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 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 VENTURA
NAME EXTENSION (J
FIRST NAME MARGIE

MIDDLE NAME OMALZA

3. DATE OF BIRTH
(mm/dd/yyyy) 5/13/1980 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth b
4. PLACE OF BIRTH COTABATO CITY If holder of dual citizenship, Pls. indicate co
please indicate the details.
5. SEX Female
Male ✘

6 CIVIL STATUS Single ✘ Married

17. RESIDENTIAL ADDRESS N/A
House/Block/Lot No. S
Widowed Separated
PUROK NANGKA MA
Other/s: Subdivision/Village Ba
7. HEIGHT (m) 1.58m PARANG MAGU
City/Municipality Pr
8. WEIGHT (kg) 68kgs ZIP CODE 9604

9. BLOOD TYPE "O"

18. PERMANENT ADDRESS N/A
House/Block/Lot No. S
10. GSIS ID NO. NONE PUROK NANGKA MA
Subdivision/Village Bar
11. PAG-IBIG ID NO. 1211-1276-3497 PARANG MAGU
City/Municipality Pro
12. PHILHEALTH NO. 200000152187 ZIP CODE 9604

13. SSS NO. NONE 19. TELEPHONE NO. NONE

14. TIN NO. 446-017-671 20. MOBILE NO. 0908-890-4120

15. AGENCY EMPLOYEE NO. V11011 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME VENTURA 23. NAME of CHILDREN (Write full name and list all)

FIRST NAME MAXIMINO VICENTE

NAME EXTENSION (JR., SR.) N/A MUJAHID VINCENT O. VENTURA

MIDDLE NAME PANGANIBAN ALJAMIN KARIM O. VENTURA

OCCUPATION FIREFIGHTER (Ret) ABDIER BEN O. VENTURA

EMPLOYER/BUSINESS NAME BFP-ARMM

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

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

FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME KATADA

FIRST NAME MARIA

MIDDLE NAME OMALZA (Continue on separate sheet if necessar

III. EDUCATIONAL BACKGROUND

HIGHEST
26. NAME OF SCHOOL PERIOD OF ATTENDANCE LEVEL/
BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in UNITS
(Write in full) EARNED
full)
From To (if not graduated)
 ELEMENTARY SPENCERS FOUNDATION SCHOOL INC. PRIMARY EDUCATION 1987 1993 GRADUATED

SECONDARY
VOCATIONAL / SPENCERS FOUNDATION SCHOOL INC. HIGH SCHOOL 1993 1997 GRADUATED

NONE NONE NONE NONE NONE

TRADE
BACHELOR OF ELEMENTARY
COURSE
COLLEGE HOLY CROSS OF DAVAO COLLEGE 1997 2001 GRADUATED
EDUCATION
GRADUATE STUDIES NONE NONE NONE NONE NONE
(Continue on separate sheet if necessary)
SIGNATURE DATE Septemb
BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FORM
L DATA SHEET
perience Sheet shall cause the filing of administrative/criminal case/s against the person

BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

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

Dual Citizenship
✘ by birth by naturalization
Pls. indicate country:

N/A
Street
MAKING
Barangay
MAGUINDANAO
Province
9604
N/A
Street
MAKING
Barangay
MAGUINDANAO
Province

NONE

0908-890-4120

DATE OF BIRTH (mm/dd/yyyy)

5/13/2006

4/29/2008

6/25/2015

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
 1993 DIPLOMA

1997 DIPLOMA

NONE NONE

2001 DIPLOMA

NONE NONE
eparate sheet if necessary)
September 20, 2019
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

RA 1080 - LICENSURE EXAMINATION FOR

TEACHERS
77.6 8/14/2001 DAVAO CITY

(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
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

7/15/2019 PRESENT FIRE OFFICER III TACURONG TRAINING CAMP Ᵽ 32,114 14-1
BUREAU OF FIRE PROTECTION - Ᵽ 32,114
1/1/2018 12/31/2018 FIRE OFFICER III 14-1
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 16,934
7/1/2017 12/31/2017 FIRE OFFICER II 14-1
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 16,934
1/1/2016 12/31/2016 FIRE OFFICER II 12-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 16,934
12/12/2015 12/31/2015 FIRE OFFICER II 12-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 16,934
8/22/2014 12/31/2014 FIRE OFFICER II 12-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 16,934
1/20/2014 8/21/2014 FIRE OFFICER II 12-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 14,834
1/1/2014 1/19/2014 FIRE OFFICER I 10-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 14,834
1/1/2013 12/31/2013 FIRE OFFICER I 10-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 14,834
8/23/2012 12/31/2012 FIRE OFFICER I 10-0
ARMM
BUREAU OF FIRE PROTECTION - Ᵽ 14,834
7/17/2012 8/22/2012 FIRE OFFICER I 10-0
ARMM
1/3/2012 7/16/2012 FIRE OFFICER I FIRE NATIONAL TRAINING INSTITUTE Ᵽ 14,834 10-0
BUREAU OF FIRE PROTECTION - Ᵽ 14,834
12/16/2011 1/2/2012 FO1 ON-THE-JOB-TRAINING 10-0
ARMM
 (Continue on separate sheet if necessary)

SIGNATURE DATE September 20, 2019

BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FORM 212 (Re
 LICENSE (if applicable)

NUMBER Date of
Validity

0719991 5/13/2020

ue on separate sheet if necessary)

n of duties should be indicated in the attached Work Experience sheet.

GOV'T
SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

PERMANENT Y

TEMPORARY Y

TEMPORARY Y
ue on separate sheet if necessary)

September 20, 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 / NATUR
From To

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

FIRE BASIC RECRUIT COURSE 1/13/2012 7/16/2012 960 HRS TECHNICAL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

NONE NONE

(Continue on separate sheet if necessary)

SIGNATURE DATE Sept

BFP-QSF-HRMD-018 Rev. ØØ (05.04.18)
NT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

separate sheet if necessary)

G PROGRAMS ATTENDED
e last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

FNTI

separate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)

NONE

separate sheet if necessary)

September 20, 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:
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 withi
the last 6 months
SUPT IBRAHIM P GUIAMALON FORT PIKIT, NORTH COTABATO 9462569398 3.5 cm. X 4.5 cm
(passport size)

SFO2 WAHAB M BALINDONG MALABANG, LANAO DEL SUR 9473386664 With full and handwrit
name tag and signature
printed name

Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pictur
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: BFP ID
ID/License/Passport No.: V11011 Signature (Sign inside the box)
September 20, 2019
Date/Place of Issuance: 7/11/2018 Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated abo
 Person Administering Oath
BFP-QSF-HRMD-018 Rev. ØØ (05.04.18) CS FORM 212 (Revised 201
 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________
✘ NO

✘ NO

✘ NO
If YES, give details (country):

✘ NO

✘ NO

✘ NO

ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

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