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 MABALHIN
NAME EXTENSION (JR., SR) N/A
FIRST NAME EDGAR
MIDDLE NAME BAGASBAS
3. DATE OF BIRTH
(mm/dd/yyyy) 11/27/1984 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH TUBOD, SURIGAO 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

Widowed Separated House/Block/Lot No. Street
PUROK 6 MARGA
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.57 TUBOD SURIGAO DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 8406
18. PERMANENT ADDRESS
9. BLOOD TYPE A+
House/Block/Lot No. Street

10. GSIS ID NO. N/A PUROK 6 MARGA

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121017904009 TUBOD SURIGAO DEL NORTE

City/Municipality Province

12. PHILHEALTH NO. 18-025139325-5 ZIP CODE 8406

13. SSS NO. 3380704340 19. TELEPHONE NO. N/A

14. TIN NO. 220-479-826-000 20. MOBILE NO. 09472602154

15. AGENCY EMPLOYEE NO. BN1-20-M193300 21. E-MAIL ADDRESS (if any) Kymrexmabalhin@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MABALHIN 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) GUIL DREDGE A. MABALHIN
FIRST NAME ARCELYN N/A 9/2/2009

MIDDLE NAME ALAC GUIL KYMREX A. MABALHIN 11/11/2013

OCCUPATION JAIL OFFICER GAIL ALTHEA A. MABALHIN 10/25/2017

EMPLOYER/BUSINESS NAME BUREAU OF JAIL MANAGEMENT AND PENOLOGY

BUSINESS ADDRESS SURIGAO CITY JAIL, BRGY. BONIFACIO, SURIGAO CITY

TELEPHONE NO. N/A

24. FATHER'S SURNAME MABALHIN (DECEASED)

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

MIDDLE NAME GUILES

25. MOTHER'S MAIDEN NAME

SURNAME BAGASBAS

FIRST NAME FELIXBERTA

MIDDLE NAME RUYERAS (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 GRADUATED
HONORS
(Write in full) EARNED
full) (if not graduated) RECEIVED
From To

CALANG - CUSTODIO ELEMENTARY FIRST

ELEMENTARY PRIMARY 1992 1998 GRADUATED 1998
SCHOOL HONORABLE

SECONDARY /
VOCATIONAL TUBOD NATIONAL HIGH SCHOOL HIGH SCHOOL 1998 2002 GRADUATED 2002 N/A

N/A N/A N./A N/A N/A N/A N/A

TRADE
SURIGAO STATE COLLEGE OF BACHELOR OF SECONDARY
COURSE
COLLEGE 2013 2017 GRADUATED 2017 N/A
TECHNOLOGY MAINIT CAMPUS EDUCATION

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

(Continue on separate sheet if necessary)

SIGNATURE DATE January 21, 2021

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

PROFESSIONAL TEACHER 82% 09/24/2017 CAGAYAN DE ORO CITY 1583375 11/27/2020

(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 GOV'T
SALARY/ JOB/ PAY SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
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)

BUREAU OF JAIL MANAGEMENT AND

07/01/2019 PRESENT JAIL OFFICER 1 29,668.15 10 PERMANENT Y
PENOLOGY
06/23/2005 1/3/2007 BODY SHOP OPERATIONAL STAFF FORD MOTOR COMPANY PHILIPPINES, INC. 14,000.00 N/A REGULAR N

(Continue on separate sheet if necessary)

SIGNATURE DATE January 21, 2021

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 / NATURE OF WORK
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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
NATIONAL JAIL MANAGEMENT AND PENOLOGY
JAIL BASIC RECRUIT COURSE 9/11/2019 03/24/2020 640.0 MANDATORY
TRAINING INSTITUTE

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE January 21, 2021

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? ________________________________
FORD MOTORS COMPANY - FINISHED CONTRACT
________________________________
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: MANUBO
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
J/SINSP JONATHAN N ARAWANGSA DIPOLOG CITY N/A 3.5 cm. X 4.5 cm
(passport size)

J/INSP MARICAR C GONZALES BUTUAN CITY N/A With full and handwritten
name tag and signature over
printed name
EMALINA L. EBOL Ph.D MAINIT, SURIGAO DEL NORTE N/A
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: BJMP ID

ID/License/Passport No.: BN1-20-M193300

Signature (Sign inside the box)
January 21, 2021
Date/Place of Issuance: APRIL 08, 2020
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 4