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 GARGUEÑA
NAME EXTENSION (JR., SR)
FIRST NAME DEOGANI

MIDDLE NAME OCHATE

3. DATE OF BIRTH
(mm/dd/yyyy) 11/24/1995 16. CITIZENSHIP

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

17. RESIDENTIAL ADDRESS BLOCK 27 LOT 6

6 CIVIL STATUS
House/Block/Lot No. Street
EMILY HOMES LIBERTAD
Subdivision/Village Barangay
BUTUAN AGUSAN DEL NORTE
7. HEIGHT (m) 1.60
City/Municipality Province
8. WEIGHT (kg) 67 ZIP CODE 08600

18. PERMANENT ADDRESS BLOCK 27 LOT 6

9. BLOOD TYPE O
House/Block/Lot No. Street
EMILY HOMES LIBERTAD
10. GSIS ID NO. 2005695689
Subdivision/Village Barangay
BUTUAN AGUSAN DEL NORTE
11. PAG-IBIG ID NO. 1212-6015-3948
City/Municipality Province

12. PHILHEALTH NO. 18-251286992-1 ZIP CODE 8600

13. SSS NO. N/A 19. TELEPHONE NO. 816-1544

14. TIN NO. 471-782-870-000 20. MOBILE NO. 639946942517

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) dgarguena@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME N/A N/A
N/A
MIDDLE NAME N/A N/A
N/A
OCCUPATION N/A N/A
N/A
EMPLOYER/BUSINESS NAME N/A N/A
N/A
BUSINESS ADDRESS N/A N/A
N/A
TELEPHONE NO. N/A N/A
N/A
24. FATHER'S SURNAME GARGUEÑA N/A
NAME EXTENSION (JR., SR) N/A
FIRST NAME DEOGENIO III N/A
N/A
MIDDLE NAME ALABAT N/A
N/A
25. MOTHER'S MAIDEN NAME OCHATE N/A
N/A
SURNAME GARGUEÑA N/A
N/A
FIRST NAME LANI N/A

MIDDLE NAME APDUHAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ACADEMIC AWARD
ELEMENTARY BLISS ELEMENTARY SCHOOL ELEMENTARY 2002 2008 N/A 2008 OF EXCELLENCE

5TH HONORABLE
SECONDARY /
VOCATIONAL LIBERTAD NATIONAL HIGH SCHOOL HIGH SCHOOL 2008 2012 N/A 2012 MENTION

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

TRADE COURSE BACHELOR OF SCIENCE IN CIVIL

COLLEGE SAINT JOSEPH INSTITUTE OF TECHNOLOGY 2013 2018 N/A 2018 NONE
ENGINEERING

MASTER IN PUBLIC SERVICE

GRADUATE STUDIES SAINT JOSEPH INSTITUTE OF TECHNOLOGY 2020 PRESENT 18 N/A N/A
MANAGEMENT
(Continue on separate sheet if necessary)

SIGNATURE DATE October 12, 2022

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
UNTIL
CIVIL SERVICE (CSE-PROFESSIONAL) 80.93 3/18/2018 BUTUAN CITY 530392 PRESENT
K01-16-
DRIVER'S LICENSE N/A 11/22/2018 BUTUAN CITY 11/24/2023
004929

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
full/Do not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
2/3/2022 PRESENT ADMINISTRATIVE ASSISTANT II (ADAS-II) DEPARTMENT OF EDUCATION 18251.00 8 PERMANENT Y
LABOR AND EMPLOYMENT OFFICER II - DEPARTMENT OF LABOR AND
7/1/2021 1/7/2022
FOREIGN NATIONALS LABOR INSPECTOR
28754.00 13 CONTRACTUAL Y
EMPLOYMENT CARAGA
LABOR AND EMPLOYMENT OFFICER II - DEPARTMENT OF LABOR AND
1/1/2021 6/30/2020
FOREIGN NATIONALS LABOR INSPECTOR
28754.00 13 CONTRACTUAL Y
EMPLOYMENT CARAGA
LABOR AND EMPLOYMENT OFFICER II - DEPARTMENT OF LABOR AND
7/1/2020 12/31/2020
FOREIGN NATIONALS LABOR INSPECTOR
26754.00 13 CONTRACTUAL Y
EMPLOYMENT CARAGA
LABOR AND EMPLOYMENT OFFICER II - DEPARTMENT OF LABOR AND
1/1/2020 6/30/2020
FOREIGN NATIONALS LABOR INSPECTOR
25232.00 13 CONTRACTUAL Y
EMPLOYMENT CARAGA
LABOR AND EMPLOYMENT OFFICER II - DEPARTMENT OF LABOR AND
9/3/2019 12/31/2019
FOREIGN NATIONALS LABOR INSPECTOR
25232.00 13 CONTRACTUAL Y
EMPLOYMENT CARAGA
JODEL CONSTRUCTION SUPPLY AND
1/11/2019 8/23/2019 LIAISON OFFICER 13000.00 N/A PERMANENT N
MERCHANDISE
JODEL CONSTRUCTION SUPPLY AND
1/11/2019 8/15/2019 RESIDENT ENGINEER 13000.00 N/A PERMANENT N
MERCHANDISE
JODEL CONSTRUCTION SUPPLY AND
1/11/2019 6/11/2019 SITE ENGINEER 13000.00 N/A PERMANENT N
MERCHANDISE

