CSC Personal Data Sheet

CS FORM 212 (Revised 2005)
PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes q with "P" and use separate sheet if necessary.
1. CS ID No.
I. PERSONAL INFORMATION
2. SURNAME
MAESTRECAMPO
FIRST NAME
NOVEE
MIDDLE NAME
ESTIVA
3. NAME EXTENSION (e.g. Jr., Sr.)
4. DATE OF BIRTH (mm/dd/yyyy)

5. PLACE OF BIRTH
11/05/1962
Sipalay City, Negros Occidental
16. RESIDENTIAL ADDRESS
Brgy. Gil Montilla, Sipalay City, Negros Occidental
6. SEX
7. CIVIL STATUS
Single
Married
Annulled
8. CITIZENSHIP
Filipino
9. HEIGHT (m)
170
10. WEIGHT (kg)
68
11. BLOOD TYPE
"A''
Widowed
Separated
Others, specify ___________
ZIP CODE
17. TELEPHONE NO.
18. PERMANENT ADDRESS
ZIP CODE
Brgy. Gil Montilla, Sipalay City, N
6113
19. TELEPHONE NO.
12. GSIS ID NO.
20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID NO.
21. CELLPHONE NO. (if any)
14. PHILHEALTH NO.
6113
11-000087794-8
+63 9993826041
22. AGENCY EMPLOYEE NO.
15. SSS NO.
23. TIN
152-134-018
II. FAMILY BACKGROUND

24. SPOUSE'S SURNAME
MAESTRECAMPO
25. NAME OF CHILD (Write full name and list all)
FIRST NAME
EVELYN
VEE ELARMO MAESTRECAMPO
MIDDLE NAME
ELARMO
MA.LEE ELARMO MAESTRECAMPO
OCCUPATION
GOVERNMENT EMPLOYEE
NOVEE ELARMO MAESTRECAMPO
EMPLOYER/BUS. NAME
LGU-HINOBA-AN, NEG.OCC.
IAN ELARMO MAESTRECAMPO
BUSINESS ADDRESS
HINOBA-AN, NEG.OCC
TELEPHONE NO.
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME
MAESTRECAMPO
FIRST NAME
ANGELINO
MIDDLE NAME
DAQUIPEL
DECEASED
27. MOTHER'S MAIDEN NAME

SURNAME
ESTIVA
FIRST NAME
ERLINDA
MIDDLE NAME
DELA TORRE
DECEASED
(Continue on separate sheet if neces
III. EDUCATIONAL BACKGROUND

28.
LEVEL
NAME OF SCHOOL
(Write in full)
DEGREE COURSE
(Write in full)
YEAR
GRADUATED
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
(if
INCLUSIVE DATE
ATTENDANCE
From
graduated)
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GENARO P. ALVAREZ ELEMENTARY SCHOOL, SIPALAY CITY,

NEG. OCC.
1974
GRADUATED
1969
HOLY ROSARY ACADEMY, SIPALAY CITY, NEG.OCC
1978
GRADUATED
1974
NEGROS OCCIDENTAL AGRICULTURAL COLLEGE, KABANKALAN

CITY, NEG. OCC.
1983
GRADUATED
1978
GRADUATE STUDIES
(to be filled up by CSC)
g. Jr., Sr.)
Occidental
palay City, Negros Occidental
DATE OF BIRTH (mm/dd/yyyy)

02/22/1988
12/18/1990
09/10/1993
09/24/1996
/
eet if necessary)
SIVE DATES OF
TENDANCE
To
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
1974
1978
1983
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY

29.
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER

SPECIAL LAWS/ CES/ CSEE
RATING
DATE OF EXAMINATION
/ CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
PNP ENTRANCE EXAMINATION
74.50%
11/05/1990
ILOILO CITY
SENIOR POLICE OFFICER
70.90%
04/26/1993
ILOILO CITY
POLICE OFFICER
72.14%
05/25/2003
ILOILO CITY
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30.
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE
DEPARTMENT / AGENCY / OFFICE / COMPANY

