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 GALLANO
NAME EXTENSION (JR., SR)
FIRST NAME ROBERT JETHRO

MIDDLE NAME GARSUTA

3. DATE OF BIRTH
(mm/dd/yyyy)
11/20/1998 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS LOT 9 BLOCK 2

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
SKYLINE PHASE 3 CATALUNAN GRANDE
Other/s:
Subdivision/Village Barangay
DAVAO CITY DAVAO DEL SUR
7. HEIGHT (m) 1.7 m. (170 cm.)
City/Municipality Province
8. WEIGHT (kg) 100 kg ZIP CODE 8000

18. PERMANENT ADDRESS LOT 9 BLOCK 2

9. BLOOD TYPE A
House/Block/Lot No. Street
SKYLINE PHASE 3 CATALUNAN GRANDE
10. GSIS ID NO. ~N/A~
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121293730486 DAVAO CITY DAVAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 16-250629060-0 ZIP CODE 8000

13. SSS NO. 09-4177209-9 19. TELEPHONE NO. ~N/A~

14. TIN NO. 493-310-818-000 20. MOBILE NO. 0939-918-0469

15. AGENCY EMPLOYEE NO. ~N/A~ 21. E-MAIL ADDRESS (if any) robertjethrogallano@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ~N/A~ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME ~N/A~

NAME EXTENSION (JR., SR) ~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 GALLANO

NAME EXTENSION (JR., SR)
FIRST NAME ROBERT

MIDDLE NAME TONGSON

25. MOTHER'S MAIDEN NAME

SURNAME GARSUTA

FIRST NAME CRISTETA

MIDDLE NAME ALMONTE (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) (if not graduated)
GRADUATED HONORS
From To RECEIVED

Nursery
DAVAO CENTRAL HIGH SCHOOL (DAVAO CHONG Chinese
ELEMENTARY
HUA HIGH SCHOOL)
PRIMARY 6/4/2004 4/16/2011 2011 Language
Recognition

SECONDARY ATENEO DE DAVAO HIGH SCHOOL HIGH SCHOOL 6/4/2011 4/16/2015 2015 ~N/A~

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

BACHELOR OF SECONDARY EDUCATION MAJOR IN

COLLEGE ATENEO DE DAVAO UNIVERSITY
SOCIAL SCIENCES
6/4/2017 4/18/2021 2021 ~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
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

Licensure Exam for Teachers PASSED 12/17/2022 UM MATINA CAMPUS 2029416 2023-2026

Civil Service Examination pen and paper test STA. ANA CENTRAL ELEM. SCHOOL, 2022-
PASSED 06/19/2022 408180
PROFESSIONAL LEVEL MAGSAYSAY AVE., DAVAO CITY PRESENT
Insurance Commision Traditional/ Variable Life
PASSED 11/18/2016 PRULIFE UK N/A 2016-2018
Insurance license

~N/A~ ~N/A~ ~N/A~ ~N/A~ ~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.
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

DAX AGRI-INDUSTRIAL DEVELOPMENT

1/6/2019 present SEC AUTHORIZED FILER 3000.00 N/A fixed N
FOUNDATION INC.
CALL CENTER AGENT (AT&T CLG
3/2/2022 10/24/2022 VXI GLOBAL HOLDINGS B.V. PHILIPPINES 20000.00 N/A contract N
MOBILITY)
REGISTRY SYSTEM FOR BASIC SECTORS IN
09/21/2021 12/31/2021
AGRICULTURE (RSBSA) DATA ENCODER
DEPARTMENT OF AGRICULTURE 17000.00 N/A contract N

DAVAO RIVER INITIATIVES CRISTETA GALLANO

10/27/2020 12/30/2020 RESEARCH ASSISTANT CONSULTANCY/UNITED NATIONS EDUCATIONAL 25000.00 N/A contract N
SCIENTIFIC CULTURAL ORGANIZATION CONTRACT

11/20/2016 11/20/2017 INSURANCE AGENT PRULIFE U.K. commission N/A contract N

~N/A~ ~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 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

Caritas Davao Foundation, Inc. 1/2/2020 present 5 hrs/week SEC Securities and Exchange Commision Authorized Filer

Catanihan Foundation, Inc. 6/1/2021 present 5 hrs/week SEC Securities and Exchange Commision Authorized Filer

~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
TECHNOLOGIES FOR DISTANCE LEARNING: UTILIZATION OF TV FREQUENCIES, DIGITAL TV AND
10/12/2020 10/12/2020 3.0 TECHNICAL DEPARTMENT OF SCIENCE AND TECHNOLOGY
OTHER SOLUTIONS FOR DISTANCE LEARNING IN THE PHILIPPINES

EDUCATION AS THE FOUNDATION OF INCLUSIVENESS: LEAVING NO ONE BEHIND 10/5/2020 10/5/2020 3.0 TECHNICAL MALAYSIA UNESCO COOPERATION PROGRAMME

SUSTAINABLE TOURISM IN HARMONY WITH NATURE, PEOPLE AND SPIRITUALITY 10/12/2020 10/12/2020 3.0 TECHNICAL MALAYSIA UNESCO COOPERATION PROGRAMME

A TALK ON “OBESE CHILDREN LIVING IN POVERTY” 8/9/2019 8/9/2019 2.0 TECHNICAL

ATENEO DE DAVAO UNIVERSITY

INTERNATIONAL STUDIES RESEARCH DESSIMINATION 1/19/2019 1/19/2019 2.0 TECHNICAL ATENEO DE DAVAO UNIVERSITY

~N/A~ ~N/A~ ~N/A~ ~N/A~ ~N/A~ ~N/A~

(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)

BCBP BROTHERHOOD OF CHRISTIAN

Information Technology PRULIFE UK Insurance Sales Recognition
BUSINESSMEN & PROFESSIONALS
Computer literate ~N/A~ FUTURE EDUCATORS OF ATENEO (FEAT)
SAN ISIDRO LABRADOR PARISH FAMILY
Hobbies: assembling materials/handicrafts,
BLESSINGS CHOIR
sketching, digital drawing, cooking ~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 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: 50% Ilocano, 50% Boholano
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
Davao City Councilor, SP Bldg
HON. Engr. Alberto T. Ungab 9085657588 4.5 cm. X 3.5 cm
(passport size)
Teresian Daughters of Mary Convent,
Sr. Mary Grace L. Lumawag, TDM 09398773905
Matina, Davao City
Computer generated
Ofelia D. Dacudao Robinsons Heights, Davao City 09177010765 or photocopied picture
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: PASSPORT

ID/License/Passport No.: P9436785A

Signature (Sign inside the box)

Date/Place of Issuance: DAVAO 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