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 ORDANEZA
NAME EXTENSION(JR, SR)
FIRST NAME JAZZY JANE
N/A
MIDDLE NAME TACATANI
3. DATE OF BIRTH
16. CITIZENSHIP [ X ] Filipino [ ] Dual Citizenship
(mm/dd/yyy) 09/27/1995
[ ] by birth [ ] by naturalization

4. PLACE OF BIRTH MALUNGON, SARANGANI if holder of dual citizenship Pls. indicate country:

5. SEX [ ] Male [ X ] Female Pls. indicate the details N/A

N/A Purok 1
6. CIVIL STATUS [ X ] Single [ ] Married 17. RESIDENTIAL ADDRESS
House/Block/Lot No. Street
[ ] Widowed [ ] Separated
N/A Malalag Cogon
[ ] Other/s: N/A Subdivision/Village Barangay
MALUNGON Sarangani
7. HEIGHT (m) 1.58
City/Municipality Province
8. WEIGHT (kg) 58 Zip Code 9503
N/A Purok 1
9. BLOOD TYPE O+ 18. PERMANENT ADDRESS
House/Block/Lot No. Street
N/A Malalag Cogon
10. GSIS ID NO. N/A
Subdivision/Village Barangay
MALUNGON SARANGANI
11. PAGIBIG ID NO. 1212-0066-7548
City/Municipality Province
12. PHILHEALTH NO. 17-251942106-8 ZIP CODE 9503

13. SSS NO. 0941894113 19. TELEPHONE NO. N/A

14. TIN NO. 735-323-527 20. MOBILE NO. 09105704290

15. AGENCY EMPLOYEE NO. N-12150 21. E-MAIL ADDRESS (if any) jazzyordaneza4@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME. 23. NAME of CHILDREN (Write full name and list DATE OF BIRTH
N/A (mm/dd/yyyy)
all)
NAME EXTENSION (JR.,SR)
FIRST NAME N/A N/A N/A
N/A
MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYERS/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER 'S SURNAME. ORDANEZA

NAME EXTENSION (JR.,SR)
FIRST NAME WILDON
N/A
MIDDLE NAME AYOK

24. MOTHER'S MAIDEN NAME. JUDITA ANADIA TACATANI

SURNAME ORDANEZA

FIRST NAME JUDITA

MIDDLE NAME TACATANI (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

From To

ELEMENTARY MALALAG COGON ELEMENTARY SCHOOL Primary 2002 2008 N/A 2008 N/A

SECONDARY MALALAG COGON NATIONAL SCHOOL Secondary 2008 2012 N/A 2012 N/A

VOCATIONAL / TRADE COURSE N/A N/A N/A N/A N/A N/A N/A

BACHELOR OF SCIENCE IN HUMAN

COLLEGE ATENEO DE DAVAO UNIVERSITY 2012 2017 N/A N/A N/A
RESOUCE MANAGEMENT

MASTER OF PUBLIC ADMINISTRATION

GRADUATE STUDIES NOTRE DAME OF DADIANGAS UNIVERSITY 2018 2020 N/A 2020 N/A
(MPA)

(Continue on separate sheet if necessary)

SIGNATURE DATE

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 BARANGAY ELGIBILITY / EXAMININATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
DRIVER'S LICENSE CONFERNMENT
NUMBER Date of Validity

Career Service Professional 81.68 03/12/2017 DAVAO CITY N/A 03/12/2017

(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.
SALARY / JOB
/ PAY GRADE
(if
INCLUSIVE DATES GOV'T
28. POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY applicable)
(mm/dd/yyyy) STATUS OF APPOINTNMENT SERVICE
(Write in full / Do not abbreviate) (Write in full/Do not abbreviate) SALARY & STEP
(Y/N)
(Format
"00-0") /
INCREMENT
From To
DEPARTEMENT OF THE INTERIOR AND LOCAL
09/01/2021 Present Administrative Assistant II P 18,251.00 8-1 Permanent YES
GOVERNMENT XII - KORONADAL CITY
DEPARTMENT OF THE INTERIOR AND LOCAL
01/01/2021 08/31/2021 Administrative Aide IV P 14,400.00 4-2 Permanent YES
GOVERNMENT RO XII
12/13/2018 12/31/2020 Administrative Aide IV DILG P 13,214.00 4-1 Permanent YES

04/16/2018 09/16/2018 PROJECT EMPLOYEE SOUTH COTABATO ELECTRIC COOPERATIVE II P 6,500.00 Contractual NO

06/17/2017 02/01/2018 COMMUNITY EXTENSION WORKER LOCAL GOVERNMENT OF MALUNGON P 6,500.00 Job Order YES

(Continue on separate sheet if necessary)

