CS Form No. ***

Revised ****

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 BASILIO

NAME EXTENSION (JR., SR)

FIRST NAME ROLAND

MIDDLE NAME CABANAL

3. DATE OF BIRTH

16. CITIZENSHIP

(mm/dd/yyyy) 8/10/1979 Filipino Dual Citizenship

by by

birth naturalization

4. PLACE OF BIRTH TETUAN, Zamboanga City If holder of dual citizenship, Pls. indicate country:

please indicate the details.

5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS Datelis Drive

Widowe Separat House/Block/Lot No. Street

Km-5 Lantawan Pasonanca

dOther/s: ed

Subdivision/Village Barangay

Zamboanga City Pasonanca

7. HEIGHT (m) 5 "4"

City/Municipality Province

8. WEIGHT (kg) 80 KG ZIP CODE 7000 Zamboanga Del Sur

18. PERMANENT ADDRESS Datiles Drive

9. BLOOD TYPE A+

House/Block/Lot No. Street

Km-5 Lantawan Pasonanca

10. GSIS ID NO. N/A

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121*********

Zamboanga City Pasonanca

City/Municipality Province

12. PHILHEALTH NO. 02-050*****-** ZIP CODE 7000 Zamboanga del Sur

13. SSS NO. 100*******-**. TELEPHONE NO. NONE

14. TIN NO. 253-***-***-**. MOBILE NO. 006***********

15. AGENCY EMPLOYEE NO. 201-***-**** 21. E-MAIL ADDRESS (if any) ad326u@r.postjobfree.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME Basilio 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) Mark Lorenz Lacastesantos Basilio

FIRST NAME Maricel January 26, 2004

Ian Roy Lacastesantos Basilio

MIDDLE NAME Lacastesantos October 07, 2005

OCCUPATION House Wife

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Basilio

NAME EXTENSION (JR., SR)

FIRST NAME Andres

MIDDLE NAME Reyes

25. MOTHER'S MAIDEN NAME Edna Ladon Cabanal

SURNAME Basilio

FIRST NAME Edna

MIDDLE NAME Cabanal (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/

26. PERIOD OF ATTENDANCE YEAR

LEVEL (Write in BASIC EDUCATION/DEGREE/COURSE UNITS

GRADUATED

ACADEMIC

full)

(Write in full) EARNED HONORS

(if not graduated) RECEIVED

From To

March Band

ELEMENTARY TETUAN, Zamboanga City 1986 1992

VOCATIONAL / 1992 Member

Zamboanga City High School March

SECONDARY 1992 1996

( Main ) 1996

Zamboanga State College Of Marine Bachelor Of Science In Marine March Baseball

1996 2000

COLLEGE Science And Technology Technology 2000 Varsity

TRADE COURSE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE ROLAND C. BASILIO DATE August 17, 2023

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

(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 (mm/dd/ SALARY/ JOB/ PAY SERVICE

yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if

MONTHLY STATUS OF

(Write in full/Do not (Write in SALARY

applicable)& STEP

APPOINTMENT

abbreviate) full/Do not abbreviate) (Format "00-0")/

INCREMENT

From To

(Y/ N)

01-04-2023 Present ADMINSTRATIVE ASST. II (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

1/4/2022 12/31/2022 ADMINSTRATIVE ASST. (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

1/5/2021 12/31/2021 ADMINSTRATIVE ASST. (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

1/3/2020 12/31/2020 ADMINSTRATIVE ASST. (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

1/4/2019 12/31/2019 ADMINSTRATIVE ASST. (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

10-01-2018 12/31/2018 ADMINSTRATIVE ASST. (CONTRATUAL) DOH REGIONAL OFFICE IX Php.16,20

0

10-17-2017 ABLE SEAMAN PHILIPPINE TRANSMARINE CARRIER $1,315.00

4/7/2016 ABLE SEAMAN CITADEL SHIPPING INC. $1,257.00

ABLE SEAMAN CITADEL SHIPPING INC.

ABLE SEAMAN CITADEL SHIPPING INC.

ABLE SEAMAN CITADEL SHIPPING INC.

ABLE SEAMAN CITADEL SHIPPING INC.

12-26-2010 ABLE SEAMAN / ORDINARY SEAMAN CITADEL SHIPPING INC. $950.00

PROPERTY CUSTODIAN ATENEO DE

06-01-2007 10-23-2009 OFFICE SUPPORT STAFF

ZAMBOANGA UNIVERSITY

DIRECTOR FOR STUDENT AFFAIRS

06-01-2004 05-26-2007 STUDENT ASSISTANT

ATENEO DE ZAMBOANGA UNIVERSITY

(Continue on separate sheet if necessary)

SIGNATURE ROLAND C. BASILIO DATE August 17, 2023

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

(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

Zamboanga Maritime Training Center

CROWD AND CRISIS MANAGEMENT 8/23/2018 8/25/2018 24 HRS

INC.

SHIP STEERING COURE 1/8/2016 1/8/2016 8 HRS SEAPRENEUR TRAINING CENTER INC.

AMC MARITIME SKILLS COMPETENCY

ENCLOSE SPACE ENTRYAND RESCUE 1/4/2016 1/5/2016 16 HRS

CENTER

SHIP SECURITY AWARENESS TRAINING AND SEAFARERS WITH

7/30/2014 7/30/2014 8 HRS MARIANA MARITIME CENTER, INC.

DESIGNATED SECURITY DUTY

Zamboanga Maritime Training Center

PROFICIENCY IN SURVIVAL CRAFT AND RESCUE BOAT 7/16/2014 7/19/2014 31.5 HRS

INC.

Zamboanga Maritime Training Center

MARPOL 73/78, ANNEXES I-VI CONSOLODATED COURSE 7/9/2014 7/13/2014 40 HRS

INC.

Zamboanga Maritime Training Center

BASIC TRAINING 6/25/2014 7/2/2014 60 HRS

INC.

Zamboanga Maritime Training Center

PROFICIENCY IN FAST RESCUE BOAT 6/11/2014 6/14/2014 24 HRS

INC.

Zamboanga Maritime Training Center

ADVANCE TRAINING IN FIRE FIGTHING 6/18/2014 6/22/2014 36 HRS

INC.

TECHNICAL EDUCATION AND SKILL

CERTIFICATE OF COMPETENCY 2/5/2010

DEVELOPMENT AUTHORITY

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

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

(Write in full)

full)

BASKETBALL

BASEBALL VARSITY ATENEO DE ZAMBOANGA UNIVERSITY

SOFTBALL VARSITY ATENEO DE ZAMBOANGA UNIVERSITY

(Continue on separate sheet if necessary)

SIGNATURE ROLAND C. BASILIO DATE : AUGUST 17, 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

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

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

JOSE NOEL F. TORRES TETUAN ZAMBOANGA CITY 955-***-**** 3.5 cm. X 4.5 cm

(passport size)

BAMBI B. SARSOSA STA. MARIA ZAMBOANGA CITY 917-***-**** With full and handwritten

name tag and signature over

printed name

CRISPIN R. BASILIO GUIWAN ZAMBOANGA CITY 906-***-****

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

complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the is not acceptable

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 administrative/

criminal case/s against me. PHOTO

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

Government Issued ID: 201-***-****

ID/License/Passport No.: JQ4-01-086862

Signature (Sign inside the box)

Date/Place of Issuance: 01/2018 /Zamboanga 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

Contact this candidate