Vous êtes sur la page 1sur 11

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 ABBAS
NAME EXTENSION (JR., SR)
FIRST NAME BINASSER

MIDDLE NAME GURO


3. DATE OF BIRTH
(mm/dd/yyyy) 9/27/1996 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MALABANG, LANAO 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 No. 3 Pitunia Street
Widowed Separated House/Block/Lot No. Street
RIVERA VILLAGE BARANGAY RIVERA
Other/s:
Subdivision/Village Barangay
PASAY CITY MANILA
7. HEIGHT (m) 5.6 m
City/Municipality Province
8. WEIGHT (kg) 76kg ZIP CODE 1630

18. PERMANENT ADDRESS BLOCK 5/LOT18 LIBRA ST.


9. BLOOD TYPE "O"
House/Block/Lot No. Street
TINAGO BEL-AIR SUBDIVISION BARANGAY BURU-UN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
ILIGAN CITY LANAO DEL NORTE
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9200

13. SSS NO. N/A 19. TELEPHONE NO. 221 - 0435

14. TIN NO. N/A 20. MOBILE NO. 09169802286

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) binasser.abbas@gmail.com
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) N/A
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. 2210435

24. FATHER'S SURNAME ABBAS


NAME EXTENSION (JR., SR)
FIRST NAME BASHER

MIDDLE NAME MACATANONG

25. MOTHER'S MAIDEN NAME GURO

SURNAME ABBAS

FIRST NAME NOBAISAH

MIDDLE NAME INDAR (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

JOSE ABAD SANTOS CENTRAL ELEMENTARY


ELEMENTARY
SCHOOL
GRADE 1-6 6/9/2003 4/1/2009 N/A 2009 N/A

SECONDARY /
VOCATIONAL St. Therese Academy HIGHSCHOOL 6/8/2009 3/25/2013 N/A 2013 N/A

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


TRADE
BACHELOR OF SCIENCE IN CUSTOMS
COURSE
COLLEGE LYCEUM OF ILIGAN FOUNDATION
ADMINISTRATION
6/10/2013 3/28/2017 N/A 2017 N/A

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE April 8, 2018

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

LICENSURE CUSTOMS BROKERAGE


75.9 11/22-23/17 MANILA 9656
EXAMINATION

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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

BARANGAY PEACEKEEPING ACTION


12/10/2017 1/17/2019 LOCAL GOVERNMENT UNIT N/A N/A N/A
TEAM
(Continue on separate sheet if necessary)

SIGNATURE DATE APRIL 8, 2019


CS FORM 212 (Revised 20
LICENSE (if applicable)

Date of
Validity

12/20/2017

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES
arate sheet if necessary)

CS FORM 212 (Revised 2017), Page 2 of 4


INCLUSIVE
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT DATES
/ PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION
29. NUMBER
(Write in full) POSITION / N
OF HOURS
From
(mm/dd/yyyy)To
SAGIP MARAWI AND BANGON MARAWI 5/24/2017 PRESENT VO

(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 Divisio
positions) INCLUSIVE DATES OF
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING NUMBER OF ( Managerial/ CONDUCT
PROGRAMS (Write in full) HOURS Supervisory/
(mm/dd/yyyy) Technical/etc)
From To
LYCEUM O
SEMINAR ON ABC OF CMTA AND ITS IRR 3/21/2017 8.0 TECHNICAL
TECHNICAL AND
SEMINAR-WORKSHOP ON CUSTOMS MODERNIZATION AND TARIFF ACT (CMTA) AND CODE OF ETHICS MANAGERIAL
LYCEUM O
FOR CUSTOMS BROKERS: “ITS IMPLICATION TO THE FUTURE OF THE CUSTOMS BROKERAGE 2/25/2017 8.0 ( Managerial/
INDUSTRY". Supervisory/
SEMINAR-WORKHOP ON EFFECTIVE COMMUNICATION AND PUBLIC Technical/etc)
3/8/2015 8.0 TECHNICAL
SPEAKING OF JCI-KULINTANG WITH THE THEME: "A SOUNDING LEGACY" TECHNICAL AND
ADVOCACY FOR YOUTH ON THE BANGSAMORO WITH THE THEME: MANAGERIAL
LYCEUM O
TOWARDS UNDERSTANDING THE BANGSAMORO; A PERSPECTIVE FROM 3/4/2015 8.0 ( Managerial/
THE YOUTH". Supervisory/
SEMINAR -WORKSHOP ON PROMOTING DIGITAL LITERACY THROUGH Technical LYCEUM O
10/23/2014 8.0 TECHNICAL
LANGUAGE AND ARTS
SEMINAR-WORKSHOP ON BASICS OF RESEACH: ORGANIZING LYCEUM O
8/22/2014 8.0 TECHNICAL
RESEARCH PROPOSAL & CONSTRUCTING RESEARCH INSTRUMENT
BUREAU O
CUSTOMS NAIA BORDER PROTECTION SEMINAR 2/19/2019 8.0 TECHNICAL
DRUG

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

MEMBE
PLAYING BASKETBALL
MEM
PLAYING CHESS
JOGGING EARLY IN THE MORNING

ENCODING

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

VOLUNTARY

parate sheet if necessary)


ROGRAMS ATTENDED
nt L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial

CONDUCTED/ SPONSORED BY
(Write in full)

LYCEUM OF ILIGAN FOUNDATION, ILIGAN


CITY
LYCEUM OF ILIGAN FOUNDATION, ILIGAN
CITY
JCI KULINTANG
LYCEUM OF ILIGAN FOUNDATION, ILIGAN
CITY
LYCEUM OF ILIGAN FOUNDATION, ILIGAN
CITY
LYCEUM OF ILIGAN FOUNDATION, ILIGAN
CITY
BUREAU OF CUSTOMS AND PHILIPPINE
DRUG ENFORCEMENT AGENCY

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
MEMBER, CHAMBER OF CUSTOMS
BROKER INC.
MEMBER, MORIATAO DIWAN
CLAN,BAYANG, LDS
eparate sheet if necessary)

APRIL 8, 2019
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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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: Maranaw
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
ROCAINA M. BASAR RTC BRANCH 12, MALABANG, LDS 9204170895 3.5 cm. X 4.5 cm
(passport size)
PRINCIPAL, MUSLIM VILLAGE ES,
HEDJARA S. MACAPINTO WAO, LDS
9196304201 With full and handwritten
name tag and signature over
PRINCIPAL, CALIMODAN VILLAGE, printed name
LALOY M. ALAMADA MALABANG, LDS
9076404281
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: PRC

ID/License/Passport No.: 9656


Signature (Sign inside the box)

Date/Place of Issuance: DECEMBER 20, 2017


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


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