CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 BUENAFRANCISCA
NAME EXTENSION (JR., SR)
FIRST NAME ZAIRRA MAE N/A

MIDDLE NAME ATENTAR

3. DATE OF BIRTH
(mm/dd/yyyy) 08/13/2000 16. CITIZENSHIP

4. PLACE OF BIRTH QUEZON If holder of dual citizenship, Pls. indicate country:

please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS BLK 1 LOT3 PHASEK1

6 CIVIL STATUS
House/Block/Lot No. Street
FRANCISCO HOMES YAKAL
Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
7. HEIGHT (m) 1.524
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 3023

9. BLOOD TYPE N/A 18. PERMANENT ADDRESS BLK 1 LOT3 PHASE K1

House/Block/Lot No. Street
FRANCISCO HOMES YAKAL
10. GSIS ID NO. N/A
Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 3023

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 0919 348 1997

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
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)

NAME EXTENSION (JR., SR)

FIRST NAME N/A N/A N/A N/A

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME BUENAFRANCISCA N/A N/A

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

MIDDLE NAME LAZADO N/A N/A

25. MOTHER'S MAIDEN NAME RUTAQUIO N/A N/A

SURNAME ABANICA N/A N/A

FIRST NAME BABY JEAN N/A N/A

MIDDLE NAME ATENTAR (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
ELEMENTARY BUSDAK ELEMENTARY SCHOOL ELEMENTARY 06/01/2006 03/31/2012 Graduate 2011 W/ HONOR

SECONDARY
VOCATIONAL / BUSDAK NATIONAL HIGH SCHOOL HIGH SCHOOL 06/01/2012 03/31/2016 Graduate 2016 W/ HONOR

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

TRADE
BACHELOR OF SCIENCE IN BUSINESS CYSDO &
COURSE
COLLEGE LA CONCEPCION COLLEGE ADMINISTRATION MAJOR IN MARKETING 06/01/2018 08/27/2022 N/A 08/27/2022 BARANGAY
MANAGEMENT SCHOLAR
BACHELOR OF SCIENCE IN BUSINESS CYSDO &
GRADUATE STUDIES LA CONCEPCION COLLEGE ADMINISTRATION MAJOR IN MARKETING 06/01/2018 08/27/2022 Graduate 08/27/2022 BARANGAY
MANAGEMENT SCHOLAR
(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 DATE OF
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

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

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

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

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

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

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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)
ON THE JOB
09/11/2017 10/06/2017 ENCODER DEPARTMENT OF AGRARIAN REFORM N/A N/A N/A
TRAINING

ON THE JOB
10/182021 1/10/2022 ENCODER,EDITOR. GIFT CAFÉ N/A N/A N/A
TRAINING

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

N/A 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 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

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

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

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

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/
NUMBER OF HOURS CONDUCTED/ SPONSORED BY (Write in full)
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To
HR MASTERCLASS WEBINAR SERIES 4:Preparing the Future Talents for the Corporate World
5/21/2022. 5/21/2022 4 hour's FOUNDATIONAL La Concepcion College
of Work

Voter's Education Program 3/10/2022 3/10/2022 5 hour's FOUNDATIONAL Barangay Francisco Homes Yakal,CSJDM,Bulacan

Skills Needed in Seeking a Job,Boosting your Confidence 12/19/2021 12/19/2021 8 Hour's FOUNDATIONAL La Concepcion College

Convention Center,Barangay Sapang Palay Proper,City of San Jose del

Life After College:Boost your Employability and Carrer Pathing Seminar 3/12/2022 3/12/2022 5 hour's FOUNDATIONAL
Monte,Bulacan

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION

31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

COMPUTER LITERATE N/A N/A

VERBAL AND WRITTEN COMMUNICATION SKILLS N/A N/A

READING N/A N/A

DANCING N/A N/A

PERSERVANCE AND MOTIVATION N/A N/A

TIME MANAGAMENT 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?
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 phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
Resignation from a private company
________________________________
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
LA CONCEPCION COLLEGE, INC. the last 6 months
MR. CHRISTOPHER DC. CORREA INSTRUCTOR / BSBA OIC
9218416952 3.5 cm. X 4.5 cm
(passport size)
LA CONCEPCION COLLEGE, INC. BSBA
MR. JAYSON CLARK PANGILINAN SOCIETY PRESIDENT
9760731109 With full and handwritten
name tag and signature over
printed name
MS. HANNAH R. ESPAÑOL DENR CENTRAL OFFICE, Q.C 9659318530
Computer generated
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 administrative/criminal case/s against me.
or photocopied picture
is not acceptable

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: Barangay ID

ID/License/Passport No.: 22-06135

Signature (Sign inside the box)

JUNE 8,2022/BARANGAY FRANCISCO

Date/Place of Issuance:
HOMES YAKAL 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