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 QUIMBO
NAME EXTENSION (JR., SR) N/A
FIRST NAME NITZ VANESSA

MIDDLE NAME ALLIOSADA

3. DATE OF BIRTH
09/06/1993 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
✘
by by
birth naturalization
4. PLACE OF BIRTH VITAS KATUPARAN TONDO MANILA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female
6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS Purok Rovalgon

Widowe Separat House/Block/Lot No. Street

Calumpang
d ed
Other/s: Subdivision/Village Barangay
General Santos City South Cotabato
7. HEIGHT (m) 1.52
City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 9500

18. PERMANENT ADDRESS Purok Rovalgon

9. BLOOD TYPE O
House/Block/Lot No. Street
Calumpang
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1211-4190-7242 General Santos City South Cotabato

City/Municipality Province

12. PHILHEALTH NO. 1725-0776-2013 ZIP CODE 9500

13. SSS NO. 0111-4949317-9 19. TELEPHONE NO. N/A

14. TIN NO. 766-040-536-00000 20. MOBILE NO. 0920-9189-362

15. AGENCY EMPLOYEE NO. 2020001 21. E-MAIL ADDRESS (if any) quimbonitzvanessa@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 N.A

MIDDLE NAME N/A

OCCUPATION ACCOUNT ASSOCIATE

EMPLOYER/BUSINESS NAME VA MAJEC CREDIT & FINANCE CORPORATION

BUSINESS ADDRESS ONE IRIS BUILDING PENDATUN AVENUE GENERAL SANTOS CITY

TELEPHONE NO. 554-1604

24. FATHER'S SURNAME QUIMBO

NAME EXTENSION (JR., SR)
FIRST NAME FELOMINO

MIDDLE NAME CALUNOD

25. MOTHER'S MAIDEN NAME NENITA CAMPANER ALLIOSADA

SURNAME ALLIOSADA

FIRST NAME NENITA

MIDDLE NAME CAMPANER (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/ SCHOLARSHIP/
26. PERIOD OF ATTENDANCE YEAR
BASIC EDUCATION/DEGREE/COURSE UNITS ACADEMIC
LEVEL (Write in EARNED
GRADUATED
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY ROMANA C. ACHARON ELEMENTARY SCHOOL ELEMENTARY 2000 2006 GRADUATED 2006 N/A

SECONDARY /
VOCATIONAL GENERAL SANTOS CITY HIGH SCHOOL SECONDARY 2006 2010 GRADUATED 2010 N/A

GENERAL SANTOS NATIONAL SCHOOL OF ARTS

AND TRADES
VOCATIONAL-BOOKKEEPING 04/01/2017 07/10/2017 COMPLETED 2017 N/A
TRADE
BACHELOR OF SCIENCE IN INFORMATION
COURSE
COLLEGE GOLDENSTATE COLLEGE
TECHNOLOGY
2010 2015 GRADUATED 2015 N/A

BACHELOR OF SCIENCE IN SECONDARY 18 UNITS

COLLEGE BROKENSHIRE COLLEGE 03/19/2017 08/13/2017 2017 N/A
EDUCATION COMPLETED

GRADUATE STUDIES MINDANAO STATE UNIVERSITY MASTER IN PUBLIC ADMINISTRATION 2018 ONGOING 30 UNITS N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 08/03/2020

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

LICENSED PROFESSIONAL TEACHER 78.2% 09/30/2018 GENERAL SANTOS CITY 1716436 01/11/2019

(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
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To
(Y/ N)
VA MAJEC CREDIT & FINANCE
06/01/2015 PRESENT ACCOUNT ASSOCIATE REGULAR N
CORPORATION P 11,500.00 N/A
 (Continue on separate sheet if necessary)

SIGNATURE DATE 08/03/2020

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

CATHOLIC YOUTH MINISTRY 09/06/2010 PRESENT N/A TREASURER/PRAYER MEETING AND CHURCH VOLUNTEERISM AND

SUPPORT TO PRAYER ACTIVITIES.

(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

MINDANAO STATE UNIVERSITY, GENERAL SANTOS

COMMUNITY-BASED MANAGEMENT SYSTEM (CBMS) WORKSHOP FOR LGU FATIMA 11/15/2019 11/15/2019 8 HOURS MANAGERIAL CITY/BARANGAY-LGU FATIMA/SANGGUNIANG KABATAAN,
GENERAL SANTOS CITY

LEADERSHIP TRAINING ON VISION BUILDING AND STRATEGIC ACTION PLANNING USING MINDANAO STATE UNIVERSITY, GENERAL SANTOS
10/12/2019 10/12/2019 8 HOURS MANAGERIAL
TECHNOLOGY OF PARTICIPATION (ToP) CITY
TECHNICAL EDUCATION AND SKILLS
NATIONAL TVET TRAINER CERTIFICATE LEVEL I IN BOOKKEEPING NC III 11/15/2018 11/15/2018 8 HOURS TECHNICAL
DEVELOPMENT AUTHORITY
TECHNICAL EDUCATION AND SKILLS
NATIONAL CERTIFICATE III IN BOOKKEEPING 08/12/2017 08/12/2017 8 HOURS TECHNICAL
DEVELOPMENT AUTHORITY

BOOKKEEPING NC III 08/12/2017 08/16/2017 292 HOURS TECHNICAL VILLAMOR COLLEGE OF BUSINESS & ARTS INC.

COMPUTERS AND OPERATING SYSTEM, INTERNET AND EMAIL, WORD PROCESSING,

11/13/2017 11/17/2017 16 HOURS TECHNICAL GENERAL SANTOS NATIONAL SCHOOL OF ARTS
SPREADSHEETS AND MULTIMEDIA
PROVINCIAL CAPITOL, PROVINCE OF DAVAO DEL
ON THE JOB TRAINING COURSE 06/01/2014 12/20/2014 960 HOURS TECHNICAL
SUR

PROVINCIAL GOVERNMENT OF DAVAO DEL SUR-

INTEGRATED COASTAL MANAGEMENT PLAN ENHANCEMENT WRITESHOP 09/02/2014 09/04/2014 24 HOURS MANAGERIAL DEPARTMENT OF ENVIRONMENT AND NATURAL
RESOURCES

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
full)

BADMINTON N/A N/A

PHOTOGRAPHY

COMPUTER LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE 08/03/2020

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? ________________________________
________________________________
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
STA. THERESA BRGY. SAN ISIDRO the last 6 months
MR. ADING DELA ROSA, RCRIM GENERAL SANTOS CITY
0948-987-8015 3.5 cm. X 4.5 cm
(passport size)

COLLEGE OF GRADUATE SCHOOL- With full and handwritten

MR. WILFRED D. BIDAD, PH.D MINDANAO STATE UNIVERSITY-DEAN
(083) 887-1160 name tag and signature over
printed name

Computer generated
PRINCIPAL-CALUMPANG ELEMENTARY
MRS. JESSICA T. VERALLO SCHOOL
0907-279-2512 or photocopied picture
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 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
Government Issued ID: PROFESSIONAL REGULATION COMMISSION

ID/License/Passport No.: 1716436

Signature (Sign inside the box)
08/03/2020
Date/Place of Issuance: 01/11/2019/GENERAL SANTOS 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