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CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET
Print. Legibly. Mark appropriate boxes with and use separate sheet if necessary 1. CS ID (to be filled up by CSC)
1. PERSONAL INFORMATION
2. SURNAME

FIRST NAME

MIDDLE NAME
TURBELA I I I I I I I I I I
JAMES I I I I I I I I I I I I I I I I I I I
ARSENIO I I I I I I I I I I I
3. NAME EXTENTION (e.g. Jr
Sr)NONE

4. DATE OF BIRTH (mm/dd/yyyy) JAN 25, 1975
16.RESIDENTIAL ADDRESS




ZIP CODE
17. TELEPHONE NO
B11 L16, NJK SUBD, DAO PAGADIAN CITY,
ZAMBOANGA DEL SUR

5. PLACE OF BIRTH MURCIA, NEGROS OCCIDENTAL
6. SEX / Male Female
7. CIVIL STATUS

Single Widowed
/ Married Separated
Annulled Others, specify____

0947-392-5997
8. CITIZENSHIP FILIPINO
18. PERMANENT ADDRESS


ZIP CODE

19. TELEPHONE NO.
B11 L16, NJK SUBD, DAO PAGADIAN CITY,
ZAMBOANGA DEL SUR

9. HEIGHT (m) 1.75
10. WEIGHT (kg) 87 KG
11. BLOOD TYPE O 0947-392-5997
12. GSIS ID NO.
20. E-MAIL ADDRESS (if any)
jamesturbela@yahoo.com
13 . PAG-IBIG ID NO.

21. CELLPHONE NO (if any)
0947-392-5997
14. PHILHEALTH NO.
14-000073858-8
22. AGENCY EMPLOYEE NO.

15. SSS ID NO.
23. TIN
938-591-224
II. FAMILY BACKGROUND

24. SPOUSES SURNAME

FIRST NAME
MIDDLE NAME

TURBELA


25. NAME OF CHILD (write full name and list all)
DATE OF BIRTH
(mm/dd/yyyy)
/ /
DOLORES
Erica Valdez Turbela
03 /16 /2002
VALDEZ
Hans Valdez Turbela
03 /27 / 2004
OCCUPATION
NONE (HOUSEWIFE)
Dave Valdez Turbela
04 / 17 /2009
EMPLOYER/BUS. NAME
/ /
BUSINESS ADDRESS
/ /
TELEPHONE NO.
/ /
(Continue on separate sheet if necessary) / /

26. FATHERS SURNAME
FIRST NAME
MIDDLE NAME
TURBELA / /
VALENTIN / /
SABILLON / /
27. MOTHERS MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME
/ /
ARSENIO / /
NOETA / /
BULIUS (continue on separate sheet if necessary)


28. LEVEL

NAME OF SCHOOL
(Write in full)


DEGREE COURSE
(Write in full)

YEAR
GRADUATED
(If graduated)
HIGHEST
GRADE/LEVEL/
UNITS
EARNED
(If not graduated)
INCLUSIVE DATES
OF ATTENDANCE
SCOLARSHIP/
ACADEMIC
HONORS
RECEIVED
FROM TO

ELEMENTARY
LOPES JAENA ELEM SCH

1989

1983 1989 5TH

SECONDARY
LOPES JAENA NATL HS

1993

1989 1993 SALUTATORI
AN
VOCATIONAL/TRADE
COURSE




COLLEGE
WEST NEGROS
COLLEGE
BACHELOR IN
SECONDARY
EDUCATION

1997



1993 1997 NONE

GRADUATE
STUDIES
PNPA

BACHELOR OF
SCIENCE IN
PUBLIC SAFETY
2000 1998 2000 NONE
(Continue on separate sheet if necessary)
Page 1 of 4


IV. CIVIL SERVICE ELIGIBILITY
29.

CAREER SERVICE/RA 1080(BOARD/BAR)

UNDER SPECIAL LAWS/ CES/CSEE


RATING

DATE OF

EXAMINATION

CONFERMENT

PLACE OF EXAMINATION/
CONFERMENT
LICENSE (If any)

NUMBER


DATE OF
RELEASE
NONE


















(Continue on separate sheet if necessary)
V. WORK EXPERIENCE ( Include private employment, Start from your current work)

30. INCLUSIVE DATES
(mm/dd/yyyy)

POSITION
TITLE

DEPARTMENT/AGENCY OFFICE/ COMPANY
(Write in full)

MONTHLY
RATE
SALARY GRADE
& STEP
INCREMENT
(Format 00-0)

