Académique Documents
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@fipartment o (Gtr
aratton
Region VII, Central Visayas
DIVISION OF BOHOL
City of Tagbilaran
DIVISION MEMORANDUM
No. 177 , s. 2017
1. Pursuant to CSC Resolution # 1700656 dated March 21, 2017 directed all
government employees to submit their updated Personal Data Sheet (PDS) to the Civil
Service Commission using the revised 2017 form not later than April 30, 2017.
2. In this regard, all permanent Teaching, Teaching Related and Non-Teaching personnel
including Non-Teaching with Co-terminous to the Incumbent (CTI) Status are hereby
directed to submit the above-mentioned document under oath in 2 hard copies and
electronic copy with transmittal by district not later than April 21, 2017 to the
Administrative Unit. Attached is the Revised 2017 PDS Form 212 and guide to f
ill-up
the form. ^
3. School heads are tasked in the gathering of the above-mentioned documents by school
and responsible for submission to the district supervisor/bookkeeper. Such documents
should reach the Division Ofice on or before April 21, 2017.
f
3. You are all invited to download the PDS template and guide from the websites of
("www.depedbohol.org) and (www.csc.gov.ph').
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.
Please fill out each of the fields in the PDS when applicable.
Note:
@ The PDS may be accomplished using the MS Word format or MS Excel
format.
@ In the MS Excel format, all the tick boxes will automatically be marked once
clicked.
@ The PDS must bear the signature of the employee and date of
accomplishment at the bottom of every page.
@ For purposes of application to a vacant position, the additional sheet for work
experience should be accomplished. -i
I. Personal Information
Page lof 4
II. Family Background
@ Names of spouse and parents are to be filled out the following format:
surname, first name, name extension (if any), middle name.
@ Mother's name is her maiden name, or name when she was single or
before marriage.
@ List full names (first name and surname) of ALL your children.
@ Date of birth is in numeric format: mm/dd/yyyy
Example:
V. Work Experience
@ Indicate all positions held both in the public and private employment
starting from current work.
Page 2 of 4
@ Inclusive dates are indicated in numeric format: mm/dd/yyyy.
@ Indicate FULL position titles and COMPLETE NAME of
department/agency/office/company. DO NOT ABBREVIATE.
@ Indicate monthly salary in figures (e.g. P21,877).
@ Salary grade and salary step, if applicable, should be stated in the
format "00-0" (e.g. 24-2, 24 for salary grade, 2 for salary step)
@ Indicate status of employment (e.g. permanent, temporary, casual,
contractual)
@ Indicate "yes" under government service if position held is in the public
or government employment or "no" if held in the private employment.
@ Additional sheet for work experience should be accomplished and
submitted together with the PDS in case of application to a vacant
position. This should be accomplished only for work experience
relevant to the position being applied to.
Page 3 of 4
# 34-40
#41
Indicate the FULL name of references with the format FIRST NAME, Ml,
SURNAME, their addresses and respective telephone numbers.
#42
As agreement to and for completion of the PDS, the employee's signature and
right thumb mark should be affixed in the boxes provided. Indicate also the
government ID number and date of issuance in the boxes provided. Lastly,
attach a RECENT PASSPORT SIZE (4.5 cm. x 3.5 cm.) picture with
COMPLETE AND HANDWRITTEN NAME TAG and SIGNATURE OVER
PRINTED NAME. Picture must be taken within the last six (6) months.
Computer generated or photocopied picture is not acceptable.
Page 4 of 4
CS Form NJ. 212
MIDDLENAME
3. DATEOFBIRIH ? Filipino ? Dual Citizenship
(mm/dd/my)
?by birth ?by natur
alization
IfhoWerof dualcitizenship, Pis. indicate country:
4. PLACEOFBIRTH
? Female pleaseIndicatethedetails.
? Male
?Single ?Married 17. RESIDENTIALADDRESS
?Widowed ?Separated TousaBoSMMo.
?Other/s: SlMvEhnNiltags
7. HEIGHT (to)
8. WEIGHT (kg)
1B. PERMANENTADDRESS
MSSBSMotKg.'
19.TELEPHONENO.
