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 FRANCISCO
NAME EXTENSION (JR., SR)
FIRST NAME JOSE MARIE

MIDDLE NAME REYES

3. DATE OF BIRTH
1/14/1992 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino ✘ Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MANILA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS BLOCK 71 LOT 15 N/A
Widowed House/Block/Lot No. Street
Separate
MABUHAY HOMES SALAWAG
Other/s: d
Subdivision/Village Barangay
7. HEIGHT (m) 1.67 DASMARIÑAS CAVITE
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 4114

9. BLOOD TYPE A+
18. PERMANENT ADDRESS BLOCK 71 LOT 15 N/A
House/Block/Lot No. Street
10. GSIS ID NO. 121229643293 MABUHAY HOMES SALAWAG
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 010255312729 DASMARIÑAS CAVITE

City/Municipality Province

12. PHILHEALTH NO. 34-3940594-3 ZIP CODE 4114

13. SSS NO. 34-3940594-3 19. TELEPHONE NO. N/A

14. TIN NO. 7481709340000 20. MOBILE NO. 09914164799

15. AGENCY EMPLOYEE NO. 276756 21. E-MAIL ADDRESS (if any) jmfranciscoodcop@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME FRANCISCO (DECEASED)

NAME EXTENSION (JR., SR)
FIRST NAME RODELIO

MIDDLE NAME DELGADO

25. MOTHER'S MAIDEN NAME

SURNAME REYES

FIRST NAME EDITHA

MIDDLE NAME REYES (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

GRADUATE
ELEMENTARY SERRANO ELEMENTARY SCHOOL PRIMARY EDUCATION 1998 2004 2004 N/A
D
VALENZUELA NATIONAL HIGH GRADUATE
SECONDARY /
VOCATIONAL
SCHOOL
SECONDARY EDUCATION 2004 2008 2008 N/A
D
ST. JUDEL INSTITUTE OF UNDERGRA
TECHNOLOGY
COMPUTER SYSTEM SERVICING 2010 2012 N/A N/A
DUATE
TRADE
PAMANTASAN NG LUNGSOD NG BACHELOR OF SCIENCE IN GRADUATE
COURSE
COLLEGE
VALENZUELA PUBLIC ADMINISTRATION
2014 2018 2018 N/A
D

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

N/A N/A N/A N/A 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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
OFFICE OF THE DEAN, COPRS OF 15560
5/2/2023 PRESENT ADMINISTRATIVE AIDE IV 04-0 REGULAR Y
PROFESSORS, AFP PHP
VALENZUELA CITY DISASTER RISK
ADMINISTRATIVE AIDE III / RESCUE 10800 CONTRACTU
3/15/2020 11/1/2023 REDUCTION AND MANAGEMENT 03-0 Y
OFFICER PHP AL
OFFICE
ASSET MANAGEMENT OFFICE - DE LA 20430 PROBITIONA
8/14/2018 1/31/2019 INVENTORY CLERK N/A N
SALLE UNIVERSITY (MANILA) PHP RY
PANES-HERRERA BUSINESS 16000 CONTRUCTU
9/2/2013 5/31/2014 LIAISON OFFICER N/A N
PROCESSING CO. PHP AL

1/7/2012 1/31/2014 COMPUTER TECHNICIAN FREELANCER N/A N/A N/A N

(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

SOCIAL, WELFARE, OUTREACH AND RESPONSE DELEGATION 7/18/2018 12/31/2023 N/A MEMBER

MISSION BUDDIES CHARITY ORGANIZTION 9/12/2019 PRESENT N/A MEMBER

(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

NETWORK DEFENSE 16 HRS TECHNICAL CISCO NETWORKING ACADEMY

MANAGERIA
3/14/2024 3/14/2024 5 HRS
PROJECT MANAGEMENT ESSENTIALS CERTIFICATE L
DEPARTMENT OF LABOR AND EMPLOYMENT -
EMPLOYEES' COMPENSATION PROGRAM SEMINAR 2/8/2024 2/8/2024 8 HRS TECHNICAL EMPLOYEES' COMPENSATION COMMISION

INTRODUCTION TO CYBERSECURITY COURSE 2/6/2024 2/6/2024 6 HRS FOUNDATION CISCO NETWORKING ACADEMY

TECHNICAL EDUCATION AND SKILLS

MICROSOFT DIGITAL LITERACY 2/5/2024 2/5/2024 8 HRS DEVELOPMENT AUTHORITY
TECHNICAL EDUCATION AND SKILLS
INTRODUCTION TO COMPUTER SYSTEM SERVICING 2/5/2024 2/5/2024 6 HRS FOUNDATION DEVELOPMENT AUTHORITY
OFFICE OF THE DEAN, CORPS OF
ANGER AND STRESS MANAGEMENT LECTURE 11/17/2023 11/17/2023 6 HRS PROFESSORS, AFP

GHQ, UNIFIED COMMANDS, AND AFP-WIDE SUPPORT AND SEPARATE

OFFICE OF THE DEPUTY CHIEF OF STAFF FOR
UNITS AND KEY BUDGETARY UNITS CIVILIAN HUMAN RESOURCES 9/5/2023 9/6/2023 16 HRS SUPERVISORY PERSONNEL, J1, AFP
SUMMIT 2023: 123RD PHILIPPINE CIVIL SERVICE ANNIVERSARY

OFFICE OF THE DEAN, COPRS OF

MARRIAGE ENHANCEMENT SEMINAR 9/6/2023 9/6/2023 6 HRS PROFESSORS, AFP

COMPUTER HARDWARE BASICS COURSE 6/6/2023 6/6/2023 6 HRS FOUNDATION CISCO NETWORKING ACADEMY

5TH CORPS OF PROFESSORS, ARMED FORCES OF THE PHILIPPINES

COLLOQUIUM ON PHILIPPINE MILITARY EDUCATION: PERSPECTIVE ON OFFICE OF THE DEAN, COPRS OF
7/27/2023 7/27/2023 8HRS TECHNICAL
THE PHILIPPINES' STRATEGIC POSITION IN THE CONTEMPORARY PROFESSORS, AFP
WORLD

OFFICE OF THE DEAN, COPRS OF

GENDER SENSITIVITY TRAINING 5/30/2023 5/31/2023 16 HRS PROFESSORS, AFP

(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)

FIRST-AID N/A N/A

TROUBLESHOOTING OF COMPUTER SYSTEM

PUBLIC RELATIONS

COMMUNITY INVOLVEMENT

BASIC VIDEO EDITING

BASIC PHOTO EDITING

MOUNTAINEERING
(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? RESIGNATION
________________________________
________________________________
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
JOHN CHRISTIAN CHANG POTRER, MALABON 9982457884 4.5 cm. X 3.5 cm
(passport size)

DAN ROVEM PANES BACOOR, CAVITE 9199779919

Computer generated
or photocopied picture
KELLY RIGOR ISLA, VALENZUELA CITY 9455318522 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: UMID

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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