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 PANES
NAME EXTENSION (JR., SR) N/A
FIRST NAME CRISTY
MIDDLE NAME RAKIM
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/9/1983 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH COTABATO CITY 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 BENEMBARAN

Widowed Separated House/Block/Lot No. Street
BARANGAY RH-8
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5' COTABATO CITY
City/Municipality Province
8. WEIGHT (kg) 55 KG ZIP CODE 9600
18. PERMANENT ADDRESS #22 BLK 13
9. BLOOD TYPE O
House/Block/Lot No. Street
NOTRE DAME VILLAGE BARANGAY R.H.8
10. GSIS ID NO. NONE
Subdivision/Village Barangay
COTABATO CITY SPECIAL PROVINCE
11. PAG-IBIG ID NO.
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 9600

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

14. TIN NO. 964-475-530 20. MOBILE NO. 0953-1293-229

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) jpanes1980@gmail.com
PANES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A NUR-JEHAN R. PANES
JARWIN 04/16/2009

MIDDLE NAME TANGUB NOOR RIDDICK R. PANES 5/6/2012

OCCUPATION DRIVER NOOR ZHACKIE ZAIN R. PANES 07/15/2019

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME RAKIM

NAME EXTENSION (JR., SR) N/A
FIRST NAME ANGKAD

MIDDLE NAME DALIMBANG

25. MOTHER'S MAIDEN NAME YUARATA

SURNAME RAKIM

FIRST NAME RESTITUTA

MIDDLE NAME PAROJINOG (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

NOTRE DAME VILLAGE CENTRAL ELEMENTARY

ELEMENTARY
SCHOOL
PRIMARY EDUCATION 1991 1997 GRADUATED 1997 DIPLOMA

WITH
SECONDARY /
VOCATIONAL NOTRE DAME VILLAGE NATIONAL HIGH SCHOOL HIGH SCHOOL 1997 2001 GRADUATED 2001
HONORS

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

TRADE
BACHELOR OF SCIENCE IN COMPUTER DIPLOMA
COURSE
COLLEGE COTABATO CITY STATE POLYTECHNIC COLLEGE
SCIENCE
2001 2005 GRADUATED 2005
SCHOLAR
DIPLOMA
GRADUATE STUDIES SOUTHERN PHILIPPINES ACADEMY INC. BACHELOR OF ELEMENTARY EDUCATION 2021 2023 72 UNITS
SCHOLAR
(Continue on separate sheet if necessary)
SIGNATURE DATE NOVEMBER 17, 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

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. 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)
NOVEMBER 20,
2021
PRESENT SECRETARY MALASAKIT TRI-PEOPLE OF KUTAWATO INC. ₱6,000.00 JOB ORDER NO

01/30/2015 12/30/2017 SECRETARY JAHARA MUSA MINERS HOLDING CORPORATION ₱8,000.00 JOB ORDER NO

07/15/2008 12/30/2008 ENUMERATOR CITY PLANNING-GENSAN LGU ₱10,500.00 JOB ORDER Yes

03/15/2007 03/30/2008 QUALITY CONTROL GENTUNA-GENSAN ₱9,750.00 CASUAL NO

July 7, 2005 01/30/2006 CASUAL/ CLERK COA-ARMM ₱3,000.00 CASUAL Yes

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 17, 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

MALASAKIT TRI-PEOPLE OF KUTAWATO INCORPORATED NOV. 2019 PRESENT ADMIN

JAHARA MUSA MINERS ASSOCIATION 03/15/2016 12/30/2016 SECRETARY

BANGASAMORO ISLAMIC COMMUNITY BRAINERS INC. 06/30/2014 12/20/2015 MEMBER

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

06/15/2023 06/18/2023 2 DAYS BIR-COTABATO

TAXATION RULES AND REGULATION SEMINAR
TEAM BUILDING AND LEADERSHIP TRAINING 5/7/2008 10/7/2008 LGU-GENSAN

ENTERPRENEURSHIP TRAINING 03/15/2007 03/20/2007 MSU-GENSAN

LIVELIHOOD AND FOOD PROCESSING SEMINAR 8/1/2006 03/30/2006 3 MONTHS MSU-GENSAN

(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
(Write in full)
full)

Good Communication &

Writing Skills

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 17, 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
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? ________________________________
Resignation
a. Have you ever been a candidate in a national or local election held within the last year (except ________________________________
38. 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
MP SUWAIB "GORDON" L. ORANON, AL HADJ BTA MEMBER 3.5 cm. X 4.5 cm
(passport size)

AMIR " MILKY" P. ESMAEL CHIEF CDRRMO With full and handwritten
name tag and signature over
printed name
ABDULSATAR S. ABAS BRGY. EXECUTIVE OFFICER-UBJP
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 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: TIN ID

ID/License/Passport No.: 464-475-530

Signature (Sign inside the box)

Date/Place of Issuance: Cotabato 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