(Write in full)
From
(Write in full)
MONTHLY
SALARY
To
11/16/1991
12/31/1993
POLICE OFFICER 1
PHILIPPINE NATIONAL POLICE
1,000.00
01/01/1994
12/31/1994
POLICE OFFICER 1
1,800.00
01/01/1995
12/31/1995
POLICE OFFICER 1
2,800.00
01/01/1996
12/31/1996
POLICE OFFICER 1
3,800.00
01/01/1997
10/31/1997
POLICE OFFICER 1
4,600.00
11/01/1997
12/31/1999
POLICE OFFICER 1
5,000.00
01/01/2000
12/30/2000
POLICE OFFICER 1
6,082.00
12/31/2000
06/30/2001
POLICE OFFICER 2
6,610.00
07/01/2001
06/30/2002
POLICE OFFICER 2
7,920.00
07/01/2002
01/24/2005
POLICE OFFICER 2
9,668.00
01/25/2005
06/30/2009
POLICE OFFICER 3
10,863.00
07/01/2009
06/30/2010
POLICE OFFICER 3
12,210.00
07/01/2010
05/31/2011
POLICE OFFICER 3
15,307.00
06/01/2011
05/31/2012
POLICE OFFICER 3
16,986.00
06/01/2012
TO DATE
POLICE OFFICER 3
18,665.00
STILL IN THE ACTIVE SERVICE
SALARY GRADE &

STEP INCREMENT
(Format "00-0")
LICENSE (if applicable)

NUMBER
DATE OF RELEASE
GOV'T SERVICE
STATUS OF
APPOINTMENT
(Yes / No)
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
PERMANENT
YES
CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

INCLUSIVE DATES
31.
NAME & ADDRESS OF ORGANIZATION
NUMBER OF
HOURS
(mm/dd/yyyy)
(Write in full)
From
POSITION / NATURE OF
To
VII. TRAINING PROGRAMS (Start from the most recent training.)

INCLUSIVE DATES OF ATTENDANCE
32.
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT
COURSES (Write in full)
NUMBER OF
HOURS
(mm/dd/yyyy)
From
CONDUCTED/ SPONSORED BY
To
(MANDATORY CAREER COURSES)

PUBLIC SAFETY JUNIOR LEADERSHIP COURSE
06/10/2014
10/28/2014
720
RTC6, BACOLOD CITY, NEG.OC
PUBLIC SAFETY BASIC COURSE
11/16/1991
04/30/1992
1,132
VTC7 PNP TRACOM, APAS, CE
(SPECIAL TRAINING)
SPECIAL COUNTER INSURGENCY OPERATION UNIT
TRAINING
11/03/1993
12/20/1993
PRO6, RMFB CAMP HERNAND

ILOILO
(UNIT TRAINING)
CLOSE QUARTER BATTLE (CQB)
01/19/1993
02/15/1993
PRO6, CAMP MARTIN DELGAD
INTELLIGENCE ANALYST SEMINAR
11/20/1995
11/24/1995
PRO6 , R2 CAMP MARTIN DELG
NARCOTICS INTELLIGENCE AND INVESTIGATION
09/20/1999
10/27/1999
PRO6, NOPPO, NEG. OCC.
VIII. OTHER INFORMATION
MEMBERSHIP IN ASSOCIATION
33.
SPECIAL SKILLS / HOBBIES:
34. NON-ACADEMIC DISTINCTION/RECOGNITION:
(Write in full)
35.
in full)
CS FORM 212 (Rev
TION/S
POSITION / NATURE OF WORK
CONDUCTED/ SPONSORED BY
(Write in full)
RTC6, BACOLOD CITY, NEG.OCC.
VTC7 PNP TRACOM, APAS, CEBU CITY

PRO6, RMFB CAMP HERNANDEZ, DINGLE,
ILOILO
PRO6, CAMP MARTIN DELGADO, ILOILO
PRO6 , R2 CAMP MARTIN DELGADO, ILOILO
PRO6, NOPPO, NEG. OCC.
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
36. Are you related by consanguinity or affinity to any of the following :

a. Within the third degree (for National Government Employees):
appointing authority, recommending authority, chief of office/bureau/department or person who has

immediate supervision over you in the Office, Bureau or Department where you will be appointed?
If YES, give details:

_________________________________
_________________________________
_________________________________
b. Within the fourth degree (for Local Government Employees):
appointing authority or recommending authority where you will be appointed?

