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 MAGBOO

FIRST NAME ANALYN N/A

MIDDLE NAME AXALAN

3. DATE OF BIRTH
(mm/dd/yyyy) 09/26/1979 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MABINI, BATANGAS If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRES A. MAGNAYE ST.

Widowed Separated House/Block/Lot No. Street
PULONG NIOGAN
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.73 MABINI BATANGAS
City/Municipality Province
8. WEIGHT (kg) 80 ZIP CODE 4202

9. BLOOD TYPE O 18. PERMANENT ADDRES A. MAGNAYE ST.

House/Block/Lot No. Street
10. GSIS ID NO. N/A PULONG NIOGAN
Subdivision/Village Barangay
MABINI BATANGAS
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 09-050194979-4 ZIP CODE 4202

13. SSS NO. 04-0982422-7 19. TELEPHONE NO. N/A

14. TIN NO. 265-056-693-000 20. MOBILE NO. 0939-439-0911

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if an ANALYNMAGBOO26@GMAIL.COM

II. FAMILY BACKGROUND

DATE OF BIRTH
22. SPOUSE'S SURNAME MAGBOO 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
FIRST NAME ERNANIE N/A MAGBOO, KIRBY ANGELO AXALAN 2/3/2005

MIDDLE NAME UMALI

OCCUPATION TRICYCLE DRIVER

EMPLOYER/BUSINESS NAM N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24.FATHER'S SURNAME AXALAN

FIRST NAME ARTURO SR.

MIDDLE NAME ESTORES

25. MOTHER'S MAIDEN NAME

SURNAME MAGNAYE

FIRST NAME ELENA

MIDDLE NAME ABANADOR

III. EDUCATIONAL BACKGROUND HIGHEST
SCHOLARS
PERIOD OF LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR HIP/
ATTENDANCE UNITS
LEVEL GRADUA ACADEMIC
EARNED
(Write in full) (Write in full) TED HONORS
From To (if not
graduated) RECEIVED
ELEMENTARY MABINI CENTRAL SCHOOL PRIMARY N/A 1992 N/A
VOCATIONAL /
SECONDARY MABINI COLLEGE OF BATANGAS INC. HIGH SCHOOL N/A 1996 N/A

N/A N/A

BACHELOR OF SCIENCE IN COMMERCE MAJOR

COLLEGE UNIVERSITY OF BATANGAS IN BANKING AND FINANCE N/A 2002 N/A
TRADE COURSE
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

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

ELIGIBILITY

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/ 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)

10/15/2019 7/25/2022 PRIVATE TUTOR PULONG NIOGAN, MABINI, BATANGAS PHP8,000 N/A N/A NO

4/25/2010 6/30/2018 BRGY. TREASURER PULONG NIOGAN, MABINI, BATANGAS PHP5,000 N/A N/A YES

11/1/2007 11/30/2008 MOBILE PHONE BANKING BANGKO KABAYAN PHP5,000 N/A N/A NO

3/1/2003 5/30/2004 DATA ENCODER MUNICIPAL CIVIL REGISTRAR PHP5,000 N/A N/A YES

(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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

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

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

ROLL-OUT FOR MASA MASID TEAMS 11/14/2017 11/14/2017 8.0 BARANGAY

COURAGE TO TAKE THE LEAD: EMPOWERING TFYD IN THE BARANGAY 7/29/2017 7/31/2017 20.0 BARANGAY

UPDATES ON R.A NO. 9184 6/28/2017 6/30/2017 20.0 BARANGAY

GOVT. PRCUREMENT AND MANUAL ON FINANCIAL MANAGEMENT FOR BRGYS 4/13/2016 4/15/2016 20.0 BARANGAY

THE QUALITY OF BRGY. GOVERNANCE OVER THE ENHANCE ECONOMIC PERFORMANCE 3/13/2016 3/15/2016 20.0 BARANGAY

AN EFFECTIVE FINANCIAL MANAGER, A TOOL TO GOOD GOVERNANCE 6/2/2015 6/4/2015 20.0 BARANGAY

(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)

COMPUTER LITERATE 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 ✘

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
GENER MAGBOO PULONG NIOGAN, MABINI, BATANGAS 0999-778-1299 4.5 cm. X 3.5 cm
(passport size)

ANDREA AXALAN PULONG NIOGAN, MABINI, BATANGAS 0917-773-4421

Computer generated
or photocopied picture
N/A N/A N/A is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: PHILIPPINE IDENTIFICATION CARD

ID/License/Passport No.: 2931-9650-9836-1487

Signature (Sign inside the box)

Date/Place of Issuance: 21 AUGUST 2022

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