Maintenace, Driver, Welder, Housekeeping, forklift Operator

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 if accomplished through own handwriting. Tick appropriate boxes and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.

I. PERSONAL INFORMATION

1. SURNAME CANLAS

NAME EXTENSION (JR., SR) N/A

2. FIRST NAME EMIL

MIDDLE NAME BAGASBAS

3. DATE OF BIRTH: 12/21/1974

16. CITIZENSHIP: Filipino

4. PLACE OF BIRTH: LA PAZ TARLAC PHILIPPINES

5. SEX AT BIRTH: Male

6 CIVIL STATUS: Married

17. RESIDENTIAL ADDRESS: BLOCK 13 LOT 14 PHASE 2-B Block 13 Lot 14 TERESA HOMES TIBAG

Subdivision Tibag Tarlac City

7. HEIGHT (m) 1.63

8. WEIGHT (kg) 68 ZIP CODE 2300

9. BLOOD TYPE AB +

18. PERMANENT ADDRESS: BLOCK 13 LOT 14 PHASE 2-B Block 13 Lot 14 Teresa Homes Tibag Tarlac City Philippines

10. UMID ID NO. 021*******

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

12. PHILHEALTH NO. 07-025484322-7

ZIP CODE: 2300

13. PhilSys Number (PSN): 3964108901375863 19. TELEPHONE NO. 045-*******

14. TIN NO. 914-***-***-*** 20.

MOBILE NO. 092********

15. AGENCY EMPLOYEE NO. PGT-J3363

21. E-MAIL ADDRESS ************@*****.***

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME Dejucos

FIRST NAME: Marites

MIDDLE NAME: ONEZA

OCCUPATION: Housekeeper

23. NAME of CHILDREN: LEEANN EARL D. CANLAS

19/7/2003

VINZ KRISTOFF D. CANLAS

26/7/2009

MARK ANGEL GABRIEL D. CANLAS

11/11/2013

KIZZIAH CARMELA D. CANLAS

17/11/2015

24. FATHER'S SURNAME: CANLAS

FIRST NAME: ANGEL

MIDDLE NAME: LUNDANG

25. MOTHER'S MAIDEN NAME

SURNAME: BAGASBAS

FIRST NAME: LETICIA

MIDDLE NAME: RIVAS

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/

26. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE YEAR SCHOLARSHIP/

LEVEL (Write in UNITS

(Write in full) GRADUATED ACADEMIC HONORS

full) EARNED RECEIVED

(if not graduated)

From To

ELEMENTARY LAUNGCUPANG ELEMENTARY SCHOOL ELEMENTARY 1980 1987 GRADUATED 1987 N/A

SECONDARY

VOCATIONAL /

STA. LUCIA HIGH SCOOL HIGH SCHOOL 1987 1991 GRADUATED 1991 N/A

N/A N/A

TRADE

COURSE BACHELOR OF ARTS IN SOCIAL

COLLEGE TARLAC STATE UNIVERSITY SCIENCES [HISTORY] 199*-****-** UNITS N/A

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 11, 2025

CS FORM 212 (Revised 2025), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

27. LICENSE (if applicable)

CES/CSEE/CAREER SERVICE/RA 1080 (BOARD/ BAR)/UNDER

SPECIAL LAWS/CATEGORY II/ IV ELIGIBILITY and ELIGIBILITIES RATING DATE OF EXAMINATION / PLACE OF EXAMINATION /

(If Applicable) CONFERMENT CONFERMENT NUMBER Valid Until

FOR UNIFORMED PERSONNEL

N/A

(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 (dd/mm/ GOV'T SERVICE

yyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY STATUS OF

(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) APPOINTMENT

From To (Y/ N)

PROVINCIAL GOVERNMENT OF TARLAC PROVINCIAL

1/7/2025 30/9/2025 ADMINISTRATIVE ASSISTANT 1 PLANNING DEVELOPMENT OFFICE J. O. N

PROVINCIAL GOVERNMENT OF TARLAC PROVINCIAL

1/1/2025 30/6/2025 ADMINISTRATIVE ASSISTANT 1 PLANNING DEVELOPMENT OFFICE J. O. N

PROVINCIAL GOVERNMENT OF TARLAC PROVINCIAL

1/7/2024 31/12/2024 ADMINISTRATIVE ASSISTANT 1 PLANNING DEVELOPMENT OFFICE J. O. N

PROVINCIAL GOVERNMENT OF TARLAC PROVINCIAL

6/5/2024 30/6/2024 ADMINISTRATIVE ASSISTANT 1 PLANNING DEVELOPMENT OFFICE J. O. N

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 11, 2025

CS FORM 212 (Revised 2025), 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) (dd/mm/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

INCLUSIVE DATES OF

ATTENDANCE Type of L&D

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY

(Write in full) (dd/mm/yyyy) HOURS Supervisory/ (Write in full)

Technical/etc)

From To

NATIONAL CERTIFICATE IN HOUSEKEEPING 19/1/2024 30/3/2024 440.0 TECHNICAL TECHNICAL EDUCATION AND SKILLS

DEVELOPMENT AUTHORITY [TESDA]

NATIONAL CERTIFICATE IN DRIVING 13-05-2022 28-05-2022 120.0 TECHNICAL TECHNICAL EDUCATION AND SKILLS

DEVELOPMENT AUTHORITY [TESDA]

NATIONAL CERTIFICATE IN SHIELD METAL ARC WELDING [SMAW NC1] 22-10-2020 15-12-2020 360.0 TECHNICAL TECHNICAL EDUCATION AND SKILLS

DEVELOPMENT AUTHORITY [TESDA]

DIDITAL PHOTOGRAPHY & ADOBE PHOTOSHOP CS2 BASIC 24-02-2006 3/2/2006 112.0 TECHNICAL PHILIPPINE CENTER FOR CREATIVE IMAGING

(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)

COOKING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 11, 2025

CS FORM 212 (Revised 2025), 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

b. within the fourth degree (for Local Government Unit - Career Employees)? YES

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 out (abolition) YES NO

If YES, give details:

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,

as amended); and (c) Expanded Solo Parents Welfare Act (RA 11861), 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)

CONTACT NO. AND/OR

NAME OFFICE / RESIDENTIAL ADDRESS EMAIL

JHAN KENNERY B. TOLENTINO SAN ISIDRO, TARLAC CITY 091*-***-****

Passport-sized unfiltered

JOVELYN NAVARRO TIBAG, TARLAC CITY 092*-***-**** digital picture taken within

the last 6 months

4.5 cm. X 3.5 cm

EDUARDO PASACAY TIBAG, TARLAC CITY 090*-***-****

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

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: DRIVERS LICENSE

ID/License/Passport No.: C11-09-007135

Signature (Sign inside the box)

SEPTEMBER 11, 2025

Date/Place of Issuance: LTO TARLAC DISTRICT OFFICE

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 2025), Page 4 of 4

Contact this candidate