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 POGOSA
NAME EXTENSION (JR., SR)
FIRST NAME MELJUN

MIDDLE NAME ARLALEJO

3. DATE OF BIRTH
(mm/dd/yyyy) 10/15/1991 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH CORTES,SURIGAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed House/Block/Lot No. Street
Separate
d P-5 POBLACION
Other/s:
Subdivision/Village Barangay
CORTES SURIGAO DEL SUR
7. HEIGHT (m) 1.62
City/Municipality Province
8. WEIGHT (kg) 78 ZIP CODE 8313

18. PERMANENT ADDRESS

9. BLOOD TYPE O
House/Block/Lot No. Street
P-5 POBLACION
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121117441545 CORTES SURIGAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 18-200807060-2 ZIP CODE 8313

13. SSS NO. 08-2446818-7 19. TELEPHONE NO. N/A

14. TIN NO. 325-046-016-000 20. MOBILE NO. 09618347098

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) pogosameljun@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME POGOSA 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
ZAINA ABIAH P. POGOSA
FIRST NAME EDNA 9/1/2022
MIDDLE NAME PLAZA
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME POGOSA

JR
FIRST NAME ENETILIO

MIDDLE NAME AVERIO

25. MOTHER'S MAIDEN NAME

SURNAME ARLALEJO

FIRST NAME MARIFE

MIDDLE NAME PAGANGPANG (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY CORTES CENTRAL ELEMENTARY SCHOOL PRIMARY EDUCATION 1999 2004 GRADUATED 2004 N/A

SECONDARY /
VOCATIONAL CORTES ACADEMY SECONDARY EDUCATION 2004 2008 GRADUATED 2008 N/A

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

TRADE BACHELOR OF SCIENCE IN BUSINESS ADMINISTRATION MAJOR IN
COLLEGE
COURSE SURIGAO DEL SUR STATE UNIVERSITY FINANCIAL MANAGEMENT 2010 2014 GRADUATED 2014 N/A

GRADUATE STUDIES SAINT THERESA COLLEGE OF TANDAG INC BACHELOR IN SECONDARY EDUCATION 2020 2021 27 UNITS 2021 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE JAN. 2025

CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity
LICENSURE EXAMINATION FOR PROFESSIONAL 75.00% Mar-24 BUTUAN CITY 2232576 10/15/2027
TEACHER

S
A
L
A
R
Y
/
J
O
B
/
P
A
Y
G
R
A
D
E
(
i
(Continue on separate sheet if necessary) f

V. WORK EXPERIENCE a
p
p
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. l
i GOV'T
c
SERVICE
28. INCLUSIVE DATES a
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY b
MONTHLY l STATUS OF
(Write in full/Do (Write in SALARY e APPOINTMENT
not abbreviate) full/Do not abbreviate) )
From To & (Y/
S N)

2017 2025 BRANCH HEAD PALAWAN PAWNSHOP PALAWAN 27200.00

T
E REGULAR N
EXPRESS PERA PADALA INC. P

2015 2016 SALES ASSISTANT GAISANO CAPITAL TANDAG 6000.00 (

F CONTRACTUAl N
o
r
m
2015 2015 ENUMERATOR MUNICIPALTY OF CORTES 6000.00 a CONTRACTUAl N
t
"
2014 2014 BAGGER/MESSENGER HYPER MARKET MALL OF ASIA 13500.00 0 CONTRACTUAl N
0
-
0
"
)
/
I
N
C
R
E
M
E
N
T

(Continue on separate sheet if necessary)

SIGNATURE DATE JAN. 2025

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

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)

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

(LH) BASIC PAWNSHOP OPERATIONS LEVEL 2 04/19/2017 04/19/2017 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY

(LH) BASIC JEWELRY APPRAISING 2/8/2017 2/8/2017 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY

(LH) PREVENTIVE MEASURE REQUIREMENTS FOR COVERED INSTITUTION 7/7/2021 7/7/2021 8 HOURS MANAGERIAL HUMAN RESOURCES PPS ACADEMY

(LH) COMPLIANCE TRAINING MODULE 3- PPG MONEY LAUNDERINGAND

07/20/2022 07/20/2022 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
TERORRIST FINANCING PREVENTION PROGRAM (MTPP)

BRANCH OPERATIONS TRAINING II SAKES TRAINING 10/13/2023 10/13/2023 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY

MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM HUMAN RESOURCES PPS ACADEMY
IMPLEMENTING RULES AND GUIDELINES 10/16/2023 10/16/2023 8 HOURS MANAGERIAL

MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM

1/13/2023 1/13/2023 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
IMPLEMENTING RULES AND GUIDELINES

BASIC CONCEPTS OF ANTI-MONEY LAUNDERING AND COUNTERING FINANCING

1/16/2023 08/17/2023 16 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
OF TERRORISM

MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM

1/19/2023 1/19/2023 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
IMPLEMENTING RULES AND GUIDELINES
MODULE - 3 MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION
7/20/2022 7/20/2022 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
PROGRAM
COMPLIANCE TRAINING 2 PPG MONEY LAUNDERING AND TERRORIST
12/16/2022 12/16/2022 8 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
FINANCING PREVENTION PROGRAM
MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM
7/28/2023 7/29/2023 16 HOURS MANAGERIALHUMAN RESOURCES PPS ACADEMY
IMPLEMENTING RULES AND GUIDELINES
MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM
7/31/2023 4/8/2023 32 HOURS MANAGERIAL
IMPLEMENTING RULES AND GUIDELINES HUMAN RESOURCES PPS ACADEMY
EY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM IMPLEMENTING RULES AND
7/8/2023
GUIDELINES
11/8/2023 40 HOURS MANAGERIAL
HUMAN RESOURCES PPS ACADEMY
MONEY LAUNDERING AND TERRORIST FINANCING PREVENTION PROGRAM
8/15/2023 8/15/2023 8 HOURS MANAGERIAL
IMPLEMENTING RULES AND GUIDELINES HUMAN RESOURCES PPS ACADEMY
(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 3 (Write
. in full)

N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE September 15, 2023

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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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
by any court or tribunal? YES ✘ NO
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 ✘ YES NO
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 election)? YES ✘ NO
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
RUBY JANE PORTUGALIZA CARRASCAL 9505626510 3.5 cm. X 4.5 cm
(passport size)
MICHELLE ASILUM TANDAG CITY
With full and handwritten
name tag and signature over
ANGELYN DAHUNOG SAN MIGUEL
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and Computer generated
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the or photocopied picture
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. is not acceptable
I agree that any misrepresentation made in this document and its attachments shall cause the filing of
administrative/criminal case/s against me. 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: PRC ID

ID/License/Passport No.: 2232576 Signature (Sign inside the box)

Date/Place of Issuance: BUTUAN 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