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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 ag
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

I. PERSONAL INFORMATION
2. SURNAME MOKAMAD
NAME EXTENSION (JR., SR
FIRST NAME BAI MOHARA

MIDDLE NAME BIRUAR


3. DATE OF BIRTH
(mm/dd/yyyy) 9/24/1978 16. CITIZENSHIP Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH COTABATO CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 22A SEKAK APARTMENT GONZA


6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
ROSARY
Other/s:
Subdivision/Village Ba
COTABATO
7. HEIGHT (m) 159
City/Municipality Pr
8. WEIGHT (kg) 58 ZIP CODE 9600

18. PERMANENT ADDRESS 42 M


9. BLOOD TYPE O
House/Block/Lot No. S
BA
10. GSIS ID NO. N/A
Subdivision/Village Ba
COTABATO
11. PAG-IBIG ID NO. 1211-8811-8741
City/Municipality Pr

12. PHILHEALTH NO. N/A ZIP CODE

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

14. TIN NO. 402-652-612 20. MOBILE NO. 09261657211

15. AGENCY EMPLOYEE NO. 222 21. E-MAIL ADDRESS (if any) moharabiruar@yahoo.com/bmamilhasa
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AMILHASAN 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) NAIM ALMAKTOUM M. AMILHASAN
FIRST NAME MENNALDZ

MIDDLE NAME AKIN

OCCUPATION GOVERNMENT EMPLOYEE


DSWD-ARMM PANTAWID PAMILYA OFFICE, ORG COMPOUND
EMPLOYER/BUSINESS NAME
COTABATO CITY
BUSINESS ADDRESS

TELEPHONE NO. 9265630111

24. FATHER'S SURNAME MOKAMAD


NAME EXTENSION (JR., SR)
FIRST NAME AKAS

MIDDLE NAME KAHAR

25. MOTHER'S MAIDEN NAME 1986

SURNAME BIRUAR

FIRST NAME LIKA

MIDDLE NAME MACARIMBANG (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND


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

NOTRE DAME OF COTABATO FOR GIRLS


ELEMENTARY
DEPARTMENT 1986 1992 1992

NOTRE DAME OF COTABATO FOR GIRLS


SECONDARY
DEPARTMENT 1992 1996
VOCATIONAL /

NONE NONE NONE NONE


TRADE
BACHELOR OF SCIENCE MAJOR IN
COURSE
COLLEGE NOTREDAME UNIVERSITY
BIOLOGY 1996 2000

COTABATO CITY STATE POLYTHECNIC


GRADUATE STUDIES
COLLEGE
MASTERS IN PUBLIC ADMINISTRATION 2008 2010
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.


(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization

Pls. indicate country:

GONZALO JAVIER
Street
ROSARY HEIGHTS 7
Barangay

Province
9600

MABINI
Street
BAGUA 3
Barangay

Province

09261657211

moharabiruar@yahoo.com/bmamilhasan@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

2/4/2016

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1996
NONE NONE

2000

parate 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

Institutional Partnership Division Officer for Department of Social Welfare &


2/1/2011 present NGAS/ ESGPPA Focal Development- ARMM ### 15 MOA
Department of Social Welfare &
4/1/2010 1/31/2011 Administrative Assistant Development- ARMM ### N/A MOA
Department of Social Welfare &
2/1/2010 3/31/2010 Technical Staff Development- ARMM 7,000.00 N/A MOA
Department of Social Welfare &
2/1/2009 12/31/2009 Regional Secretary Staff Development- ARMM ### N/A Contractual

7/23/2007 8/30/2007 Enumerator NSO Maguindanao ### N/A Contractual

9/20/2005 3/15/2007 HR Assistant Local Government of Parang 6,000.00 N/A Contractual

4/15/2005 6/30/2005 TELEMARKETER FORD DAVAO 4,500.00 N/A Contractual


Department of Environment and Natural
5/3/2002 12/30/2004 Administrative Assistant Resources-ARMM 6,000.00 N/A Contractual
PROVINCIAL GOVERNOR'S OFFICE,
6/15/2000 3/30/2002 Administrative Assistant PROVINCE OF MAGUINDANAO 5,000 N/A Contractual
(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)

Yes

Yes

Yes

Yes

NO

NO

NO

Yes

Yes
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
Department
ESGPPA Leadership Journey 2/8/2016 2/13/2016 32 HOUR TECHNICAL
Developmen
2015 Philhealth Forum 11/11/2015 11/13/2015 12 hours TECHNICAL

Department
Planning and Strategizing Workshop for ESGPPA Focal 10/21/2015 10/24/2015 24 HOURS TECHNICAL
Developmen
Zonal Assembly on ESGPPA Mindanao Cluster 8/26/2015 8/26/2015 8 HOURS TECHNICAL
Department
LGU Orientation on BUB Implementation 10/9/2014 10/11/2014 16 HOURS TECHNICAL
Developmen
Department
DSWD-ARMM Consultation Workshop with Grants team 8/13/2014 8/15/2014 18 HOURS TECHNICAL
Developmen
Department
Skill Enhancement on Technical Writing and Public Speaking 10/23/2013 10/25/2013 16 HOURS TECHNICAL
Developmen
Department
Gender Sensitivity Training 7/25/2013 7/27/2013 16 HOURS TECHNICAL
Developmen
Skills Enhancement Training for Project Development Officers for Institutional Department
5/28/2013 5/31/2013 24 HOURS TECHNICAL
Partnership Level 2 Developmen
Skills Enhancement Training for Project Development Officers for Institutional Department
10/16/2012 10/19/2012 24 HOURS TECHNICAL
Partnership Developmen
Department
Orientation Briefing on DSWD-CSO Engagement on FDS and FDS Plus 8/28/2012 8/31/2012 26 HOURS TECHNICAL
Developmen
Department
Quick Supply Side Assessment Database Training 24 HOURS TECHNICAL
Developmen
Department
Capability Building Training for CPAD 24 HOURS TECHNICAL
Developmen
Department
Pantawid Pamilya Prrogram Orientation 24 HOURS TECHNICAL
Developmen
Leadership Training for Youth Leaders 7/8/2009 7/9/2009 8 HOURS TECHNICAL CCSPC
Department
Compliance, Verification & Grievance System orientation 3/31/2009 4/4/2009 24 HOURS TECHNICAL
Developmen

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


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

NOTRE
filing, encoding, cooking, baking 4 YEARS PERFECT ATTENDANCE AWARD DEPA
COTABATO
facilitating

(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)

Department of Social Welfare and


Development
PHILHEALTH
Department of Social Welfare and
Development
CHED National Office
Department of Social Welfare and
Development ARMM
Department of Social Welfare and
Development ARMM
Department of Social Welfare and
Development ARMM
Department of Social Welfare and
Development ARMM
Department of Social Welfare and
Development
Department of Social Welfare and
Development
Department of Social Welfare and
Development
Department of Social Welfare and
Development
Department of Social Welfare and
Development
Department of Social Welfare and
Development
CCSPC
Department of Social Welfare and
Development

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
NOTRE DAME OF COTABATO FOR GIRLS
DEPARTMENT ALUMNI ASSOCIATION
COTABATO CITY STATE POLYTHECNIC COLLEGE
ALUMNI ASSOCIATION

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 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
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

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