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.
PNLE BOARD EXAM
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 SERRANO
NAME EXTENSION (JR., SR)
FIRST NAME DANIEL ELIJAH

MIDDLE NAME SIMEON

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

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS 134 ADELA HIDALGO ST
Widowed Separated House/Block/Lot No.
65 ZONE 8
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 5'7 PASAY CITY NCR
City/Municipality Province
8. WEIGHT (kg) 80kg ZIP CODE 1300

9. BLOOD TYPE O+
18. PERMANENT ADDRESS 134 ADELA HIDALGO ST
House/Block/Lot No. Street
10. GSIS ID NO. 65 ZONE 8
Subdivision/Village Barangay
PASAY CITY NCR
11. PAG-IBIG ID NO. 121164673872
City/Municipality Province

12. PHILHEALTH NO. 010259147374 ZIP CODE 1300

13. SSS NO. 34-5719164-0 19. TELEPHONE NO. 02255-3525

14. TIN NO. 327-470-180-00000 20. MOBILE NO. 0994-649-0083

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) danielelijahserrano17@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME SERRANO

FIRST NAME BERNIE SR

MIDDLE NAME MACAPAGAT

25. MOTHER'S MAIDEN NAME

SURNAME CATAP

FIRST NAME MA. TERESITA

MIDDLE NAME SIMEON (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
DR. RAFAEL V. PALMA ELEMENTARY
ELEMENTARY PRIMARY EDUCATION 2004 2010 GRADUATE 2010 N/A
SCHOOL
SECONDARY SAN ANTONIO NATIONAL HIGH SCHOOL HIGHSCHOOL 2010 2014 GRADUATE 2014 N/A
VOCATIONAL /

EULOGIO "AMANG" RODRIGUEZ

INSTITUTE OF SCIENCE AND UNDERGRADUATE 2014 2016
TECHNOLOGY - MANILA CAMPUS
TRADE
COURSE ACCESS COMPUTER COLLEGE, MANILA
COLLEGE GRADUATE OF BACHELOR 2018 2023 GRADUATE 2023 N/A
CAMPUS
GRADUATE STUDIES NOT APPLICABLE
(Continue on separate sheet if necessary)

SIGNATURE DATE April 17, 2024

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

(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 full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)

- - -

(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 17, 2024

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

NOT APPLICABLE

NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
NOT APPLICABLE
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

VIII.

OT sheet if necessary)
nue on separate
HE
R
INF
OR NON-ACADEMIC DISTINCTIONS /
MA RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write
TIO (Write in in full)
N full)

nue on separate sheet if necessary)

SIGNATURE DATE APRIL

CS FORM 21217,(Revised
2024 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 out If YES, give details:
(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
ROWENA CRUZ 134 ADELA HIDALGO ST. PASAY CITY 0946-269-8626 3.5 cm. X 4.5 cm
(passport size)
ROXANNIE G. GASGONIA 34F.VICTOR ST. PASAY CITY 0917-177-4633 With full and handwritten
name tag and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
is not acceptable
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: DRIVER'S LICENSE

ID/License/Passport No.: N01-22-321592 Signature (Sign inside the box)

APRIL 17, 2024
Date/Place of Issuance: 7/21/22/ SAN JUAN 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