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 ALLA
NAME EXTENSION (JR., SR)
FIRST NAME LAIZA LYN

MIDDLE NAME MALANA

3. DATE OF BIRTH
11/16/1992 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH LIBAG NORTE, TUGUEGARAO 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 31 MAHARLIKA HIGHWAY

Widowed Separated House/Block/Lot No. Street
LIBAG NORTE
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) TUGUEGARAO CAGAYAN VALLEY
1.524 City/Municipality Province
8. WEIGHT (kg) ZIP CODE
75
18. PERMANENT ADDRESS 31 MAHARLIKA HIGHWAY
9. BLOOD TYPE
O House/Block/Lot No. Street
10. GSIS ID NO. TUGUEGARAO CAGAYAN VALLEY
N/A Subdivision/Village Barangay
11. PAG-IBIG ID NO.
9143-3624-3526 City/Municipality Province
12. PHILHEALTH NO. ZIP CODE 3500
01-052000975-8

13. SSS NO. 19. TELEPHONE NO.

34-4834290-3 N/A

14. TIN NO. 20. MOBILE NO.

319-618-583 09752434131

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

664 laizalyn.alla@gmail.com
II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME
N/A N/A
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME ALLA

FIRST NAME NAME EXTENSION (JR., SR)

JOSELITO
MIDDLE NAME TALUSAN
25. MOTHER'S MAIDEN NAME

SURNAME MALANA
FIRST NAME HILARIA
MIDDLE NAME SORIANO (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST
PERIOD OF LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR SCHOLARSHIP/
ATTENDANCE UNITS
LEVEL (Write in full) GRADUAT ACADEMIC HONORS
EARNED
(Write in full) ED RECEIVED
From To (if not
graduated)
ELEMENTARY LIBAG ELEMENTARY SCHOOL ELEMENTARY 1999 2005 GRADUATED 2005 VALEDICTORIAN

5TH HONORABLE
SECONDARY /
VOCATIONAL CAGAYAN NATIONAL HIGH SCHOOL HIGH SCHOOL 2005 2009 GRADUATED 2009 MENTION; CARSUMCO
SCHOLAR

N/A

TRADE BIN-I TI AGTUTUBO,

COURSE CAGAYAN STATE UNIVERSITY-ANDREWS BACHELOR OF SCIENCE IN
COLLEGE 2009 2014 GRADUATED 2014 MAYOR'S SCHOLAR,
CAMPUS ACCOUNTANCY
CARSUMCO SCHOLAR

GRADUATE STUDIES UNIVERSITY OF CAGAYAN VALLEY MASTER IN BUSINESS ADMINISTRATION 2016 2018 GRADUATED 2018 N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE

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 applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

CERTIFIED PUBLIC ACCOUNTANT BOARD EXAM 79.57 OCTOBER 2014 MANUEL L. QUEZON UNIVERSITY-QUIAPO 0158123 11/16/2020

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP STATUS OF APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
N)

04/16/2019 PRESENT OIC-CAMPUS ACCOUNTANT CAGAYAN STATE UNIVERSITY - GONZAGA 20,135.40 Contractual Yes

03/07/2016 04/15/2019 UNIVERSITY ACCOUNTANT UNIVERSITY OF CAGAYAN VALLEY 27,900.00 Permanent No

01/31/2018 05/31/2019 PART-TIME PROFESSOR UNIVERSITY OF CAGAYAN VALLEY 5,220.00 Contractual No

08/07/2016 12/16/2016 PART-TIME PROFESSOR UNIVERSITY OF CAGAYAN VALLEY 4,860.00 Contractual No

11/03/2015 03/05/2016 FULL-TIME PART-TIME PROFESSOR CAGAYAN STATE UNIVERSITY - APARRI 18,000.00 Contractual Yes
RAMON F. GARCIA & COMPANY, CERTIFIED PUBLIC
11/10/2014 05/27/2015 ASSOCIATE AUDITOR ACCOUNTANTS' 15,000.00 Contractual No

75

664

(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

N/A N/A N/A N/A N/A

(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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

CAPACITY BUILDING OF CSU PROCUREMENT OFFICIALS AND STAFF 06/17/2019 06/18/2019 16.0 TECHNICAL CAGAYAN STATE UNIVERSITY

QMS REQUIREMENTS TRAINING COURSE (ISO 9001:2015) 1/9/2018 1/9/2018 8.0 TECHNICAL BRITISH STANDARDS INSTITUTION (BSI)
PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC
AUDIT REPORT AND COMMON ERRORS IN FINANCIAL STATEMENTS 02/24/2018 02/24/2018 8.0 TECHNICAL ACCOUNTANTS
PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC
TAX UPDATES AND TAX REFORM (TRAIN) 02/22/2018 02/22/2018 8.0 TECHNICAL ACCOUNTANTS
IPG TRAINING INSTITUTE FOR
PREPARING INCOME TAX RETURNS FOR THE APRIL 15, 2017 TAX FILING 02/25/2017 02/25/2017 3.3 TECHNICAL PROFESSIONAL ADVANCEMENT
IPG TRAINING INSTITUTE FOR
THE CURRENT UPDATES IN WITHHOLDING TAX 8/8/2016 8/8/2016 4.0 TECHNICAL PROFESSIONAL ADVANCEMENT

TRANSITION COURSE FOR THE QUALITY MANAGEMENT SYSTEM 5/20/2016 5/20/2016 4.0 TECHNICAL UNIVERSITY OF CAGAYAN VALLEY,INC.
INSTITUTE OF CERTIFIED PUBLIC
1ST NOTHERN LUZON REGIONAL CONFERENCE 2/19/2016 2/20/2016 17.0 TECHNICAL ACCOUNTANTS

BUSINESS ASSURANCE SEMINAR 1 10/11/2014 11/25/2014 95.0 TECHNICAL RFG & COMPANY CPAs

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)
PHILIPPINE INSTITUTE OF CERTIFIED PUBLIC
Written and Oral Communication Skills N/A
ACCOUNTANTS

Basic Accounting and Bookkeeping

Basic Computer Operations

Interpersonal Skills

Financial Statement Preparation and Analysis *

(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 ✘ 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? RESIGNATION
________________________________
________________________________
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
EMERITA P. GERON TUGUEGARAO CITY 09361929128 (passport size)

With full and handwritten

VENANCIO C. DEL ROSARIO JR. TUGUEGARAO CITY 09176053697 name tag and signature over
printed name
MADELEINE M. ADDUN TUGUEGARAO CITY 09176214346 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
PROFESSIONAL REGULATION
Government Issued ID:
COMMISSION

ID/License/Passport No.: 0158123

Signature (Sign inside the box)

Date/Place of Issuance: MANILA

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