(Continue on separate sheet if necessary)

SIGNATURE DATE October 12, 2022

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
(Write in full) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To

MG5 CLUB PHILIPPINES 8/8/2020 PRESENT OFFICIAL MEMBER (OM)

PHILIPPINE INSTITUTE OF CIVIL ENGINEERS, INC. - SAINT JOSEPH

9/2/2015 PRESENT STUDENT MEMBER
INSTITUTE OF TECHNOLOGY (SJIT) CHAPTER
RESERVE OFFICER TRAINING CORPS - MINDANAO STATE UNIVERSITY
3/13/2013 PRESENT CADET PVT, 3CL
MAIN CAMPUS (MARAWI)

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

BASIC TRAINING COURSE FOR LABOR INSPECTORS - LEVEL 1A (REGIONAL DEPARTMENT OF LABOR AND EMPLOYMENT
4/21/2021 4/23/2021 24.0 TECHNICAL
LEVEL) CARAGA REGIONAL OFFICE

DEPARTMENT OF LABOR AND EMPLOYMENT -

BASIC OCCUPATIONAL SAFETY AND HEALTH TRAINING FOR SAFETY OFFICER 1 2/23/2021 2/24/2021 10.0 TECHNICAL OCCUPATIONAL SAFETY AND HEALTH
CENTRE

VIRTUAL DISCUSSION ON THE DOH ADMINISTRATIVE ORDER NO. 2019-0047 DEPARTMENT OF HEALTH (DOH) CHD
"NATIONAL STANDARD ON THE DESIGN, CONSTRUCTION, OPERATION AND 12/17/2020 12/17/2020 8.0 TECHNICAL CARAGA ENVIRONMENTAL AND
MAINTENANCE OF SEPTIC TANK SYSTEMS OCCUPATIONAL HEALTH PROGRAM

TRAINING TO ACHIEVE THE SKILLSETS REQUIRED TO BECOME KNOWLEDGABLE ANTI-RED TAPE AUTHORITY (ARTA) -
8/25/2020 8/26/2020 16.0 TECHNICAL
IN WEB APPLICATION SECURITY NEXUSGUARD

