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 BALILING
NAME EXTENSION (JR., SR)
FIRST NAME KENT ELY

MIDDLE NAME MONOY

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) NOVEMBER 23, 1997 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH JABONGA AGUSAN DEL NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS PUROK-6
Widowed Separated House/Block/Lot No. Street
POBLACION
Other/s:
Subdivision/Village Barangay
JABONGA AGUSAN DEL NORTE
7. HEIGHT (m) 5'4m
City/Municipality Province
8. WEIGHT (kg) 64kg. ZIP CODE 8607
18. PERMANENT ADDRESS PUROK-6
9. BLOOD TYPE A+
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay
JABONGA AGUSAN DEL NORTE
11. PAG-IBIG ID NO. 919308137138
City/Municipality Province
12. PHILHEALTH NO. 182502549317 ZIP CODE 8607

13. SSS NO. 09-4675987-1 19. TELEPHONE NO. N/A

14. TIN NO. 364-173-798-000 20. MOBILE NO. 09381940006

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) kentelybaliling97@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)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A 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 BALILING

NAME EXTENSION (JR., SR)
FIRST NAME ELY

MIDDLE NAME MORAN

25. MOTHER'S MAIDEN NAME

SURNAME MONOY

FIRST NAME ELIZABETH

MIDDLE NAME LIBOT (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

JABONGA CENTRAL ELEMENTARY

ELEMENTARY
SCHOOL
PRIMARY EDUCATION 10/6/2004 05/15/2010 N/A 2010 N/A
VOCATIONAL /
SECONDARY JABONGA NATIONAL HIGH SCHOOL HIGH SCHOOL 06/15/2010 8/5/2014 N/A 2014 N/A

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

CARAGA STATE UNIVERSITY-
COLLEGE TRADE DIPLOMA COMPUTER TECHNOLOGY 08/20/2016 05/30/2018 N/A 2018 N/A
COURSE CABADBARAN CAMPUS

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

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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ SERVICE
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY
(mm/dd/yyyy) MONTHLY PAY GRADE (if STATUS OF
(Write in full/Do SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
CARAGA STATE UNIVERSITY-CABADBARAN
1/4/2018 05/30/2018 ON THE JOB TRAINING CAMPUS (COMPUTER LABORATORY) OJT N

GOVERNMENT INTERNSHIP PROGRAM HUMAN RESOURCE MANAGENENT OFFICE,

2/7/2018 12/31/2018
(CLERK) MUNICIPALITY OF JABONGA, AGUSAN DEL NORTE GIP Y

4/3/2019 06/30/2019
TOIURISM OFFICE,
TOURISM STAFF MUNICIPALITY OF JABONGA, AGUSAN DEL NORTE
JOB ORDER Y
12/4/2021 12/31/2021

11/23/2019 03/15/2020 PROMODISER GAESANO MALL DAVAO, BAJADA, DAVAO CITY PROMO N
BARANGAY HALL POBLACION, JABONGA, AGUSAN
3/1/2022 08/24/2023 CLERK DEL NORTE
JOB ORDER Y

(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

CHILDREN OF MARY (C.O.M.) 10/1/2012 PRESENT VICE PRESIDENT - ORGANIZATION

PAGOSI DANCE COMMUNITY (PADCOM) 5/6/2018 PRESENT SECRETARY

KABATAAN MAKA DAGAT (KAMADA) 1/4/2021 PRESENT TREASURER

01/20/2022 10/1/2023 BOARD OF DIRECTORS

MUNICIPAL YOUTH DEVELOPMENT COUNCIL 10/1/2023 6/1/2024 AUDITOR
(MYDC)
6/1/2024 PRESENT BOARD OF DIRECTORS
KABATAAN KONTRA DROGA AT TORRISMO
1/4/2021 PRESENT MEMBERS
(KKDAT)
PARISH YOUTH APOSTULATE (PARISH WIDE) 04/20/2022 PRESENT AUDITOR
(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
TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD
30. ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS NUMBER OF HOURS
Supervisory/
(mm/dd/yyyy) (Write in full)
(Write in full) Technical/etc)
From To
KIMBERRY BEACH RESORT, TAGCATONG,
PROVINCIAL YOUTH SUMMIT 06/19/2019 06/21/2019 MUNICIPALITY OF CARMEN, AGUSAN DEL
NORTE

BARANGAY HALL POBLACION, JABONGA,

PEER EDUCATORS 11/17/2021 11/19/2021 AGUSAN DEL NORTE

FESTIVAL MANAGEMENT WORKSHOP 10/5/2023 12/5/2023 SOCIAL HALL, CABADBARAN CITY

MUNICIPAL LEGISLATIVE, POBLACION,

COMMUNITY PROCUREMENT TRAINING 11/24/2022 11/25/2022 JABONGA, AGUSAN DEL NORTE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 33.
(Write in full) (Write in
full)
N/A N/A 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
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, YES ✘ NO
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 YES ✘ NO
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before YES ✘ NO
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?
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.
items:
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
PUROK-5 POBLACION, JABONGA, the last 6 months
MRS. ANAJOYCE M. CAMBLINDA AGUSAN DEL NORTE
9109868263 3.5 cm. X 4.5 cm
(passport size)
PUROK-6 POBLACION, JABONGA,
HON. PRECIOUS JOY C. MORALES AGUSAN DEL NORTE
9480706051 With full and handwritten
name tag and signature over
PUROK-7 POBLACION, JABONGA, printed name
MRS. STEPHANIE A. JANDUG AGUSAN DEL NORTE
9123395749
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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 PHOTO
filing of 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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place 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