Ponsica Pds

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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 PONSICA
N/A
FIRST NAME EMERSON

MIDDLE NAME BERENGUEL


3. DATE OF BIRTH
(mm/dd/yyyy) 10/6/1992 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX MALE

17. RESIDENTIAL ADDRESS N/A N/A


6 CIVIL STATUS SINGLE
House/Block/Lot No. Street
BAROY BARANGAY ZONE 1
Subdivision/Village Barangay
SANTA CRUZ DAVAO DEL SUR
7. HEIGHT (m) 1.64m
City/Municipality Province
8. WEIGHT (kg) 68kg ZIP CODE 8001

18. PERMANENT ADDRESS N/A N/A


9. BLOOD TYPE B+
House/Block/Lot No. Street
BAROY BARANGAY ZONE 1
10. GSIS ID NO. N/A
Subdivision/Village Barangay
SANTA CRUZ DAVAO DEL SUR
11. PAG-IBIG ID NO. 1210-7565-9053
City/Municipality Province

12. PHILHEALTH NO. 1605-0448-2313 ZIP CODE 8001

13. SSS NO. 0932524489 19. TELEPHONE NO. N/A

14. TIN NO. 429-878-177 20. MOBILE NO. 09464790650

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) emersonponsica@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)

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME PONSICA 5/24/1966

FIRST NAME ERMELITO

MIDDLE NAME ALCOVER

25. MOTHER'S MAIDEN NAME CORAZON B. BERENGUEL 4/20/1968

SURNAME BERENGUEL

FIRST NAME CORAZON

MIDDLE NAME BORINAGA (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
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY ALASKA ELEMENTARY SCHOOL ELEMENTARY 2000 2005 GRADUATED 2005 WITH HONORS

WITH
SECONDARY /
VOCATIONAL SANTA CRUZ NATIONAL HIGH SCHOOL HIGH SCHOOL 2007 2010 GRADUATED 2010
HONORS

N/A

TRADE
COURSE
COLLEGE UNIVERSITY OF MINDANAO DIGOS COLLEGE BACHELOR OF SCIENCE IN CRIMINOLOGY 2015 2010 GRADUATED 2018 CUM LAUDE

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/14/2022

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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

REGISTERED CRIMINOLOGIST 86.8 JUNE 2019 UNIVERSITY OF MINDANAO MATINA 0190283 2025

CUM LAUDE (PD 907)

(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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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)
CONTRACT OF
2020 2021 SITE COORDINATOR GENESISI88 CONSTRUCTION INC. N
SERVICE
CONTRACT OF
2019 2020 CRIMINOLOGY LECTURER SAINT LOIUS REVIEW CENTER N
SERVICE
CONTRACT OF
2013 2014 QUALITY ASSURANCE OFFICER FRANKLIN BAKER COMPANY N
SERVICE
CONTRACT OF
2011 2012 PROMODISER CAMEL APPLIANCES INC N
SERVICE
CONTRACT OF
2010 2011 UTILITY PERSONNEL DAVAO CENTRAL WAREHOUSE CLUB N
SERVICE

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/14/2022

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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

COSH AND BOSH 2020 2020 1 week SUPERVISOR TRAINOVATE

SEMINAR ON CRIMINALISTICS 2018 2018 16 hours EDUCATIONA PNP CRIME LABORATORY

UM AND PUBLIC SAFETY AGENCY PARTNERSHIP 2018 2018 4.0 hours EDUCATIONA RESEARCH AND PUBLICATION UM DAVAO
DEPARTMENT OF CRIMINAL JUSTICE
THE BASICS OF RESEARCH 2017 2017 8.0 hours EDUCATIONA EDUCATION

2018 2018 16 hours EDUCATIONAL


FIRE AND ARSON INVESTIGATION BUREAU OF FIRE PROTECTION

(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)
MUSICAL DIRECTOR AT SAINT JOSEPH THE
SINGING AND PLAYING PIANO CHAMPION OF TAWAG NG TANGHALAN UM INTER BRANCH COMPETITION
WORKER PARISH

(Continue on separate sheet if necessary)

SIGNATURE
1stAttritionCY2022_2022_941AMU DATE 10/14/2022
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, NO
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? 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 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,
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? ________________________________
RESIGNATION
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last 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? 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: NO
a. Are you a member of any indigenous group?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
ENGR. HAZEL A. CUIZON SANTA CRUZ DAVAO DEL SUR 9778017297 3.5 cm. X 4.5 cm
(passport size)

PAUL R. OLVIS DIGOS CITY DAVAO DEL SUR 9154139333 With full and handwritten
name tag and signature over
printed name
REV. FATHER JERIC C. BARIQUIT MATANAO DAVAO DEL SUR 9456775099
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: PRC

ID/License/Passport No.: 0190283


Signature (Sign inside the box)
10/14/2022
Date/Place of Issuance: 8/21/2019
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

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