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 DUCOL
NAME EXTENSION (JR., SR)
FIRST NAME MAHID

MIDDLE NAME SHIEK

3. DATE OF BIRTH
(mm/dd/yyyy) 9/20/1986 16. CITIZENSHIP

4. PLACE OF BIRTH PUALAS LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
House/Block/Lot No. Street
TUBOD
Subdivision/Village Barangay
ILIGAN LANAO DEL NORTE
7. HEIGHT (m) 1.65 M
City/Municipality Province

8. WEIGHT (kg) 70 Kg ZIP CODE 9200

18. PERMANENT ADDRESS

9. BLOOD TYPE "o"
House/Block/Lot No. Street
DANUGAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
PUALAS LANAO DEL SUR
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9313

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

14. TIN NO. N/A 20. MOBILE NO. 09065509750

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) imazheadadducol@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)
NAME EXTENSION (JR., SR) N/A
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME SHIEK

NAME EXTENSION (JR., SR)
FIRST NAME PANTAO

MIDDLE NAME IBRAHIM

25. MOTHER'S MAIDEN NAME

SURNAME DUCOL

FIRST NAME SALAM

MIDDLE NAME IDOR (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY DANUGAN CENTRAL ELEMENTARY SCHOOL ELEMENTARY 1991 1997 N/A 1997 DIPLOMA

SECONDARY DANUGAN NATIONAL HIGH SCHOOL SECONDARY 1999 2003 N/A 2003 DIPLOMA

VOCATIONAL /
TRADE COURSE

COLLEGE MARAWI CAPITOL COLLEGE FOUNDATION INC. BACHELOR OF SCIENCE IN COMMERCE 2006 2013 185 UNITS 2013 DIPLOMA

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE February 6, 2018

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

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

2013 2014 SECURITY GUARD DANUGAN NATIONAL HIGH SCHOOL CONTRACTUAL YES

2/1/2017 PRESENT PERSONAL DRIVER LASURECO JOB ORDER NO

 (Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 06, 2018

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

(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 Type of LD

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE FEBRUARY 06, 2018

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?
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?
If YES, give details:
________________________________
________________________________

b. Have you been criminally charged before any court?

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?
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? ________________________________
________________________________

38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If 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 YES, give details:

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
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?
.
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.

HADJI YANES GANDAMASIR PUALAS LANAO DEL SUR

 NORHAINA DIPATUAN ILIGAN CITY 222-1187

ALNAIR MANGRAY ILIGAN CITY

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, rul

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.: M05-14-001052

Signature (Sign inside the box)

Date/Place of Issuance: Marawi 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