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 ag
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

I. PERSONAL INFORMATION
2. SURNAME ORENSE
NAME EXTENSION (JR., SR
FIRST NAME AURELIA ANDREA

MIDDLE NAME BRIZUELA

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) ✘

by birth by

4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate cou

please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS V. BO

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Other/s: SAN A
Subdivision/Village Ba
TABACO CITY A
7. HEIGHT (m) 1.5875 m.
City/Municipality Pr
8. WEIGHT (kg) 63 kgs. ZIP CODE 4511

18. PERMANENT ADDRESS PUROK 4 NUMBER 5 MOL

9. BLOOD TYPE "A"
House/Block/Lot No. S
LEGAZPI CITY A
10. GSIS ID NO. N/A
Subdivision/Village Ba

11. PAG-IBIG ID NO. 0501-39211-810

City/Municipality Pr

12. PHILHEALTH NO. 10-025016552-2 ZIP CODE 4500

13. SSS NO. 03-93307184 19. TELEPHONE NO.

14. TIN NO. 403-797-045-000 20. MOBILE NO. 0928-4131494 / 0926-7290202

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) aurelia_orense@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ORENSE

NAME EXTENSION (JR., SR)
FIRST NAME JAIME (deceased)
 MIDDLE NAME BOBIER

25. MOTHER'S MAIDEN NAME BORJAL

SURNAME ORENSE

FIRST NAME NILA (deceased)

MIDDLE NAME BRIZUELA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

DIVINE WORD COLLEGE - ELEMENTARY

ELEMENTARY
DEPARTMENT
PRIMARY GRADUATE 1974 1979 N/A

SECONDARY /
VOCATIONAL SAINT AGNES ACADEMY HIGH SCHOOL GRADUATE 1979 1983 N/A

NON-FORMAL LEARNING CENTER PROJECT

IMPACT
BASIC COMPUTER COURSE 1992 1993

TRADE
COURSE AGO MEDICAL AND EDUCATIONAL CENTER BACHELOR OF SCIENCE IN MEDICAL
COLLEGE
BICOL CHRISTIAN COLLEGE OF MEDICINE TECHNOLOGY 1983 1987 N/A

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

V. BONGANAY
Street
SAN ANTONIO
Barangay
ALBAY
Province
4511

MOLAVE ST.
Street
ALBAY
Barangay

Province

0928-4131494 / 0926-7290202

aurelia_orense@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1979

1983

EFFICIENCY
1987 AWARD

parate sheet if necessary)

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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.
SALARY/ JOB/
28.
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE (if
MONTHLY applicable)&
(Write in full/Do (Write in full/Do SALARY STEP (Format
not abbreviate) not abbreviate) "00-0")/
From To INCREMENT

PROVINCIAL GOVERNMENT OF ALBAY

1/3/2017 6/30/2017 REAL PROPERTY APPRAISAL AIDE P5,050
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2016 6/30/2016 REAL PROPERTY APPRAISAL AIDE P5,050
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/5/2015 12/31/2015 REAL PROPERTY APPRAISAL AIDE P5,050
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2013 12/31/2014 ADMINISTRATIVE AIDE P5,500
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2013 12/3/2013 LABORER P5,500
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2012 12/31/2012 LABORER P3,850
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2011 12/31/2011 LABORER P3,850
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/4/2010 12/31/2010 LABORER P3,850
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2009 12/31/2009 LABORER P3,300
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2008 12/31/2008 LABORER P3,000
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
7/2/2007 12/31/2007 LABORER P3,000
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/2007 8/30/2007 BOOK BINDER 1 P2,640
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
7/1/2006 12/31/2006 CLERK P2,640
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
2/1/2006 6/30/2006 BOOK BINDER 1 P2,640
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
3/6/1996 10/18/2003 CLERK RESEARCHER TYPIST P4,000
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
2/3/1992 2/29/1992 CLERK TYPIST P1,320
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
12/2/1992 12/31/1991 CLERK TYPIST P1,161
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/16/1991 2/23/1991 CLERK TYPIST P1,161
PROVINCIAL ASSESSOR'S OFFICE
 PROVINCIAL GOVERNMENT OF ALBAY
11/7/1990 12/31/1990 SKILLED LABORER P 561.22
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
8/1/1990 10/31/1990 SKILLED LABORER P 561.22
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
2/5/1990 4/30/1990 SKILLED LABORER P 561.22
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
9/1/1989 10/31/1989 SKILLED LABORER P 561.22
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/2/1989 8/31/1989 LABORATORY TECHNICIAN P500.00
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
1/3/1988 6/30/1988 STOCK CLERK P1,150
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
8/3/1987 12/31/1987 SALES REPRESENTATIVE COM. BASIS
PROVINCIAL ASSESSOR'S OFFICE
PROVINCIAL GOVERNMENT OF ALBAY
3/4/1985 5/31/1945 CLERK/SKILLED LABORER P 312.00
PROVINCIAL ASSESSOR'S OFFICE

