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 PEDRO
NAME EXTENSION (JR., SR)
FIRST NAME CECELIO

MIDDLE NAME PARIÑAS

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/9/1984 ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH BAYUGAN, AGUSAN DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street
Widowed Separated
CAMANTILES
Other/s: Subdivision/Village Barangay
URDANETA CITY PANGASINAN
7. HEIGHT (m) 179
City/Municipality Province
8. WEIGHT (kg) 79 ZIP CODE 2428

18. PERMANENT ADDRESS

9. BLOOD TYPE "O"
House/Block/Lot No. Street
CAMANTILES
10. GSIS ID NO. N/A
Subdivision/Village Barangay
URDANETA CITY PANGASINAN
11. PAG-IBIG ID NO. 1211-7915-7965
City/Municipality Province

12. PHILHEALTH NO. 05-025162668-2 ZIP CODE 2428

13. SSS NO. 02-2261557-4 19. TELEPHONE NO. N/A

14. TIN NO. 312-205-001 20. MOBILE NO. 09263471236

15. AGENCY EMPLOYEE NO. 228929 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME PEDRO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) DION CEASAR G PEDRO
FIRST NAME REINA CHAMAE 10/26/2009

MIDDLE NAME GARCIA FRANCIS EARL G PEDRO 9/19/2015

OCCUPATION SELF EMPLOYED

EMPLOYER/BUSINESS NAME PEDRO'S CHICKEN PRODUCT

BUSINESS ADDRESS SAN VICENTE, URDANETA CITY AND SAN MANUEL, PANGASINAN

TELEPHONE NO. N/A

24. FATHER'S SURNAME PEDRO

NAME EXTENSION (JR., SR)
FIRST NAME CESAR

MIDDLE NAME VICMUDO

25. MOTHER'S MAIDEN NAME PARIÑAS

SURNAME PEDRO

FIRST NAME ERLINA

MIDDLE NAME CANSINO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BANNAWAG NORTE, ELEMENTARY SCHOOL PRIMARY 1992 1998 GRADUATED 1998 NONE
SECONDARY
VOCATIONAL / SANTIAGO CITY NATIONAL HIGH SCHOOL SECONDARY 1998 2002 GRADUATED 2002 NONE

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

TRADE
COURSE
COLLEGE SANTIAGO CITY COLLEGES (SCC) BACHELOR OF SCIENCE IN CRIMINOLOGY 2002 2007 GRADUATED 2007 NONE

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 02/01/20

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

R.A 6506 BOARD OF CRIMINOLOGY 75.00% 08/20-30, 2010 PRC TUGUEGARAO CITY 00533601 12/9/2020

(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)
PHILIPPINE NATIONAL POLICE, PRO1,
3/15/2019 TO DATE POLICE CORPORAL ₱30,867.00 12 PERMANENT YES
PANG PPO, URDANETA CPS
PHILIPPINE NATIONAL POLICE, PRO1,
1/1/2018 3/14/2019 POLICE OFFICER 1 ₱29,668.00 10 PERMANENT YES
PANG PPO, URDANETA CPS
11/23/2012 12/31/2017 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE, RTS 1 ₱14,834.00 10 PERMANENT YES

6/1/2012 11/22/2012 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE, RTS 1 ₱14,834.00 10 TEMPORARY YES

1/11/2011 5/31/2012 POLICE OFFICER 1 PHILIPPINE NATIONAL POLICE, RTS1 ₱13,492.00 10 TEMPORARY YES
 (Continue on separate sheet if necessary)

SIGNATURE DATE 02/01/2020

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
(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
RPSB 1 3rd Mnaeuver Coy, San Roque, San Manuel,
PNP STANDARD HANDGUN MARKMANSHIP TRAINING PHASE 1 & 2 9/17/2015 9/18/2015 24 HRS Technical
Pangasinan
RPSB 1 3rd Mnaeuver Coy, San Roque, San Manuel,
MODIFIED PNP SPECIAL COUNTER INSURGENCY OPERATION UNIT TRAINING (SCOUT) 6/17/2013 9/26/2013 440 Hrs Technical
Pangasinan

MARKMANSHIP TRAINING (PHASE 1 AND 2) 9/17/2013 9/18/2013 24.0 Technical REGIONAL PUBLIC SAFETY BATTALLION 1

FIVE (5) DAYS BASIC POLICE FUNCTION ORIENTATION SEMINAR 11/26/2012 11/30/2012 40.0 Technical PRO1

PUBLIC SAFETY FIELD TRAINING PROGRAM (PSFTP) 5/15/2012 11/3/2012 760 Hrs Technical RSTU 1/URDANETA CITY PS

PUBLIC SAFETY BASIC RECRUIT COURSE 11/1/2011 11/23/2012 1920 Hrs Technical RTC 1, ARINGAY, LA UNION

(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)

Driving MEDALYA NG KASANAYAN N/A

MEDALYA NG PAPURI
 TSAPA NG NATATANGING YUNIT

COMMENDATION

MEDALYA NG PAGLILINGKOD SA SANTO PAPA

MEDALYA NG PAGTULONG SA NASALANTA

(Continue on separate sheet if necessary)

SIGNATURE DATE 02/01/2020

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
PLTCOL VICENTE P CASTOR JR URDANETA CITY POLICE STATION 3.5 cm. X 4.5 cm
(passport size)

PMAJ APOLLO DL CALIMLIM URDANETA CITY POLICE STATION With full and handwritten
name tag and signature over
printed name
PLT ROBERTO J REYES URDANETA CITY POLICE STATION
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: PNP

ID/License/Passport No.: 19E270027

Signature (Sign inside the box)
02/01/2020
Date/Place of Issuance: 5/27/2019/CAMP CRAME QC
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

PMAJ APOLLO DL CALIMLIM

Person Administering Oath

CS FORM 212 (Revised 2017), Page 4 of 4