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 ABEJO
NAME EXTENSION (JR., SR) N/A
FIRST NAME JEPOLD
MIDDLE NAME GOMEZ
3. DATE OF BIRTH
(mm/dd/yyyy) MARCH 02,1987 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH ANTIPULUAN NARRA PALAWAN If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS PUROK MASIPAG

Widowed Separated House/Block/Lot No. Street
ANTIPULUAN
Other/s: Subdivision/Village Barangay
NARRA PALAWAN
7. HEIGHT (m) 1.55 City/Municipality Province
8. WEIGHT (kg) 57 KILOS ZIP CODE 5303

18. PERMANENT ADDRESS PUROK MASIPAG

9. BLOOD TYPE +B
House/Block/Lot No. Street
ANTIPULUAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
NARRA PALAWAN
11. PAG-IBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 09-201561150-4 ZIP CODE 5303
13. SSS NO. 042146699-3 19. TELEPHONE NO.

14. TIN NO. 397-271-824-000 20. MOBILE NO. 09380388612

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) Jepoldgabejo@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ABEJO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) BON JEFFREY CARL G. ABEJO
FIRST NAME JHAY-FE 10/23/2017
MIDDLE NAME NANGIT JULIETT ADELE G. ABEJO 06/26/2021
NOTHING TO FOLLOWS
OCCUPATION SECURITY GUARD
EMPLOYER/BUSINESS NAME COOPERATIVE BANK OF PALAWAN
BUSINESS ADDRESS NARRA PALAWAN
TELEPHONE NO. N/A
24. FATHER'S SURNAME GOMEZ
NAME EXTENSION (JR., SR) JR.
FIRST NAME BONIFACIO
MIDDLE NAME ALABI
25. MOTHER'S MAIDEN NAME

SURNAME SABLA-ON
FIRST NAME JULIETA
MIDDLE NAME ESTREBOR (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND HIGHEST

NAME OF SCHOOL LEVEL/ SCHOLARSHIP
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS / ACADEMIC
LEVEL (Write in EARNED
GRADUATED
(Write in full) HONORS
full) From To (if not RECEIVED
graduated)
ELEMENTARY ANTIPULUAN ELEMENTARY SCHOOL ELEMENTARY GRADUATED 1995 2000 2000 N/A
VOCATIONAL /
SECONDARY NARRA NATIONAL HIGH SCHOOL SECONDAY GRADUATED 2001 2004 2004 N/A
NATIONAL CERTIFICATE I AND II (FOOD PROCESSING AND
TESDA CARPENTRY) 2022 2022 2022 N/A
WESTERN PHILIPPINES UNIVERSITY/REMNANT CHRISTIAN BS IN AGRICULTURE MAJOR IN ECONOMICS/CERTIFICATE OF
COLLEGE TRADE COLLEGE-PALAWAN TEACHER'S PROGRAM 2004 2009 2009 N/A
COURSE
GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 17,2023 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

N/A 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
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
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To
(Y/ N)

(Continue on separate sheet if necessary)

SIGNATURE DATE 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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

(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
(Write in full)
in full)

(Continue on separate sheet if necessary)

SIGNATURE DATE
 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 NO
YES
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
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 administrative/criminal case/s PHOTO
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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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