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FOR
 LICENSE (if applicable)

NUMBER Date of
Validity

e on separate sheet if necessary)

duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF APPOINTMENT

(Y/
N)
JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

CASUAL YES

CASUAL YES

CASUAL YES
 CASUAL YES

CASUAL YES

CASUAL YES

CASUAL YES

TEMPORARY NO

TEMPORARY NO

CONTRACTUAL NO

SUMMER JOB YES

e on separate sheet if necessary)

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 /
From To

SOCIAL ACTION CENTER 1995 VOLUNTEER

PARISH PASTORIAL COUNCIL FOR RESPONSIBLE VOTING 1997 WATCHER

OPLANG TULONG-TYPHOON REMING 2006 VOLUNTEER

(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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

OJT (INTERNSHIP/AFFLIATION) VETERANS MEMORIAL MEDICAL CENTER 7/15/1985 7/15/1987 AMEC/BCCM

 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

*RESEARCH WORK* TYPING, 1. PRIZE WINNER (AS TRAINER) CHORAL COMPETITION AND HELD AT DIVINE WORD COLLEGE ON BROTHERHOO
BOOKBINDING, FILING & RECORDING FEBRUARY 1999

2. 2ND PRIZE WINNER (AS TRAINER) CHORAL COMPETITION AND HELD AT ALBAY ATRIUM ALBAY
AL
CAPITOL, LEGAZPI CITY ON DECEMBER 22, 2005

MARY'S HEA
SEGREGATING AND SORT-OUTING INT

FAIR KNOWLEDGE IN COMPUTER

BASIC ECCLE
PLAYING MUSICAL INSTRUMENTS CATH

DANCING & SINGING

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

VOLUNTEER

WATCHER

VOLUNTEER

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

AMEC/BCCM
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
BROTHERHOOD OF CHRISTIAN BUSINESSMEN
AND PROFESSIONALS

ALBAY CATHEDRAL PARISH CHOIR

MARY'S HEALING SANCTURY STO. DOMINGO (S.O.L.T)

INTEORATIVE HEALING MINISTERY

CURSILLO MOVEMENT

BASIC ECCLECIAL COMMUNITY (BEC) ALBAY

CATHEDRAL YOUTJ GROUP (TRASURER)

eparate sheet if necessary)

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
LILIBETH L. DE OCAMPO PROVINCIAL ASSESSOR'S OFFICE 9396029779 3.5 cm. X 4.5 cm
(passport size)

ROSARIO MARIA J. GONZALES PROVINCIAL ASSESSOR'S OFFICE 9196456137 With full and handwritten
name tag and signature over
printed name
MAYFLOR ATOS DEANG. ICO PROVINCIAL ASSESSOR'S OFFICE 742-6248
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: 03-93802384 (SSS)

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

Date/Place of Issuance: LEGAZPI 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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

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