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
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.

I. PERSONAL INFORMATION
2. SURNAME BALIAT

FIRST NAME AUREA BELEN

MIDDLE NAME PATTAUI

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) Filipino Dual Citiz
3/13/1983
4. PLACE OF BIRTH TUGUEGARO CITY If holder of dual citizenship,

please indicate the details.

5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 126

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.

Other/s:
Subdivision/Village
TUGUEGARO
7. HEIGHT (m) 1.62
City/Municipality
8. WEIGHT (kg) 83 ZIP CODE 3500

18. PERMANENT ADDRESS 56

9. BLOOD TYPE A+
House/Block/Lot No.

10. GSIS ID NO. 02004547647

Subdivision/Village
TUGUEGARAO
11. PAG-IBIG ID NO. 1340-0031-0526
City/Municipality

12. PHILHEALTH NO. 06-200498592-9 ZIP CODE 3500

13. SSS NO. 01-1759955-0 19. TELEPHONE NO. N/A

14. TIN NO. 942-570-560 20. MOBILE NO. 0926036

15. AGENCY EMPLOYEE NO. 220140006 21. E-MAIL ADDRESS (if any) atty.aurea18@
II. FAMILY BACKGROUND
23. NAME of CHILDREN (Write full nam
22. SPOUSE'S SURNAME BALIAT and list all)
NAME EXTENSION (JR., SR)
FIRST NAME FRANK DAREN PASCUAL BENEDICT FRAN
P. BALIAT
MIDDLE NAME SALVADOR

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PATTAUI

NAME EXTENSION (JR., SR)
FIRST NAME PASCUAL

MIDDLE NAME REMOLACIO

25. MOTHER'S MAIDEN NAME ADORACION M. SANTOS

SURNAME SANTOS

FIRST NAME ADORACION

MIDDLE NAME MANGUNAY (Continue on separate

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL
(Write in full)
(Write in full)
From To

TUGUEGARAO CENTRAL ELEMENTARY

ELEMENTARY
SCHOOL
PRIMARY EDUCATION 1990 1995
 SAINT LOIUS COLLEGE OF TUGUEGARAO
SECONDARY
(NOW UNIVERSITY OF SAINT LOIUS)
HIGH SCHOOL 1995 1999

COLLEGE UNIVERSITY OF THE PHILIPPINES DILIMAN A.B. PHILOSOPHY 1999 2004

UNIVERSITY OF CAGAYAN BACHELORS OF LAWS AND LETTERS WITH

GRADUATE STUDIES
VALLEY MASTERS IN BUSINESS ADMINISTRATION
2006 2013

SAINT PAUL UNIVERSITY MASTER OF SCIENCE IN TEACHING MAJOR IN

GRADUATE STUDIES
PHILIPPINES MATHEMATICS
2008 2010

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS
AL DATA SHEET
k Experience Sheet shall cause the filing of administrative/criminal case/s against the person

DS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Filipino Dual Citizenship

by birth by naturalization

Pls. indicate country:

AVOCADO ST
Street
TANZA
Barangay
PROVINCE
Province
3500

LUNA ST.
Street
UGAC SUR
Barangay
CAGAYAN
Province

N/A

09260362547

atty.aurea18@gmail.com

23. NAME of CHILDREN (Write full name DATE OF BIRTH

and list all) (mm/dd/yyyy)
PASCUAL BENEDICT FRANCIS 7/13/2001
P. BALIAT

(Continue on separate sheet if necessary)

HIGHEST
SCHOLARS
LEVEL/
HIP/
UNITS YEAR
ACADEMIC
EARNED GRADUATED
HONORS
(if not
RECEIVED
graduated)

n/a 1995 n/a

 n/a 1999 n/a

n/a 2004 n/a

n/a 2013 n/a

n/a 2010 n/a

on separate sheet if necessary)

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

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

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
arate sheet if necessary)

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

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

eparate sheet if necessary)

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
b. within the fourth degree (for Local Government Unit - Career Employees)? YES
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
YES NO
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, YES NO
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 YES NO
Barangay election)?
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
3.5 cm. X 4.5 cm
(passport size)

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
is not acceptable
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 PHOTO
administrative/criminal case/s against me.
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID:

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

Date/Place of Issuance:
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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4