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 LUNA
NAME EXTENSION (JR., SR)
FIRST NAME JOVIJANE

MIDDLE NAME GONZAGA

3. DATE OF BIRTH
(mm/dd/yyyy) 08/18/1995 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
PUROK 13 POBLACION, NABUNTURAN birth
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
DAVAO
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS PUROK 21
Widowed Separated House/Block/Lot No. Street
POBLACION
Other/s:
Subdivision/Village Barangay
NABUNTURAN COMPOSTELA VALLEY
7. HEIGHT (m) 5'0
City/Municipality Province
8. WEIGHT (kg) 45 kg ZIP CODE 8800

18. PERMANENT ADDRESS PUROK 21

9. BLOOD TYPE 0
House/Block/Lot No. Street
POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay
NABUNTURAN COMPOSTELA VALLEY
11. PAG-IBIG ID NO. 121-193-198-115
City/Municipality Province

12. PHILHEALTH NO. 16-251999126-8 ZIP CODE 8800

13. SSS NO. 09-3585535-9 19. TELEPHONE NO. N/A

14. TIN NO. 496-503-470 20. MOBILE NO. 09095056242

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) jovijanegluna18@yahoo.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME 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 LUNA

NAME EXTENSION (JR., SR)
FIRST NAME JOSE

MIDDLE NAME RABOR

25. MOTHER'S MAIDEN NAME

SURNAME GONZAGA

FIRST NAME VIRGINIA

MIDDLE NAME TAGUD (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

8TH
ELEMENTARY NABUNTURAN CENTRAL ELEMENTARY SCHOOL ELEMENTARY 2003 2008 GRADUATED 2008
HONOR
NABUNTURAN NATIONAL COMPREHENSIVE HIGH
SECONDARY /
VOCATIONAL SCHOOL
HIGH SCHOOL 2008 2012 GRADUATED 2012 N/A

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

TRADE
COURSE
COLLEGE ASSUMPTION COLLEGE OF NABUNTURAN BACHELOR OF SCIENCE IN ACCOUNTANCY 2012 2016 GRADUATED 2016 N/A

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
MAGUGPO PILOT IMELDA ELEMENTARY SCHOOL SPED CENTER,
CAREER SERVICE EXAMINATION (PROFESSIONAL) 80.78 10/18/2015 SOBRECAREY ST. MAGUGPO POBLACION TAGUM CITY 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/ 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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)
RURAL BANK OF COMPOSTELA (DAVAO), PROBATIONAR
5/2/2017 1/20/2018 TELLER/LOAN DOCUMENTATION CLERK 8,560.00 N/A NO
INC. -TAGUM BRANCH Y
NABUNTURAN FARMERS MULTI-PURPOSE PROBATIONAR
1/24/2017 3/10/2017 PROBATIONARY ACCOUNTING CLERK 7,291.00 N/A NO
COOPERATIVE 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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

N/A

(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

NATIONAL CERTIFICATE III IN BOOKKEEPING 1/26/2016 1/26/2016 8 HRS TECHNICAL TESDA

(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)

DANCING N/A N/A

SINGING

(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 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? I resigned from a 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
ASSUMPTION COLLEGE OF the last 6 months
Mrs. Felinita R. Barroga, CPA, MBA NABUNTURAN
N/A 3.5 cm. X 4.5 cm
(passport size)
ASSUMPTION COLLEGE OF
Mr. Delfin J. Enargan, MA NABUNTURAN
N/A With full and handwritten
name tag and signature over
printed name
MRS. Reynita L. Villan MUNICIPALITY OF NABUNTURAN 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: TIN

ID/License/Passport No.: 496-503-470

Signature (Sign inside the box)

Date/Place of Issuance: 02/14/17

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