_________________________________
_________________________________
_________________________________
37 a. Have you ever been formally charged?

____________________________
____________________________
b. Have you ever been guilty of any administrative offense?

____________________________
____________________________
38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by
any court or tribunal?

____________________________
____________________________
39. 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, AWOL or
phased out, in the public or private sector?

____________________________
____________________________
40. Have you ever been a candidate in a national or local election (except Barangay election)?

____________________________
____________________________
41. 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?
If YES, please specify: _______________

b.
Are you differently abled?

c.
Are you a solo parent?

42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME
ADDRESS
HON. ERNESTO A. ESTRAO
HINOBA-AN, NEG.OCC.
HON. OSCAR C. MONTILLA
SIPALAY CITY, NEG. OCC.
TEL. NO.
43. I declare under oath that this Personal Data Sheet has been accomplished by me, and is a true, correct and complete
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust that this
information shall remain confidential.
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT
SIGNATURE (Sign inside the box)
ISSUED ON (mm/dd/yyyy)
DATE ACCOMPLISHED
CS FORM 212 (Revis
S, give details:
_________________________________
_________________________________
_________________________________
S, give details:
_________________________________
_________________________________
_________________________________
ES, give details:

____________________________
____________________________
ES, give details:

____________________________
____________________________
ES, give details:

____________________________
____________________________
ES, give details:

____________________________
____________________________
ES, give details:

____________________________
____________________________
S, please specify: ____________________
S, please specify: ____________________
S, please specify: ____________________
ID picture taken within

the last 6 months
3.5 cm. X 4.5 cm
(passport size)
Computer generated
or xerox copy of picture
is not acceptable
PHOTO
RIGHT THUMBMARK

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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

3. NAME EXTENSION (e.g. Jr., Sr.)

4. DATE OF BIRTH (mm/dd/yyyy)

16. RESIDENTIAL ADDRESS

Brgy. Gil Montilla, Sipalay City, Negros Occidental

10. WEIGHT (kg)

11. BLOOD TYPE

18. PERMANENT ADDRESS

Brgy. Gil Montilla, Sipalay City, N

19. TELEPHONE NO.

12. GSIS ID NO.

20. E-MAIL ADDRESS (if any)

13. PAG-IBIG ID NO.

21. CELLPHONE NO. (if any)

14. PHILHEALTH NO.

22. AGENCY EMPLOYEE NO.

15. SSS NO.

II. FAMILY BACKGROUND

25. NAME OF CHILD (Write full name and list all)

VEE ELARMO MAESTRECAMPO

MA.LEE ELARMO MAESTRECAMPO

NOVEE ELARMO MAESTRECAMPO

IAN ELARMO MAESTRECAMPO

27. MOTHER'S MAIDEN NAME

(Continue on separate sheet if neces

III. EDUCATIONAL BACKGROUND

GENARO P. ALVAREZ ELEMENTARY SCHOOL, SIPALAY CITY,

HOLY ROSARY ACADEMY, SIPALAY CITY, NEG.OCC

NEGROS OCCIDENTAL AGRICULTURAL COLLEGE, KABANKALAN

(to be filled up by CSC)

palay City, Negros Occidental

DATE OF BIRTH (mm/dd/yyyy)

IV. CIVIL SERVICE ELIGIBILITY

CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER

PLACE OF EXAMINATION / CONFERMENT

PNP ENTRANCE EXAMINATION

SENIOR POLICE OFFICER

(Continue on separate sheet if necessary)

INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

PHILIPPINE NATIONAL POLICE

STILL IN THE ACTIVE SERVICE

(Continue on separate sheet if necessary)