CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 INTERIOR
NAME EXTENSION (JR., SR) N/A
FIRST NAME JAMIE ROSE

MIDDLE NAME ONG

3. DATE OF BIRTH
(mm/dd/yyyy) 4/11/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH PANDAN, CATANDUANES If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS 109 SAN ANTONIO
Widowed Separated House/Block/Lot No. Street
MARAMBONG
Other/s:
Subdivision/Village Barangay
PANDAN CATANDUANES
7. HEIGHT (m) 1.25 m
City/Municipality Province
8. WEIGHT (kg) 60 kg ZIP CODE 4809
18. PERMANENT ADDRESS 109 SAN ANTONIO
9. BLOOD TYPE B+
House/Block/Lot No. Street
MARAMBONG
10. GSIS ID NO. 2005769458
Subdivision/Village Barangay
PANDAN CATANDUANES
11. PAG-IBIG ID NO. 1212-0778-7900
City/Municipality Province

12. PHILHEALTH NO. 10-251654253-2 ZIP CODE 4809

13. SSS NO. 05-1538524-9 19. TELEPHONE NO. N/A

14. TIN NO. 713-522-196 20. MOBILE NO. 0909 186 7552

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME INTERIOR

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

MIDDLE NAME VILLAFUERTE

25. MOTHER'S MAIDEN NAME

SURNAME ONG

FIRST NAME MARITES

MIDDLE NAME IBIERNAS (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

SALUTATOR
ELEMENTARY MARAMBONG ELEMENTARY SCHOOL ELEMENTARY 2002 2008 GRADUATE 2008 IAN

SALUTATOR
SECONDARY
VOCATIONAL / TABUGOC NATIONAL HIGH SCHOOL HIGH SCHOOL 2008 2012 GRADUATE 2012
IAN

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

TRADE
COURSE
COLLEGE CATANDUANES STATE UNIVERSITY BACHELOR OF ARTS IN ECONOMICS 2013 2017 GRADUATE 2017 PROVINCIAL

GRADUATE STUDIES BICOL UNIVERSITY MASTER OF ECONOMICS 2020 PRESENT 30 UNITS 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

CAREER SERVICE PROFESSIONAL ELLIGIBILITY 82.05 12/8/2018 VIRAC, CATANDUANES N/A N/A

LICENSURE EXAMINATION FOR TEACHERS 76.00 09/29/2019 LEGAZPI, CITY 1880765 4/11/2023

(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/ PAY SERVICE
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)

