003 2009 2009
CENTRAL ELEMENTARY
SCHOOL 1
SECONDARY
MATI POLYTECHNIC COLLEGE 2009 2013 2013 SECOND
HONOR
VOCATIONAL /
TRADE COURSE
COLLEGE
DAVAO ORIENTAL STATE BACHELOR OF SCIENCE IN 2013 2017 2017
UNIVERSITY BUSINESS ADMINSTRATION MAJOR
IN FINANCIAL MANAGEMENT
GRADUATE STUDIES
(Continue on separate sheet if necessary)
APRIL 26, 2023
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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE / Validity
CONFERMENT
CAREER SERVICE SUB-PROFESSIONAL 81.81 08/07/2022 DAVAO CITY R11-20221128- 10/26/2022
040

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

2013 2015 STUDENT ASSISTANT VICE PRESIDENT IN ACADEMIC

AFFAIRS - DORSU
REGISTRARS OFFICE - DORSU

2013 2016 SUMMER JOB – CITY OF MATI TREASURERS OFFICE

GENERAL SERVICES OFFICE

ACCOUNTING OFFICE

PESO OFFICE

AUGUST APRIL MARKETING ASSISTANT MOTORTRADE MATI 9,000 PROBATIONARY

2017 2018
JULY SEPTEMBER LOAN COORDINATOR TAYTAY SA KAUSWAGAN INC. A 10,000 REGULAR
2018 2021 MICROFINANCE NGO
NOVEMBER PRESENT PURCHASING ASSOCIATE MAER SUMMIT KONSTRUK 13,000 REGULAR
2021

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

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

LEADERSHIP SKILLS

COMMUNICATION SKILLS

MANAGEMENT SKILLS

(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 chief of
bureau or office or to the person who has immediate supervision over you in the 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:

YES NO
b. Have you been criminally charged before any court?
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 YES NO
regulation 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, retirement, YES NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) If YES, give details:
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
a.
Are you a member of any indigenous group? Are YES NO
If YES, please specify:
b.
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. 0ID picture taken within

MC ERICK LUBIANO MATI CITY the last 6 months
3.5 cm. X 4.5 cm
09190747435 (passport size)
JOHN MARVIN VALENTEROS DAVAO CITY 09481474785
With full and handwritten name
tag and signature over printed
CHERRY MAE MOLINA DAVAO CITY 09171727856 name

Computer generated or
42.
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement photocopied picture is
pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency not acceptable

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. PHOTO

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.: Date/Place

Signature (Sign inside the box)
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