STATUS OF
APPOINTMENT
GOVT
SERVICE
(Yes/No)
07/27/11
DATE
C, OPERATION
NEGROS ORIENTAL PROVINCIAL
POLICE OFFICE
P32,942 24
PERMA
NENT
YES
12/1/09
04/06/ 10
CHIEF OF
POLICE
DAPITAN CITY, ZAMBOANGA DEL
NORTE
P28,000 24
PERMA
NENT
YES
10/28/09
01/04/10
C, INTEL
BRANCH
ZAMBOANGA DEL NORTE
PROVINCIAL POLICE OFFICE
P28,000 24
PERMA
NENT
YES
07/13/09
01/04/10
C,
INVESTIGATION
ZAMBOANGA DEL NORTE
PROVINCIAL POLICE OFFICE
P24,000 24
PERMA
NENT
YES
02/15/08
07/13/09
CHIEF OF
POLICE
SINDANGAN, ZAMBOANGA DEL
NORTE
P24,000 24
PERMA
NENT
YES
06/01/04
02/11/08
COMPANY
COMMANDER
IST COMPANY, REGIONAL MOBILE
GROUP, REGION 9
P22,000 23
PERMA
NENT
YES
11/01/00
05/31/02
PCP
COMMANDER
PASAY CITY, NCR P19,000 22
PERMA
NENT
YES
/ /
/ /
/ /
/ /
/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

/ / / /

(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4








x

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE/ VOLUNTARY
ORGANIZATIONS

32. NAME & ADDRESS OF ORGANIZATION
(Write in full)
INCLUSIVE DATES
(mm/dd/yyyy

NUMBERS
OF HOURS

POSITION / NATURE OF WORK
From To

NONE













(Continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start from the most recent training)

32. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES
(Write in full)

INCLUSIVE DATESOF
ATTENDANCE
(mm/dd/yyyy)

NUMBER OF
HOURS



CONDUCTED/SPONSORED BY
(Write null)


DRUG INVESTIGATION CRUSH COURSE DEC 26 JAN 15, 2001 160
DEP CENTER TRAINING SCHOOL,
CAMP CRAME
SPECIAL POLICE TACTICS ORIENTATION
COURSE
MAY 05 JUNE 3, 1999 160 PHILIPPINE PUBLIC SAFETY COLLEGE
VITAL INSTALLATION SECURITY COURSE SEPT 8
SEPT
26,2008
40 ATAP

Human Rights gender and Law
enforcement course
Sept 28
Sept
30,2010
24 United Nation






















(Continue on separate sheet if necessary)


VI I I . OTHER I NFORMATI ON

33. SPECIAL SKILLS / HOBBIES


34. NON-ACADEMIC DISTINCTIONS / RECOGNITION
(Write in full)

35. MEMBERSHIP IN ASSOCIATION /
ORGANIZATION
(Write in full)
PLAYING BASKETBALL
NONE









(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005) Page 3 of 4




36. Are you related by consanguinity or affinity to any of the following

a. Within the third degree (for National Government Employees):
appointing authority, recommending authority, chief of office/bureau/department of person who

YES / NO
If YES, give details:






/








has immediate supervision over you in the Office, Bureau or Department where you will be
appointed?


b. Within the fourth degree (for Local Government Employees):
appointing authority or recommending authority where you will be appointed?


YES / NO
If YES, give details:



37. a. Have you ever been formally charged?




b. Have you ever been guilty of any administrative offense?

YES / NO
If YES, give details:
.

YES / NO
If YES, give details:



38. 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


39. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the role, dismissal, termination, end of term, finished contract, AWOL, or
phased out, in the public or private sector?
YES / NO
If YES, give details


40. Have you ever been a candidate in a national or local election (except Barangay election)?
YES / NO
If YES, give details


41. Pursuant to (a) Indigenous Peoples 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?
b. Are you differently abled?
c. Are you a solo parent?

YES / NO
If YES, give details ___________________
YES / NO
If YES, give details ___________________
YES / NO
If YES, give details ___________________
42. REFERENCES (Person not related by consanguinity or affinity applicant/appointee)
NAME

ADDRESS

TEL NO.



ID PICTURE TAKEN WITHIN
THE LAST 6 MONTHS
3.5 CM X 4.5 CM
(PASSPORT SIZE)


Computer generated
or Xerox copy picture
is acceptable

SUPT GLENN DULAWAN DAPITAN CITY 09054249348
SUPT RANDOLF BALONGLONG DUMAGUETE CITY 09213519115
SUPT ROY BAHIAN PAGADIAN CITY 09213080848
43. I declare under oath that this Personal Date Sheet has been accomplished by me, correct and complete
statement pursuant to the provisions of pertinent laws, rules land regulation of the Republic of the
Philippines.

I also authorize the agency head / authorized representative to verify / verify validate the contents stated herein. I trust
that this information shall remain confidential.
PHOTO



COMMUNITY TAX CERTIFICATE NO.





ISSUED AT. SIGNATURE (Sign inside the box).

ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED








RIGHT THUMB MARK

CS FORM 212 (Revised 2005) Page 4 of 4