IMflKilLVSZMmSMiim
|23. NAMEofCHILDREN (Writefullname and listail) DATE OF BIRTH (mmMii/yyyy)
,22. SPOUSE'S SURNAME
NAMEEXTENSION(JR.,SR)
FIRSTNAME
MIDDLENAME
OCCUPATION
EMPLOYER/BUSINESSNAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME
|tJAUEEXTENSION[JR..SRJ
FIRSTNAME
MIDDLENAME
25. MOTHERS MAIDENNAME
SURNAME
FIRSTNAME
MIDDLENAME (Continue onseparat
esheetifnecessary)
iMi'tilbf&iWlMf&Rf
laBHaL
f
SCHOLARSHIP/
BASICEDUCATION/DEGREE/COURSE PERIODOFATTENDANCE HIGHESTLEVEL/ YEAR ACADEWC
26. NAMEOFSCHOOL UNITSEARNED GRADUATED
LEVEL (WriteInMl) (WriteInfull) HONORS
(itnotgraduated) RECEIVED
From To
ELEMENfARf
SECONDARY
VOCATIONAL/
TRADECOURSE
COLLEGE
GRADUATESTUDIES
(Continueonsepar
atesheetHnecessary)
SIGNATURE DATE
CSFORM2)2(Revised20U).Page 1of4
tiV. CIVILSERVICEELIGIBILITY @ @ ' - @ @@ @ @ @ - . ' , " 1
27. CAREERSERVICE/RA1080(BOARD/BAR)UNDER DATEOF LICENSE(ifappltable).'
@ @'.. SPECIALLAWS/CES/CSEE RATING
EXAMINATION/ PLAGEOFEXAMINATION/CONFERMENT
'- BARANGAYELIGIBILITY/DRIVER'SLICENSE (IfApplicable) number' Daf aof:
CONFERMENT Validity
(Continueonseparatesheetifnecessary)
IV. WORKEXPERIENCE -
Vinciudearhisteemolument Startfromvourrecentwork)Descr
iotionofdutiesshouldbeindicatedIntheattachedWortExoerlencesheet. 1
(ContinueonseparatesneetHnecessary!
SIGNATURE DATE
CSFORM212(Raised2017). Page2of4
2g NAMESADDRESSOFORGANIZATION INCLUSIVEDATES
(mm/dd/yyyy) NUMBEROFHOURS POSITION/NATUREOPWORK
(Writeinfull)
Ftom- To
INCLUSIVEDATESOF
ATTENDANCE CONDUCTED/SPONSOREDBY
3.0. TITLEOFLEARNINGANDDEVELOPMENTINTE WENTIONS/TRAININGPROGRAMS NUMBEROFHOURS (Writeinfull)
(Writeinfull) lmmMdf
ow)
Techntoal/elc)
Fr
om To
[ContinueonseparatesheetIfnecessary}
\ I. OTHERINFORMATION |
NON-ACADEMICDISTlNCTIOHSr
aECOGNITION MEMBERSHIPINASSOCIATION/ORGANIZATION
31- SPECIALSKILLSandHOBBIES "@ (WriteinM) 33' (WrilEfinfull)
(Continueonsepar
atesheetifnecessary)
DATE
SIGNATURE
If YES, give details:
3* Are you related byconsanguinity or affinity to the appointing or recommending authority, or-to the
chiefofbureau oroffice ortothe person who has immediate supervision overyou inthe Office,
Bureau or Department where you will be apppointed,
: a. within the third degree? '. - . . @ ? YES ? NO
b. within the fourfh:degree(for Local Government Unit- Career Employees)? ? YES ? NO
If YES, give details:
35. a. Have you everbeen found guilty of any administrative offense? ? YES ? NO
IfYES, give details:
Status of Case/s:
35. Have you e.'erbeen convicted of any crime or violation of any law, decree, ordinance or regulation ? YES ? NO
byanycour
tortribunal? IfYES, give details:
37. Haveyou ever been separated from the service in any ofthe following modes: resignation, ? YES ? NO
retirement, dropped from therolls, dismissal,termination, end ofterm, finished contract or phased [f YES, give details:
out (abolition) in ttie 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 D NO
Barangay election)? @
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 orlocal candidate?
39; Have you acquired the status of-an immigrant or permanent resident ot another country? ? YES ? NO
If YES, give details {country):
40- Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta tor Disabled Persons (KA
7277);:and'(c) Solo Parent?Welfare-Actof2000 (RA 8972), please answerthe following items:
a- Are you a member of any indigenous group? ? YES ? NO
If YES, please specify:
*>@ Are you a person with disability? ? YES ? NO
IfYES, please specify ID No:
SUBSCRIBED AND SWORN to before me this j affiant exhibiting his/her validly issued government ID as indicated above.