DEPARTMENT OF SCIENCE AND

APPLICATIONS OF EVERYDAY LEADERSHIP 7/22/2020 7/22/2020 8.0 SUPERVISORY TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
LOCAL GOVERNMENT UNIT OF BUTUAN (LGU-
BUTUAN) / DEPARTMENT OF EDUCATION
WEBINAR 5: BASIC LABOR LAW IN THE TIME OF COVID-19 7/21/2020 7/21/2020 3.0 TECHNICAL
(DEPED) DIVISION OF BUTUAN CITY / FATHER
SATURNINO URIOS UNIVERSITY (FSUU)
DEPARTMENT OF SCIENCE AND
INTRODUCTION TO HTML 5 7/21/2020 7/21/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
LOCAL GOVERNMENT UNIT OF BUTUAN (LGU-
BALAOD: BROADENING ACCESS TO LAW FOR ALL THROUGH ONLINE DISTANCE
BUTUAN) / DEPARTMENT OF EDUCATION
EDUCATION BUTUAN'S VIRTUAL LAW CLASSROOM FOR ALL WEBINAR 4: 7/16/2020 7/16/2020 3.0 TECHNICAL
(DEPED) DIVISION OF BUTUAN CITY / FATHER
"MAKAPRISO BA ANG UTANG? BASIC LAWS EVERY DEBTOR SHOULD KNOW"
SATURNINO URIOS UNIVERSITY (FSUU)
DEPARTMENT OF SCIENCE AND
INTRODUCTION TO PSYCHOLOGY 7/15/2020 7/15/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
DEPARTMENT OF SCIENCE AND
MIND CONTROL: MANAGING YOUR MENTAL HEALTH DURING COVID-19 7/13/2020 7/13/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
DEPARTMENT OF SCIENCE AND
WORK SMARTER, NOT HARDER: TIME MANAGEMENT FOR PERSONAL &
7/13/2020 7/13/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
PROFESSIONAL PRODUCTIVITY
COURSERA
DEPARTMENT OF SCIENCE AND
INTRODUCTION TO INTERNATIONAL CRIMINAL LAW 7/6/2020 7/6/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
DEPARTMENT OF COURSERA
SCIENCE AND
SPEAK ENGLISH PROFESSIONALLY: IN PERSON, ONLINE & ON THE PHONE 7/5/2020 7/5/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
DEPARTMENT OF SCIENCE AND
LEARNING TECHNOLOGIES FOUNDATIONS AND APPLICATIONS 7/5/2020 7/5/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA OF SCIENCE AND
DEPARTMENT
USE WORDPRESS TO CREATE A BLOG FOR YOUR BUSINESS 7/4/2020 7/4/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
DEPARTMENT OF SCIENCE AND
INITIATING AND PLANNING PROJECTS 7/4/2020 7/4/2020 8.0 TECHNICAL TECHNOLOGY CARAGA (DOST-CARAGA) -
COURSERA
BASIC COURSE FOR LABOR INSPECTORS-LEVEL1A (MINIMUM WAGE FIXING DEPARTMENT OF LABOR AND
UNDER RA 6727, AND FIXED AND PERFORMANCE BASED COMPENSATION 5/28/2020 5/28/2020 8.0 TECHNICAL EMPLOYMENT/REGIONAL TRIPARTITE WAGES
SCHEME FOR THE BUS INDUSTRY AND BASIC CONCEPT OF PRODUCTIVITY) AND PRODUCTIVITY BOARD
CAPABILITY BUILDING SEMINAR FOR CARAGA SINGLE ENTRY ASSISTANCE DOLE - NATIONAL CONCILIATION AND
11/7/2019 11/8/2019 16.0 TECHNICAL
DESK OFFICERS (SEADOs) MEDIATION BOARD (NCMB) CARAGA
2-DAY BASIC COURSE FOR LABOR INSPECTORS ASSIGNED TO INSPECT DOLE - REGIONAL OFFICE 10 CAGAYAN DE
9/26/2019 9/27/2019 16.0 SUPERVISORY
WORKPLACES EMPLOYING FOREING NATIONALS (FNs) ORO
DEPARTMENT OF PUBLIC WORKS AND
ORIENTATION AND WORKSHOP ON PRECEDENCE DIAGRAM METHOD (BATCH 2) 3/21/2019 3/22/2019 16.0 TECHNICAL
HIGHWAYS REGIONAL OFFICE XIII
PHILIPPINE INSTITUTE OF CIVIL ENGINEERS,
19th NATIONAL CIVIL ENGINEERING STUDENT'S CONFERENCE 11/19/2016 11/19/2016 8.0 TECHNICAL
INC.
DRIVE TEST AND ITS THEORIES PRESCRIBED BY THE LAND TRANSPORTATION
5/26/2016 5/26/2016 8.0 TECHNICAL JACKRIDZ DRIVING SCHOOL
OFFICE (LTO)
COMPUTER LITERACY SCHOLARSHIP TRAINING ON WEBPAGE DEVELOPMENT
8/27/2011 10/1/2011 40.0 TECHNICAL ACLC COLLEGE OF BUTUAN CITY, INC.
WITH PHOTO EDITING
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

DRIVING N/A MG5 CLUB PHILIPPINES

COMPUTER LITERATE N/A N/A

MICROSOFT ORIENTED e.g. WORD,
N/A N/A
EXCEL, POWERPOINT
PHOTO EDITING N/A N/A

WEBPAGE MAKING AND DEVELOPMENT N/A N/A

N/A N/A

N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE October 12, 2022

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 theof bureau or office or to the person who has immediate supervision over you in the
chief
Office,
Bureau or Department where you will be apppointed,
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
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
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, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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 Barangay election)?
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
BIBLE BAPTIST CHURCH, AMBAGO, the last 6 months
PASTOR DONALD SABELLANO BUTUAN CITY
9079677447 3.5 cm. X 4.5 cm
(passport size)

ENGR. JOEL A. OMOY P1 BABAG, BUTUAN CITY 9106260019 With full and handwritten
name tag and signature over
printed name
ROMEO O. APROVECHAR, CESO V BUTUAN CITY 9985324551
Computer generated
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.
or photocopied picture
is not acceptable

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: DRIVER'S LICENSE

ID/License/Passport No.: K01-16-004929

Signature (Sign inside the box)
OCTOBER 1, 2021
Date/Place of Issuance: 2018-11-22 / BUTUAN
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