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

MIDDLE NAME SMITH

3. DATE OF BIRTH
(mm/dd/yyyy) 11/16/1985 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH MOLAVE, ZAMBOANGA 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 N/A N/A

Widowed House/Block/Lot No. Street
Separate
d CATADMAN TURNO
Other/s:
Subdivision/Village Barangay

7. HEIGHT (m) 1.67 DIPOLOG CITY ZAMBOANGA DEL NORTE

City/Municipality Province
8. WEIGHT (kg) 69 ZIP CODE 7100

9. BLOOD TYPE O+
18. PERMANENT ADDRESS N/A N/A
House/Block/Lot No. Street

10. GSIS ID NO. 2003694050 N/A NEW VILLAGE

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1760-0045-4525 TAMBULIG ZAMBOANGA DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 15-055094082-6 ZIP CODE 7025

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

14. TIN NO. 936-234-325 20. MOBILE NO. 09998545642

15. AGENCY EMPLOYEE NO. 20061000548 21. E-MAIL ADDRESS (if any) roelminersrh@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Dalmacio 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME Dionisia N/A COMPLETE NAME JUD 12/03/2008

MIDDLE NAME Dimacuja

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME Dalmacio

FIRST NAME Tirador NAME EXTENSION (JR., SR) SR

MIDDLE NAME Lantaka

25. MOTHER'S MAIDEN NAME

SURNAME Smith

FIRST NAME Rojk

MIDDLE NAME Volkovit (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Upper Parasan Elementary School PRIMARY 1989 1995 GRADUATED 1995 NONE

SECONDARY
VOCATIONAL / Saint Vincent High School SECONDARY 1995 1999 GRADUATED 1999 NONE

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

TRADE
COURSE
COLLEGE Saint Columban College BACHELOR OF SCIENCE IN 1999 2003 GRADUATED 2003 NONE
CRIMINOLOGY
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE

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

POLICE INSPECTOR EXAMINATION (NAPOLCOM) 73.69% 10/21/2018 PAGADIAN CITY N/A N/A

CAREER SERVICE PROFESSIONAL 80.04% 10/21/2012 PAGADIAN CITY N/A N/A

CRIMINOLOGIST LICENSURE EXAMINATION 80.04% 10/21/2012 PAGADIAN CITY 026557 12/21/2021

TEACHERS BOARD EXAMINATION 80.04% 10/21/2012 PAGADIAN CITY 026557 12/21/2021

(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)

