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.
1. CS ID No. DOCSC
(Do not fill up. For NOTuse
ABBREVIA
only)
I. PERSONAL INFORMATION
2. SURNAME CABARLES

FIRST NAME REGIE NAME EXTENSION (JR., SR)

N/A
MIDDLE NAME DILI
3. DATE OF BIRTH
(mm/dd/yyyy) 1977/1/28 16. CITIZENSHIP
Filipino Dual Citizenship
by by
birth naturalization
4. PLACE OF BIRTH BACOLOD CITY, NEGROS OCCIDENTAL 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
House/Block/Lot No. Street
Widowed Separated
N/A PAHANOCOY
Other/s:
Subdivision/Village Barangay

7. HEIGHT (m) 165.10 BACOLOD CITY NEGROS OCCIDENTAL

City/Municipality Province
8. WEIGHT (kg) 57 ZIP CODE 6100

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

10. GSIS ID NO. N/A N/A PAHANOCOY

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1212-038745-25 BACOLOD CITY NEGROS OCCIDENTAL

City/Municipality Province

12. PHILHEALTH NO. 11-025051435-2 ZIP CODE 6100

13. SSS NO. 07-1719440-3 19. TELEPHONE NO. N/A

14. TIN NO. 930-989-234 20. MOBILE NO. +63 - 930 - 0926 - 068

15. AGENCY EMPLOYEE NO. 066417 21. E-MAIL ADDRESS (if any) REGIECABARLES15@GMAIL.COM
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME CABARLES 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME MARY ANN NAME KIO ANGELO R. CABARLES 2002/8/29

EXTENSION (JR.,
MIDDLE NAME REGOLE KHATE ANGENITTE R. CABARLES 2014/12/10
SR) N/A
OCCUPATION HOUSEWIFE KLYDE ANDREI R. CABARLES 2020/7/25

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME CABARLES

FIRST NAME SALVADOR NAME

EXTENSION
MIDDLE NAME AGUDOS SR.
25. MOTHER'S MAIDEN NAME

SURNAME DILI

FIRST NAME VIRGINITA

MIDDLE NAME DALIVA (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 DON R. A. MEDEL ELEMENTARY SCHOOL N/A 1985/6/5 1991/5/13 N/A 1991 N/A

SECONDARY
VOCATIONAL / MANSILINGAN NATIONAL HIGH SCHOOL N/A 1991/6/13 1996/6/18 N/A 1996 N/A

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

TRADE
COURSE
COLLEGE CARLOS HILADO STATE COLLEGE ELECTRONICS 1996/6/18 10/19/1996 23 UNITS N/A N/A

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

(Continue on separate sheet if necessary)

SIGNATURE DATE 12-Feb-24

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

DRIVER'S LICENSE 1,2,3 N/A N/A F01 -99-132997 2027/1/28

(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/ SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
PAY GRADE (if
STATUS OF
applicable)&
(Write in full/Do not (Write in SALARY STEP (Format APPOINTMENT
abbreviate) full/Do not abbreviate) "00-0")/
From To INCREMENT
(Y/ N)

2023/5/8 2023/12/31 ADMINISTRTIVE AIDE IV DSWD FIELD OFFICE VI - SWAD NEGROS 13000.00 N/A DIRECT Y

(Continue on separate sheet if necessary)

SIGNATURE DATE 12-Feb-24

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

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

(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)

HARDWORKING N/A N/A

ATTENTIVE

TIME MANAGEMENT

PATIENCE

CLEAN DRIVING RECORD

CONCENTRATION

PROPER DRIVING
(Continue on separate sheet if necessary)

SIGNATURE DATE 12-Feb-24

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? Y
NO
ES
b. within the fourth degree (for Local Government Unit - Career Employees)? Y
NO
ES
If YES, give details:
________________________________
________________________________
Y
NO
ES
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
Y
NO
b. Have you been criminally charged before any court? ES
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:
YE
NO
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or S
regulation by any court or tribunal?
If YES, give details:
________________________________
________________________________
YE
NO
S
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 If YES, give details:
phased out (abolition) in the public or private sector? ________________________________
Y
NO
________________________________
ES
38. a. Have you ever been a candidate in a national or local election held within the last year
(except Barangay election)?
Y
NO
IfES
YES, give details:

b. Have you resigned from the government service during the three (3)-month period before the
last election to promote/actively campaign for a national or local candidate?
If YYES, give details:
NO
ES
39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA Y
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: ES
NO

a. Are you a member of any indigenous group? Y

NO
ES
If YES, please specify:
b. Are you a person with disability? Y
NO
ES
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
JOSELITO G.ESTEMBER JARO,ILOILO CITY 9683771389 4.5 cm. X 3.5 cm
(passport size)
FREDILYN P.SACLOTE MANDURRIAO,ILOILO CITY 9128304970
Computer generated
or photocopied picture
ALBERTO ZAFRA OTON,ILOILO 9103875170 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: DRIVER'S LICENCE

ID/License/Passport No.: FO1-99-132997

Signature (Sign inside the box)
5-May-25
Date/Place of Issuance: 01/28/22/ BACOLOD CITY,NEG.OCC.
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