CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misrepresentation made in 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 HASSAN
NAME EXTENSION (JR., SR) N/A
FIRST NAME FADLOLLAH
MIDDLE NAME LOMANGCO
3. DATE OF BIRTH
(mm/dd/yyyy) 12/24/1988 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH MARAWI CITY, LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS 0036 ZAID BIN THABIT
House/Block/Lot No. Street
Widowed
Separated BUADI SACAYO GREEN
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.6002 m MARAWI CITY LANAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 55 kg ZIP CODE 7000
18. PERMANENT ADDRESS 0036 ZAID BIN THABIT
9. BLOOD TYPE "O+"
House/Block/Lot No. Street

10. GSIS ID NO. NONE BUADI SACAYO GREEN

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121297036546 MARAWI CITY LANAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. NONE ZIP CODE 9700

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 607-893-204-00000 20. MOBILE NO. 0977-460-0355

15. AGENCY EMPLOYEE NO. 09-86642 21. E-MAIL ADDRESS (if any) fadlollah59@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NONE 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A NONE

MIDDLE NAME

OCCUPATION NONE

EMPLOYER/BUSINESS NAME NONE

BUSINESS ADDRESS NONE

TELEPHONE NO. NONE

24. FATHER'S SURNAME BATUGAN

FIRST NAME FAROUK N/A

MIDDLE NAME PANGLIMA

25. MOTHER'S MAIDEN NAME

SURNAME DAROMIMBANG

FIRST NAME FARIDAH

MIDDLE NAME LOMANGCO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

AMAI PAKPAK CENTRAL ELEMENTARY

ELEMENTARY PRIMARY EDUCATION 1994 2000 N/A 2000 NONE
SCHOOL

SECONDARY
VOCATIONAL / CARLOS L. ALBERT HIGH SCHOOL HIGH SCHOOL 2000 2004 N/A 2004 NONE

ILIGAN COMPUTER INSTITUTE VOCATION 2007 2008 N/A 2008 NONE

TRADE
COURSE MASTERS TECHNOLOGICAL INSTITUTE OF BACHELOR OF SCIENCE IN
COLLEGE 2014 2018 N/A 2018 NONE
MINDANAO ACCOUNTANCY
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/24/2023 CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

NONE NONE NONE NONE NONE NONE

(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. SALARY/ JOB/ PAY SERVICE
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
DEPARTMENT OF SOCIAL WLEFARE AND
1/16/2023 PRESENT MUNICIPAL FINANCIAL ANALIST 35,000.00 GRADE 15 CONTRACTUAL YES
DEVELOPMENT
DEPARTMENT OF SOCIAL WLEFARE AND
4/16/2022 PRESENT MUNICIPAL FINANCIAL ANALIST 35,000.00 GRADE 15 CONTRACTUAL YES
DEVELOPMENT
1/15/2019 7/15/2019 FINANCIAL ASSISTANT KOUZBARY BUILDERS 10,000.00 N/A CONTRACTUAL NO

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(Continue on separate sheet if necessary)

SIGNATURE DATE 01/24/2023 CS FORM 212 (Revised 2017), Page 2 of 4

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

NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE

NONE NONE NONE NONE NONE

NONE NONE NONE NONE

(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 (Write in ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
DEPARTMENT OF SOCIAL WELFARE AND
KALAHI-CIDSS ACT COACHING 32.0 HRS MANAGERIAL
6/15/2022 6/17/2022 DEVELOPMENT
DEPARTMENT OF SOCIAL WELFARE AND
ACT COACHING 5/17/2022 5/19/2022 24.0 HRS MANAGERIAL
DEVELOPMENT

TECHNICAL MASTERS TECHNOLOGICAL INSTITUTE OF

PASSIONATE LEADERS MOLD STRONGER COMMUNITIES 10/10/2018 10/10/2018 8 HRS
MINDANAO
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(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)

BASKETBALL NONE NONE

PLAYING GUITAR NONE NONE

SINGING NONE NONE

LITERATE IN MS (WORD,POWERPOINT,EXCEL) NONE NONE

CALCULATIONS NONE NONE

- NONE NONE

- NONE NONE
(Continue on separate sheet if necessary)

SIGNATURE DATE 01/24/2023 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 NO
YES ✘
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
MOHAMMAD ZUHAIR D. GANI ILIGAN CITY 3.5 cm. X 4.5 cm
(passport size)

SADRUDDIN A. MUTI MARAWI CITY 0908-898-37108 With full and handwritten

name tag and signature over
printed name
YASSER T. MUGNI MARAWI CITY
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 PHOTO
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: DRIVER'S LICENSE
ID/License/Passport No.: M02-09-003102 Signature (Sign inside the box)
01/24/2023
Date/Place of Issuance: MANILA CITY Date Accomplished Right Thumbmark

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

MA. CORAZON G. SUMICAD

Person Administering Oath

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