SIGNATURE DATE

CS Form 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME AND ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER OF
29. POSITION / NATURE OF WORK
(Write in full) (mm/dd/yyyy) HOURS
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)
Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING INCLUSIVE DATES NUMBER OF (Managerial / CONDUCTED / SPONSORED BY
PROGRAMS (mm/dd/yyyy) HOURS Supervisory / (Write in full)
(Write in full) Technical / etc.)
From To
SHARPENING THE SAW OF DILG XII PERSONNEL: LEARNING SESSIONS
FOR THE EFFECTIVE AND EFFICIENT SERVICE DELIVERY OF LGUs IN 11/09/2022 11/11/2022 72 ADMINISTRATIVE DILG XII
SOCCSKSARGEN
LEARNING AND DEVELOPMENT: RETOOLING FOR ADMINISTRATIVE
06/02/2022 06/03/2022 48 ADMINISTRATIVE DILG XII
PERSONNEL "NURTURING A CULTURE OF EXCELLENCE IN DILG DOSE"
Virtual Meeting for Harmonization of ISO Documents and forms for the
07/29/2021 07/29/2021 7 Technical DILG Central Office
Implementation of National QMS
Provincial Orientation on the One Quality Management System (QMS) 07/21/2021 07/21/2021 5 Technical DILG Sarangani
ATTENDANCE TO THE FGD & ORIENTATION ON THE FINAL LIST OF QPs &
06/04/2021 06/04/2021 8 Technical DILG CENTRAL OFFICE
SPs FOR THE NATIONAL QMS
ATTENDANCE TO THE RECORDS AND USE OF RECORDS DISPOSITION
05/28/2021 05/28/2021 4 ADMINISTRATIVE DILG XII
SCHEDULE
ATTENDANCE TO THE HARMONIZATION WORKSHOP FOR THE REGIONAL
& FIELD OFFICES ON THE ACCOUNTING PROCESSES & SUBMISSION OF 03/05/2021 03/05/2021 8 ADMINISTRATIVE DILG XII
FINANCIAL REPORTS
ISO 9001:2015 AWARENESS TRAINING 12/01/2020 12/01/2020 8 Technical Management Division, FMS

FINANCIAL LITERACY COACHING SEMINAR 01/24/2020 01/24/2020 3 SOFT SKILLS Notre Dame of Dadiangas University

Gender Equality Mainstreaming towards Nation Building 01/17/2020 01/17/2020 3 Soft Skills Notre Dame of Dadiangas University
Persuing Integrity, Resiliency, Sustainability in Ambiguity of Professional
01/10/2020 01/10/2020 3 Soft Skills Notre Dame of Dadiangas Uni
Standards and Ethics Seminar for Graduate Students
DEVELOPMENT SESSIONS FOR ADMINISTRATIVE PERSONNEL OF DILG XII
CUM 2019 HUMAN RESOURCE DEVELOPMENT PLAN AND REGIONAL ISO 07/24/2019 07/25/2019 16 ADMINISTRATIVE DILG XII
9001:2015 (QMS) IMPLEMENTATION
TRAINING OF TRAINERS FOR MODULE 4 OF Community Based Monitoring BUREAU OF LOCAL GOVERNMENT
05/26/2019 06/01/2019 40 Technical
System-Accelerated Poverty Profiling DEVELOPMENT
BUREAU OF LOCAL GOVERNMENT
COMMUNITY-BASED MONITORING SYSTEM MODULE 2 04/22/2019 04/26/2019 40 Technical
DEVELOPMENT
BUREAU OF LOCAL GOVERNMENT
COMMUNITY-BASED MONITORING SYSTEM MODULE 1 04/01/2019 04/05/2019 40 Technical
DEVELOPMENT
ALAY SA BAYAN INDUCTION PROGRAM 03/04/2019 03/06/2019 24 SOFT SKILL CIVIL SERVICE COMMISION

DISTANCE LEARNING PROGRAM 09/20/2018 10/28/2018 60 MANDATORY CIVIL SERVICE COMMISION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION /
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ORGANIZATION
(Write in full)
(Write in full)
DRIVING, COOKING, PLAYING TABLE TENNIS,
ATHLETE OF THE YEAR N/A
PLAYING MUSICAL INSTRUMENT

(Continue on separate sheet if necessary)

SIGNATURE DATE

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 [ ] YES [X] NO
where you will be apppointed,
a. within the third degree?
. [ ] YES [X] NO
If Yes, give details:
b. within the fourth degree (for Local Government Unit - Career Employees)?
[ ] YES [X] NO
35. a. Have you ever been found guilty of any administrative offense?
If Yes, give details:

. [ ] YES [X] NO
Date Filed :
b. Have you been criminally charged before any court?
. [ ] YES [X] NO
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 [ ] YES [X] NO
or tribunal? If Yes, give details:

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped [ ] YES [X] NO
from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or
private sector?
If Yes, give details:

38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay [ ] YES [X] NO
election)? If Yes, give details:

. [ ] YES [X] NO
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?
[ ] YES [X] NO
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) [ ] YES [X] NO
Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: If Yes, please specify:
a. Are you a member of any indigenous group?
. [ ] YES [X] NO
If Yes, please specify ID No:
b. Are you a person with disability
. [ ] YES [X] NO
If Yes, please specify ID No:
c. Are you a solo parent?

41. REFERENCES (Person not related by consanguity or affinity to applicant / appointee)

ID picture taken within
NAME ADDRESS TEL. NO. the last 6 months
3.5 cm. X 4.5 cm
ENG. SAMUEL A. CAMAGANACAN DAVAO CITY 09611894007 (passport size)

SHERYL D. LANTINGAN MALAPATAN, SARANGANI PROVINCE 09219784939 With full handwritten

name tag and signature
SHEILA MAE G. KUBIK GENERAL SANTOS CITY 09098826124 over
printed name
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 Computer generated
head/authorized representative to verify/validate the contents stated herein. I agree that any misrepresentation made in this or photocopied picture
document and its attachments shall cause the filing of administrative/criminal case/s against me. is not acceptable
PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's

License, etc.) PLEASE INDICATE ID Number
Government Issued ID: DILG ID
Signature (Sign inside the box)
ID/License/Passport No. N-12150

Date/Place of Issuance: SEPTEMBER 2020/DILG XII KORONADAL 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