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 Lao-un
NAME EXTENSION (JR., SR)
FIRST NAME Nasiba
MIDDLE NAME Macarandas
3. DATE OF BIRTH
(mm/dd/yyyy) 1/13/1998 16. CITIZENSHIP

Filipino
4. PLACE OF BIRTH Minabay, Buldon Maguindanao If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
House/Block/Lot No. Street
Single Calaan
Subdivision/Village Barangay
7. HEIGHT (m) 5'0 Buldon Maguindanao
City/Municipality Province
8. WEIGHT (kg) 44 ZIP CODE 9615

18. PERMANENT ADDRESS

9. BLOOD TYPE O+
House/Block/Lot No. Street
Calaan
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Buldon Maguindanao
11. PAG-IBIG ID NO. 121276587168
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 9615

13. SSS NO. 34-9791858-2 19. TELEPHONE NO.

14. TIN NO. 771-872-992 20. MOBILE NO. 09752287523

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) laounnasiba@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 N/A N/A

MIDDLE NAME N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME Lao-un

NAME EXTENSION (JR., SR)
FIRST NAME Mohamad
MIDDLE NAME Macalangcom
25. MOTHER'S MAIDEN NAME

SURNAME Macarandas
FIRST NAME Aisa
MIDDLE NAME Dimao (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Buldon, Central, Elementary School 2010-2011 With Honor

SECONDARY /
VOCATIONAL Jamiat Buldon Al-Islamia 2014-2015 With Honor

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

TRADE
COURSE
COLLEGE Cotabato City State Polytechnic College Bachelor of Science in Social Work 2019-2020

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

(Continue on separate sheet if necessary)

SIGNATURE DATE July 27, 2022

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
11/11/2021-
Registered Social Worker August 24-26, 2021 NDMU Koronadal City 0034925 01/13/2024

(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
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
(Y/ N)
Ministry of Social Welfare and Development
1/15/2020 5/15/2020 Intern N/A N/A Temporary Yes
Office
Office of Social Welfare and Development
8/1/2019 12/15/2020 Intern N/A N/A Temporary Yes
Services

(Continue on separate sheet if necessary)

SIGNATURE DATE July 27, 2022

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

Philippine Red Cross Cotabato City- Maguindanao Chapter Volunteer

IRANON YOUTH INITIATIVE, (Buldon Maguindanao) volunteer (Voluntary Organization)

(Continue on separate sheet if necessary)

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

1. 3 Days Symposium on Violence against Women 11/12/2019 11/14/2019 24.0 Technical Gender and Development office/CCSPC

2. Seminar on Social Work and Mental Health 10/19/2019 10/19/2019 5.0 Technical

3. Disaster Preparedness and Stress Coping Seminar 10/20/2019 10/20/2019 5.0 Technical

4. Seminar-Workshop on Emotional Intellegence at Work 10/17/2019 10/17/2019 5.0 Technical

5. Critical Incident Stress Depriefing Seminar 10/17/2019 10/17/2019 5.0 Technical

Building Resilence in Human Resource Management in the midst Pandmic. (Virtual) 10/26/2021 10/26/2021 3.0

IYI Youth Camp 12/23/2021 12/24/2021 16.0 Barira Maguindanao

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

ENCODING

COOKING

WRITTING

READING

ORGANIZING

(Continue on separate sheet if necessary)

SIGNATURE DATE July 27, 2022

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? No
b. within the fourth degree (for Local Government Unit - Career Employees)? No
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? 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 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, 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 No
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last 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? 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? No
If YES, please specify:
b. Are you a person with disability? No
If YES, please specify ID No:
c. Are you a solo parent? 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
4.5 cm. X 3.5 cm
FARIHA AHMAD NOH COTABATO CITY 09360467517 (passport size)

Computer generated
CAMALUDIN MASRON ESMAIL COTABATO CITY 09171224985 or photocopied picture
is not acceptable
NORKAINA C. SAMAMA COTABATO CITY 09672015154
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 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: PRC

ID/License/Passport No.: 0034925

Signature (Sign inside the box)
July 27, 2022
Date/Place of Issuance: 11/11/2021-01/13/2024
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