CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any mispresentation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s again
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 MAGOMNANG
NAME EXTENSION (JR., SR
FIRST NAME NABIL
MIDDLE NAME ROMATHO
3. DATE OF BIRTH
(mm/dd/yyyy) 2/23/1994 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth b

4. PLACE OF BIRTH MARAWI CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS N/A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Other/s: N/A DILA
Subdivision/Village Ba
7. HEIGHT (m) 5'9 TARAKA LANAO
City/Municipality Pr
8. WEIGHT (kg) 62 lbs ZIP CODE 9712
18. PERMANENT ADDRESS N/A
9. BLOOD TYPE "O+"
House/Block/Lot No. S

10. GSIS ID NO. N/A

N/A DILA
Subdivision/Village Ba
TARAKA
11. PAG-IBIG ID NO. N/A
City/Municipality Pr

12. PHILHEALTH NO. N/A ZIP CODE 9712

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

14. TIN NO. N/A 20. MOBILE NO. 09090463838 / 09382466542

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

MIDDLE NAME MANGATA ALLIYA NAJAH

__________
OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME MAGOMNANG

NAME EXTENSION (JR., SR)
FIRST NAME MONADATO

MIDDLE NAME PANGATAAN

25. MOTHER'S MAIDEN NAME IBRA

SURNAME MAGOMNANG

FIRST NAME BEDORI

MIDDLE NAME ROMATHO (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)
 BASIC EDUCATION/DEGREE/COURSE UNITS
LEVEL (Write in EARNED
(Write in full)
full) (if not graduated)
From To

ELEMENTARY TARAKA CENTRAL ELEMENTARY SCHOOL ELEMENTARY 6/6/2000 3/31/2006 GRADUATED

SECONDARY
VOCATIONAL / MSU TARAKA COMMUNITY HIGH SCHOOL HIGH SCHOOL 6/3/2006 3/2/2010 GRADUATED

PHILIPPINE ENGINEERING AND AGRO-

INDUCTRIAL COLEGGE, INC.
TRAINING FOR PC OPERATION N/A N/A 365 HOURS
TRADE
COURSE BACHELOR OF SECONDARY EDUCATION
COLLEGE MINDANAO ISLAMIC COMPUTER COLLEGE
MAJOR IN ENGLISH
6/16/2013 3/30/2017 GRADUATED

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

(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 3, 2019 CS FORM 212 (Re

L DATA SHEET
ience 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:

N/A
Street
DILABAYAN
Barangay
LANAO DEL SUR
Province
9712
N/A
Street
DILABAYAN
Barangay
LANAO DEL SUR
Province

N/A

09090463838 / 09382466542

nromatho@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

12/2/2017

11/19/2018

_________

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
 ACADEMIC
GRADUATED
HONORS
RECEIVED

2006 WITH HONOR

2010 WITH HONOR

N/A N/A

2017 DIPLOMA

N/A N/A

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 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

BARANGAY ELIGIBILITY 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
SERVICE
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 (Y/
N)
N/A N/A N/A N/A N/A N/A N/A N/A

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

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(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 3, 2019 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 / N
From To

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

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

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

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

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

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

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

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

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(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

COMPUTER LITERATE N/A

PROGRAM ORGANIZER N/A

SINGING N/A

DANCING N/A

WEBSITE DEVELOPER N/A

______________ N/A

N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JULY 3, 2019

PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

N/A

N/A

N/A

N/A

N/A

N/A
arate sheet if necessary)

OGRAMS ATTENDED
ive (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

N/A

arate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

N/A

N/A

N/A

N/A

N/A

N/A

N/A
arate 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 ✘ 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:
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
N/A N/A N/A 3.5 cm. X 4.5 cm
(passport size)

N/A N/A N/A With full and handwritten

name tag and signature over
printed name
N/A N/A N/A
Computer generated
42. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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: DRIVER'S LICENSE

ID/License/Passport No.: N03-17-030572

Signature (Sign inside the box)
JULY 3, 2019
Date/Place of Issuance: MANILA, PHILIPPINES
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