04/14/2023 PRESENT LOCAL TREASURY OPERATION OFFICER I PROVINCIAL TREASURER'S OFFICE 22,895 11/1 PERMANENT Y

01/02/2023 04/13/2023 INFORMATION TECHNOLOGIST OFFICER II PROVINCIAL GOVERNOR'S OFFICE 21,000 N/A JOB ORDER N

07/24/2020 12/30/2022 INFORMATION SYSTEM ANALYST II PROVINCIAL GOVERNOR'S OFFICE 18,000 N/A JOB ORDER N

12/5/2020 07/23/2020 ASSISTANT INFORMATION OFFICER PROVINCIAL GOVERNOR'S OFFICE 16,000 8/1 COTERMINOUS Y

5/2/2020 11/5/2020 ADMINISTRATIVE AIDE IV CONGRESSIONAL DISTRICT OFFICE 10900 N/A JOB ORDER N

PEACE AND ORDER COUNCIL SECRITARIAT

9/5/2019 4/2/2020 MUNICIPAL MAYOR'S OFFICE/DILG N/A N/A DESIGNATION N
DESIGNATE

9/5/2019 4/2/2020 POPS-PCMS ENCODER DESIGNATE MUNICIPAL MAYOR'S OFFICE/DILG N/A N/A DESIGNATION N

07/16/2019 4/2/2020 STATISTICIAN AIDE MUNICIPAL MAYOR'S OFFICE 10,500 N/A JOB ORDER N

1/4/2019 06/30/2019 INFORMATION SYSTEM ANALYST I PROVINCIAL GOVERNOR'S OFFICE 14,400 N/A JOB ORDER N

1/7/2019 03/30/2019 COMMUNITY AFFAIRS OFFICER PROVINCIAL GOVERNOR'S OFFICE 10,600 N/A JOB ORDER N

1/4/2018 06/30/2018 ADMINISTRATIVE AIDE IV PROVINCIAL GOVERNOR'S OFFICE 8,600 N/A JOB ORDER N

3/1/2018 03/30/2019 ADMINISTRATIVE AIDE III PROVINCIAL GOVERNOR'S OFFICE 7,200 N/A JOB ORDER N

1/9/2017 12/30/2017 ADMINISTRATIVE AIDE II PROVINCIAL GOVERNOR'S OFFICE 5,800 N/A JOB ORDER N

1/7/2016 08/31/2017 ADMINISTRATIVE AIDE I PROVINCIAL GOVERNOR'S OFFICE 5,480 N/A JOB ORDER N

ON-THE-JOB
9/11/2016 2/4/2017 ON-THE-JOB-TRAINING DEVELOPMENT BANK OF THE PHILIPPINES N/A N/A N
TRAINING

1/7/2013 3/6/2015 STUDENT ASSISTANT CATANDUANES STATE UNIVERSITY 3,000 N/A JOB ORDER N

SPECIAL PROGRAM FOR EMPLOYMENT OF

11/3/2013 04/30/2013 HUMAN RESOURSE OFFICE(LGU-PANDAN) 8,700 N/A SPES N
STUDENTS

SIGNATURE DATE
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

PANDANANON STUDENTS ASSOCIATION 2015 2017 PRESIDENT

BANDILLO ORGANIZATION 2013 2017 VICE PRESIDENT

(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

1ST BICOL GENDER AND DEVELOPMENT CONVENTION 10/3/2023 10/4/2023 16 FOUNDATION

BICOL REGIONAL AND DEVELOPMENT COMMITTEE

2023 PUBLIC SECTOR HR SYMPOSIUM 09/26/2023 09/27/2023 16 FOUNDATION

CIVIL SERVICE COMMISSION

SEMINAR WORKSHOP ON EFFECTIVE LOCAL LEGISLATION 08/17/2023 08/19/2023 24 FOUNDATION

DUX DUCIS RESEARCH AND LEADERSHIP CONSULTANCY

07/17/2023 07/19/2023 24 FOUNDATION PROVINCIAL DISASTER RISK REDUCTION AND

BASIC LIFE SUPPORT- HEALTH CARE PROVIDER TRAINING MAANGEMENT OFFICE

07/05/2023 07/05/2023 8 FOUNDATION

FORUM ON CIVIL SERVICE MATTERS CIVIL SERVICE COMMISSION
PERSONNEL OFFICERS ASSOCIATION OF THE
ASSERTIVE, ORAL AND WRITTEN COMMUNICATION SKILLS 05/23/2023 05/26/2023 28 FOUNDATION
PHILIPPINES, INC.

PUBLIC SERVICE VALUES PROGRAM-CATANDUANES 04/20/2023 04/20/2023 8 FOUNDATION CIVIL SERVICE COMMISSION

EMPLOYEE EMPOWERMENT IN THE WORKPLACE: A MORAL RECOVERY PROGRAM 12/16/2022 12/16/2022 4 FOUNDATION PROVINCIAL LOCAL GOVERNEMENT UNIT OF
CATANDUANES

EXECUTIVE AND LEGISLATIVE AGENDA 2023 09/26/2022 09/28/2022 24 FOUNDATION PROVINCIAL LOCAL GOVERNEMENT UNIT OF
CATANDUANES

THE BSP's MONETARY POLICY ACTION AMID COVID19 PANDEMIC: ECONOMIC IMPACT AND 06/30/2021 06/30/2021 8 FOUNDATION
LESSONS LEARNED CONTENT KNOWLEDGE AND INNOVATIVE TEACHING STRATEGIES COUNCIL OF ECONOMIC EDUCATORS AND BSP
TRAINING ON STRENGHTENING OF BARANGAY ANTI-DRUG ABUSE COUNCILS AUXILARY TEAMS, DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT-
01/13/2019 01/13/2019 8 TECHNICAL
CLUSTER LEADERS AND DUTY OFFICERS CATANDUANES

FORMULATION OF THE COMPREHENSIVE BARANGAY DISASTER RISK REDUCTION AND MUNICIPAL DISASTER AND RISK REDUCTION
11/18/2019 11/19/2019 24 TECHNICAL
MANAGEMENT PLAN MANAGEMENT OFFICE-PANDAN

FORMULATION OF THE COMPREHENSIVE BARANGAY DISASTER RISK REDUCTION AND MUNICIPAL DISASTER AND RISK REDUCTION
11/06/2019 11/08/2019 24 TECHNICAL
MANAGEMENT PLAN MANAGEMENT OFFICE-PANDAN

PROVINCIAL CONVENTION ON ECOLOGY AND CLIMATE CHANGE 10/30/2019 10/30/2019 8 FOUNDATION CARITAS VIRAC

LOCAL ANTI-DRUG ABUSE COUNCIL ORIENTATION 08/05/2019 08/05/2019 8 FOUNDATION PROVINCIAL LOCAL GOVERNEMENT UNIT OF
CATANDUANES

PEACE AND ORDER AND PUBLIC SAFETY PLAN 09/30/2019 09/30/2019 8 FOUNDATION PROVINCIAL LOCAL GOVERNEMENT UNIT OF
CATANDUANES
DEPARTMENT OF INTERIOR AND LOCAL GOVERNMENT-
ANTI-DRUG ABUSE COUNCIL PERFORMANCE AUDIT 08/01/2019 08/02/2019 16 TECHNICAL
REGIONAL OFFICE V

LINGGO NG KABATAAN 2019 09/01/2018 09/01/2018 14 TECHNICAL SANGGUNIANG KABATAAN FEDERATED COUNCIL

4H YOUTH CAMP 04/10/2018 04/11/2019 20 FOUNDATION PROVINCIAL AGRICULTURE OFFICE

TRAINING ON THE 2017 OMNIBUS RULES ON APPOINTMENT AND OTHER HUMAN RESOURSE HUMAN RESOURCE MANAGEMENT AND DEVELOPMENT
04/04/2018 04/05/2018 16 FOUNDATION
ACTION DEPARTMENT

(Please see separate sheet for continuation)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)
COLLEGE OF ARTS AND SCIENCES(CASSBO)-
COMPUTER LITERATE OUTSTANDING LEADERSHIP AWARD
VICE PRESIDENT
WRITING (SPEECH, NEWS, POETRY) ECONOMICS SOCIETY PRESIDENT

GOOD FILING AND SORTING ECONOMICS SOCIETY VICE PRESIDENT

GRADUATE SCHOOL- DEPARTMENT OF
ECONOMICS REPRESENTATIVE

(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
3 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 ✘

b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘

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? ________________________________
________________________________
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
HON. ERIC RODRIGUEZ LGU-Pandan N/A 3.5 cm. X 4.5 cm
(passport size)

ENGR. ALMA MAY T. LIM MLGOO-Pangniban N/A With full and handwritten
name tag and signature over
printed name
PROF. EUFRECINA T. DEL AGUA Calatagan, Virac N/A
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: PASSPORT

ID/License/Passport No.: P0812220B

Signature (Sign inside the box)

Date/Place of Issuance: 9/27/2018-VIRAC, CATANDUANES

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