12/16/2020 PRESENT POLICE SENIOR MASTER SERGEANT PHILIPPINE NATIONAL POLICE 34,079.00 17 PERMANENT Y

03/25/2019 12/15/2020 POLICE MASTER SERGEANT PHILIPPINE NATIONAL POLICE 33,411.00 16 PERMANENT Y

01/31/2018 03/24/2019 SENIOR POLICE OFFICER I PHILIPPINE NATIONAL POLICE 33,411.00 16 PERMANENT Y

01/01/2018 01/30/2018 POLICE OFFICER III PHILIPPINE NATIONAL POLICE 32,114.00 14 PERMANENT Y

12/31/2013 12/31/2017 POLICE OFFICER III PHILIPPINE NATIONAL POLICE 18,665.00 14 PERMANENT Y

06/01/2012 12/30/2013 POLICE OFFICER II PHILIPPINE NATIONAL POLICE 16,934.00 12 PERMANENT Y

06/01/2011 05/31/2012 POLICE OFFICER II PHILIPPINE NATIONAL POLICE 15,359.00 12 PERMANENT Y

12/31/2010 05/31/2011 POLICE OFFICER II PHILIPPINE NATIONAL POLICE 13,785.00 12 PERMANENT Y

07/01/2010 12/30/2010 POLICE OFFICER I PHILIPPINE NATIONAL POLICE 12,150.00 10 PERMANENT Y

07/01/2009 06/30/2010 POLICE OFFICER I PHILIPPINE NATIONAL POLICE 10,808.00 10 PERMANENT Y

07/01/2008 06/30/2009 POLICE OFFICER I PHILIPPINE NATIONAL POLICE 9,466.00 10 PERMANENT Y

05/28/2007 06/30/2008 POLICE OFFICER I PHILIPPINE NATIONAL POLICE 8,605.00 10 PERMANENT Y

01/07/2006 05/27/2007 POLICE OFFICER I PHILIPPINE NATIONAL POLICE 8,605.00 10 TEMPORARY Y

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

PUBLIC SAFETY SENIOR LEADERSHIP COURSE RTC9 CLASS 2021-03 ALPHA 09/20/2021 12/23/2021 560 Supervisory Regional Training Center 9, Camp Felicisimo T
Marcos, Pasonanca, Zamboanga City

FIELD TRAINING OFFICER SERVICE DUTY 07/22/2019 02/12/2020 960 Supervisory Regional Special Training Unit 9, Camp Col
Romeo A Abendan, Mercedez, Zamboanga City

FIELD TRAINING OFFICERS COURSE 06/19/2019 07/12/2019 136 Supervisory Regional Special Training Unit 9, Camp Col
Romeo A Abendan, Mercedez, Zamboanga City

PUBLIC SAFETY JUNIOR LEADERSHIP COURSE RTC9 CLASS 2017-01 BRAVO 06/19/2017 12/01/2017 720 Supervisory Regional Training School 9, Camp Felicisimo T
Marcos, Pasonanca, Zamboanga City
MODIFIED PNP SPECIAL COUNTER-INSURGENCY OPERATION UNIT TRAINING 02/01/2007 03/30/2007 360 Specialized 9th Regional Mobile Group, Camp Col Romeo
CLASS 01-2007 A Abendan, Mercedez, Zamboanga City

PUBLIC SAFETY FIELD TRAINING PROGRAM 08/14/2006 01/30/2007 960 Specialized Regional Training School 9, Camp Felicisimo T
Marcos, Pasonanca, Zamboanga City
POLICE BASIC RECRUIT COURSE RTS CLASS 2006-01A 01/07/2006 07/21/2006 960 Mandatory Regional Training School 9, Camp Felicisimo T
Marcos, Pasonanca, Zamboanga City

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE Medalya ng Papuri (38) ARMED FORCES AND POLICE SAVINGS AND
LOANS ASSOCIATION INCORPORATED
DRIVING

LY
Medalya ng Paglilingkod sa Mindanao (13) PUBLIC SAFETY SAVINGS AND LOAN
ASSOCIATION INCORPORATED

ON
Medalya ng Ugnayang Pampulisya (11) PUBLIC SAFETY MUTUAL BENEFIT FUND
INCORPORATED

K
Medalya ng Paglaban sa Manliligalig (8)

N
Medalya ng Kagalingan (5)

RA
Medalya ng Kasanayan (4)

NT
RE
Medalya ng Pagtulong sa Nasalanta (3)

R
Medalya ng Mabuting Asal (2)

U
C
Medalya ng Kadakilaan

(Continue on separate sheet if necessary)

SIGNATURE DATE
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)

ID picture taken within
the last 6 months
NAME ADDRESS TEL. NO. 3.5 cm. X 4.5 cm
(passport size)
PSSG JONATHAN F CARBONILLA Poblacion, Salug, Zamboanga del
Norte 9177899529 With full and handwritten
name tag and signature over
PSSG ALVEEN THEO H DIMASUAY Liloy, Zamboanga del Norte 9177985510 printed name

Computer generated
PAT AIRECH G ESPEDILLON Jose Dalman, Zamboanga del Norte 9270484835 or photocopied picture
is not acceptable
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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
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: PHILIPPINE NATIONAL POLICE

ID/License/Passport No.: 22K0300098 Signature (Sign inside the box)

Date/Place of Issuance: 11/03/2022 / Camp Crame, Quezon 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