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

MIDDLE NAME MINDALANO

3. DATE OF BIRTH
(mm/dd/yyyy) 1/10/1992 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH PAGAYONAN, MADAMBA, LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
✘ Male
17. RESIDENTIAL ADDRESS N/A N/A
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separated
BO. POBLACON MARAWI SARIMANOK
Other/s: Subdivision/Village Barangay
MARAWI CITY LANAO DEL SUR
7. HEIGHT (m) 1.767m
City/Municipality Province
8. WEIGHT (kg) 179Kg ZIP CODE 9700

18. PERMANENT ADDRESS N/A Ali St.

9. BLOOD TYPE 0
House/Block/Lot No. Street
BRGY. PAGAYONAN UUYAAN
10. GSIS ID NO. CRN:021-3146-2445-6
Subdivision/Village Barangay
MADAMBA LANAO DEL SUR
11. PAG-IBIG ID NO. 121218905216
City/Municipality Province

12. PHILHEALTH NO. 15-025502924-1 ZIP CODE 9340

19. TELEPHONE NO.

13. SSS NO. 08-2821563-7 N/A N/A

14. TIN NO. 710-723-097 20. MOBILE NO. +63 927 630 0414/ +63 499 9762 423
15. AGENCY EMPLOYEE NO. 10-1710267 21. E-MAIL ADDRESS (if any) alihasanie850@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 N/A

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME ALI

NAME EXTENSION (JR., SR) N/A
FIRST NAME ROMEO
MIDDLE NAME ABDULLAH
25. MOTHER'S MAIDEN NAME AMOL
SURNAME MINDALANO
FIRST NAME NORHAYA
MIDDLE NAME AMOL (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE
UNITS
YEAR
ACADEMIC
LEVEL (Write in full) (Write in full) GRADUATED HONORS
EARNED
(if not graduated) RECEIVED
From To

AMAI PAK-PAK CENTRAL ELEMENTARY SCHOOL JUNE 26, MARCH 26,

ELEMENTARY (APCES_ N/A 2000 2005 GRADUATED 2005 N/A

JUNE 6, MARCH 19,

SECONDARY
VOCATIONAL /
DANSALAN COLLEGE OUNDATION INC. N/A 2005 2009 GRADUATED 2009 N/A

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

TRADE
COURSE JUNE 25, MARCH 24,
COLLEGE MINDANAO STATE UNIVERSITY (MAIN CAMPUS) A B PSYCHOLOGY 2009 2012 56 units N/A N/A
OCTOBER MARCH 29,
COLLEGE LOURDES COLLEGE BACHELOR OF SCIENCE IN SOCIAL WORK 15, 2012 2016 GRADUATED 2016 N/A

MARCH 17,
GRADUATE STUDIES MINDANAO STATE UNIVERSITY (IIT) MASTERS OF PUBLIC ADMINISTRATION 2009 Present 33 units N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 1, 2024

CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity
LICENSURE EXAMINATION FOR SOCIAL WORK 78. 10 JULY 26-27,2017 ST.MARY ACADEMY, CARMEN, CAGAYAN DE 0027962 10/1/2020
PROFESSION ORO 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.
GOV'T
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if 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)

2 018 Present PROJECT DEVELOPMENT OFFICER II/ DSWD REGION X P36, 601 SG-15 CONTARCTUAL Y
MUNICIPAL LINK
2 017 2 018 PROJECT DEVELOPMENT OFFICER I DSWD REGION X P22,000 SG-11 MOA Y

2 016 2 017 VOLUNTEER TEACHER DepEd-ARMM P7,500 SG-5 JOB ORDER Y

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 1, 2024
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

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Type of LD CONDUCTED/ SPONSORED
( Managerial/
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/ BY
Technical/etc) (Write in full)
From To

FAMILY DEVELOPMENT SESSION ON 7YTLP 11/18/2023 11/22/2023 32 hrs TECHNICAL DSWD REGION 10

FAMILY DEVELOPMENT SESSION ON TUBERCULOSIS AWARENESS 5/26/2023 5/29/2023 32 hrs TECHNICAL DSWD REGION 10

ROLL OUT TRAINING: KILOS UNLAD 3/26/2022 3/29/2022 32hrs TECHNICAL DSWD REGION 10

CHILD LABOR MODULE 11/19/2018 11/22/2018 32 hrs TECHNICAL DSWD REGION 10

Roll Out Training and Saturation on Child sexual abuse and Prevention 7/17/2018 7/20/2018 32 hrs TECHNICAL DSWD REGION 10

FDS-MAScum Positive Discipline & Referral Pathways 12/5/2018 12/7/2018 36 Hrs TECHNICAL DSWD REGION 10

GENDER AND DEVELOPMENT (Gender Sensitivity) 9/4/2018 9/7/2018 36 hrs TECHNICAL DSWD REGION 10

Training on Caseload Management through enhance data management, E-case

Management and Priority Integeration of Convergence Approach and Community 01/16/2018 01/19/2018 32 Hrs TECHNICAL DSWD REGION 10
Organizing

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
ASSOCIATION/ORGANIZ
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. ATION
(Write in full)
Computer Literate (Microsoft Word, Excel, N/A PASWI Since 2017
Powerpoint & ADOBE Photoshop)
Artistic in terms of Sketching & Drawing NASWI Since 2017

Case Manager JSWAP Since 2012

Good in Planning and Organizing in the field

areas

(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 1, 2024

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
by any court or tribunal? YES NO
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 YES ✘ NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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
NEL K. LABRADOR, RSW CAGAYAN DE ORO CITY 915427357 3.5 cm. X 4.5 cm
(passport size)
KENDI LOVELEEN E. VILLARIN, RSW TUBOD, LANAO DEL NORTE 9176247494 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 or photocopied picture
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable
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 against me. PHOTO

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.: RSW-OO27962

Signature (Sign inside the box)
JANUARY 1, 2024
Date/Place of Issuance: 10/25/2017/ PRC Cagayan de Oro City
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