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 VALENCIA
NAME EXTENSION (JR., SR)
FIRST NAME EARLY JOY STEPHANIE
MIDDLE NAME ABAN
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
12/25/90

4. PLACE OF BIRTH VILLA VERDE NUEVE VISCAYA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 262 BLK 17 PUROK IMELDA
House/Block/Lot No. Street
Dela Paz
Subdivision/Village Barangay

7. HEIGHT (m) 1.63m Antipolo Rizal

City/Municipality Province
8. WEIGHT (kg) 88kg ZIP CODE 1870

9. BLOOD TYPE O+ 18. PERMANENT ADDRESS 262 BLK 17 PUROK IMELDA

House/Block/Lot No. Street

10. GSIS ID NO. 02005656370 Dela Paz

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-3082-9975 Antipolo City Rizal

City/Municipality Province

12. PHILHEALTH NO. 060501306269 ZIP CODE 1870

13. SSS NO. CRN-0111-266762Y9 19. TELEPHONE NO. N/A

14. TIN NO. 470-136-591 20. MOBILE NO. 09676616192

15. AGENCY EMPLOYEE NO. 06-38-0759 21. E-MAIL ADDRESS (if any) earlyjoystephanievalencia@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME VALENCIA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ALISON Gillianne Grace Castanas Arquero 11/07/2016
MIDDLE NAME MOYA Sean Gilmer Castanas Arquero 06/11/2019
OCCUPATION POLICEMAN
EMPLOYER/BUSINESS NAME PHILIPINE NATIONAL POLICE
BUSINESS ADDRESS CAMP CRAME QUEZON CITY
TELEPHONE NO. N/A
24. FATHER'S SURNAME ABAN
Sr
FIRST NAME DIOS ARMIE
MIDDLE NAME TAROMA
25. MOTHER'S MAIDEN NAME CELY CALOCRON UBALDO
SURNAME ABAN
FIRST NAME CELY
MIDDLE NAME UBALDO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LAWIG ELEMENTARY SCHOOL PRIMARY 1998 6/26/1905 N/A N/A

SECONDARY BINTAWAN NATIONAL HIGHSCHOOL SECONDARY 2004 2007 N/A 2007 N/A
VOCATIONAL /

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

TRADE
COURSE
COLLEGE PURISIMU WIS A. TIAM COLLEGE INC BACHELOR
NURSING
OF SCIENCE IN 2007 2011 N/A 2011 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. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

NURSE LICENCE EXAMINATION 76.97 DECEMBER 7,8, TUGUEGARAO CITY 0927088

2013

(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 SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
SALARY/ JOB/ PAY
GRADE (if STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/ APPOINTMENT
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/ N)

NURSE CONTRACTUAL RIZAL PROVINCIAL HOSPITAL 35,097.00 N/A CONTRACTUA YES

ANTIPOLO ANNEX L
6/15/2015 STAFF NURSE NUEVA VISCAYA PROVINCIAL 8,000.00 N/A YES
HOSPITAL
4/1/2014 RESIDENT NURSE PURISIMO LUIS A. TIAM MEDICAL 8,000.00 N/A VOLUNTEER NO
CENTER

(Continue on separate sheet if necessary)

SIGNATURE DATE January 10, 2023

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
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

C2020 ADVANCED CARDIAC SUPPORT 5/1/22 5/1/22 8hours technical HEART UP TRAINING CENTER

CADIOVASCULAR PHARMACOLOGY 5/1/2022 5/1/2022 8hours technical

HEART UP TRAINING CENTER
ELECTRICAL THERAPHY 4/30/2022 5/1/2022 8hours technical
HEART UP TRAINING CENTER
BASIC ELECTRO CARDIOGRAPHY 4/30/2022 4/30/2022 8hours technical
HEART UP TRAINING CENTER
C2020 BASIC LIFE SUPPORT 4/30/2022 4/30/2022 8hours technical
HEART UP TRAINING CENTER
MEGA CODE 4/30/2022 4/30/2022 8hours technical
HEART UP TRAINING CENTER
REGULAR VI PROGRAM 2/23/2011 2/23/2011 8hours technical
PURISIMOLUIS A. LIAM MEDICAL C

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write
in full)

NURSING PROCEDURE N/A PHILIPINE NURSES ASSOCIATION

SINGING COLORING

COMMUNICATION SKILLS

ABILITY TO WORK INDEPENDENCY

(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?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details: ________________________________
________________________________

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details: ________________________________
________________________________

b. Have you been criminally charged before any court?

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 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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details: ________________________________
phased 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 Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the
last 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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
MS.RIZALINA C. PALOS ANTIPOLO CITY 9957813668 3.5 cm. X 4.5 cm
(passport size)
MS. GLORIA MOZO ANTIPOLO CITY 9556990165 With full and handwritten
name tag and signature over
printed name
MS.RARIDA T. PANGILINAN ANTIPOLO CITY 9052790365
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I is not acceptable
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 administrative/criminal case/s
against me. PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of Issuance

Government Issued ID: PRC

ID/License/Passport No.: 0827088 Signature (Sign inside the box)

Date/Place of Issuance: 2/9/2014 TUGUEGARAO 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

 WORK EXPERIENCE SHEET

Instructions: 1. Include only the work experiences relevant to the position being applied to.

2. The duration should include start and finish dates, if known, month in abbreviated
form, if known, and year in full. For the current position, use the word Present, e.g.,
1998-Present. Work experience should be listed from most recent first.
Applying for Promotion for: Police Staff Sergeant
● Duration: July 19, 2019 to Present

● Position: Police Corporal/ Custodial Officer

● Name of Office/Unit: Antipolo City Police Station

● Immediate Supervisor: PCPT DOMINIC A BLAZA

● Name of Agency/Organization and Location: Antipolo City Police Station, Rizal

Police Provincial Office, Police Regional Office 4A
● List of Accomplishments and Contributions (if any):
Follow-up Commitment Order's and Case Status of PUPC's in Court

● Summary of Actual Duties:

(Signature over Printed Name

of Employee/Applicant)

Date: