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 MANZO
NAME EXTENSION (JR., SR)
FIRST NAME DONNA LYN
MIDDLE NAME DIONES
3. DATE OF BIRTH
10/15/1988 16. CITIZENSHIP Dual
(mm/dd/yyyy) ✘ Filipino by by
Citizenship
birt naturalizatio
4. PLACE OF BIRTH QUEZON CITY If holder of dual citizenship, Pls. h n
indicate country:
please indicate the details.
5. SEX Male ✘ Femal
Single ✘
e
Marrie 17. RESIDENTIAL ADDRESS BLK 7 LOT 12 MAHOGANY
6 CIVIL STATUS
House/Block/Lot No. Street
Widow Separ
d SILANGANAN 167
Other/
ed ated Subdivision/Village Barangay
7. HEIGHT (m)
s:
157.48 CM CALOOCAN METRO MANILA
City/Municipality Province
8. WEIGHT (kg) 72 KG ZIP CODE 1400
18. PERMANENT ADDRESS
9. BLOOD TYPE
House/Block/Lot No. Street
10. GSIS ID NO.
Subdivision/Village Barangay
11. PAG-IBIG ID NO.
City/Municipality Province
12. PHILHEALTH NO. 02-250863463-7 ZIP CODE
13. SSS NO. 19. TELEPHONE NO.
14. TIN NO. 460-274-923-000 20. MOBILE NO. 09154402656
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) MHICODHONZ08@[Link]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME MANZO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME MICHAEL KYLE MATTHEW MANZO 8/14/2010
MIDDLE NAME BARCE
OCCUPATION MAINTENANCE
EMPLOYER/BUSINESS NAME BESTLINK COLLEGE OF THE PHILIPPINES
BUSINESS ADDRESS QUEZON CITY
TELEPHONE NO. N/A
24. FATHER'S SURNAME DIONES
NAME EXTENSION (JR., SR)
FIRST NAME MAXIMO
MIDDLE NAME ASENAS
25. MOTHER'S MAIDEN NAME
SURNAME CRUZ
FIRST NAME EVELYN
MIDDLE NAME CALMA (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 CAMARIN D ELEMENTARY SCHOOL 1995 2001
SECONDARY MALIGAYA HIGH SCHOOL 2001 2005
VOCATIONAL /
TRADE
COURSE UNDERGR
COLLEGE OUR LADY OF FATIMA UNIVERSITY BACHELOR OF SCIENCE IN NURSING 2005 ADUATE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE
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 SALARY/ JOB/ PAY SERVICE
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY GRADE (if 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)
3/18/2022 9/8/2024 ADMIN STAFF / LIASON OFFICER / FIRST ELECTRICAL CONTROL CORPORATION
AIDER /
10/10/2010 2/1/2012 OFFICE WORKER REBISCO GROUP OF COMPANIES
(Continue on separate sheet if necessary)
SIGNATURE DATE
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
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
BASIC FIRE SAFETY AWARENESS TRAINING 3/18/20/24 3/18/20/24 4.0 TRAINOVATE
INTRODUCTION TO CSS N/A 11/6/20/22 TECHNICAL EDUCATION AND SKILLS
DEVELOPMENT AUTHORITY
LIVELIHOOD PROJECT BASIC CELLPHONE REPAIR TECHNICIAN 11/16/2020 12/4/20/20 BARANGAY 167
LIVELIHOOD PROJECT BASIC ELECTRONICS (TV REPAIR) 11/28/2020 12/29/2020 BARANGAY 167
COMPUTER LITERACY PROGRAM 10/22/2014 12/13/2014 BARANGAY 167
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (Write in
full)
Computer Literate
Can handle calls and mails
Can get along well with different kind of people
Willing to try new things and interested in
improving efficiency on assigned tasks
(Continue on separate sheet if necessary)
SIGNATURE DATE
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 ✘
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 ✘YES NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
RESIGNATION
________________________________
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
MARY ANN ABANTE CALOOCAN CITY 4.5 cm. X 3.5 cm
(passport size)
MALOU SUIZO CALOOCAN CITY
Computer generated
or photocopied picture
ELISEO LIBRE BOHOL is not acceptable
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 ([Link], GSIS, SSS, PRC, Driver's License, etc.)
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: 7501-0631B-J1588DDM20000
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 of 4
