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 only.)

I. PERSONAL INFORMATION
2. SURNAME ETCOBANEZ

FIRST NAME DAISY NAME EXTENSION (JR., SR) N/A

MIDDLE NAME MIANO

3. DATE OF BIRTH 16. CITIZENSHIP √ Filipino Dual Citizenship

(mm/dd/yyyy) 12/26/1988 If holder of dual citizenship, √ by birth by naturalization
please indicate the details. Pls. indicate country:

4. PLACE OF BIRTH GUADALUPE, BOGO, CEBU 17. RESIDENTIAL ADDRESS

MALIPAYON
5. SEX Male √ Female House/Block/Lot No. Sitio

6 CIVIL STATUS Single √ Married PUROK MAPAHIYUMON GUADALUPE

Widowed Separated Subdivision/Village Barangay

Other/s: BOGO CITY CEBU

City/Municipality Province
7. HEIGHT (m) 1.473m

WEIGHT (kg) 47 kg ZIP CODE 6010

8.
18. PERMANENT ADDRESS MALIPAYON
9. BLOOD TYPE O
House/Block/Lot No. Sitio
PUROK MAPAHIYUMON GUADALUPE
10. GSIS ID NO. N/A
Subdivision/Village Barangay
BOGO CITY CEBU
11. PAG-IBIG ID NO. 9181-2437-4458
City/Municipality Province

12. PHILHEALTH NO. 0125-2361-9398 ZIP CODE 6010

13. SSS NO. 06-4117521-3 19. TELEPHONE NO. N/A

14. TIN NO. 350-695-352-0000 20. MOBILE NO. 9559964862

15 AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) daisyetcobanez581@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME ETCOBANEZ 23. NAME OF CHILDREN (Write full name & list all) DATE OF BIRTH(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME ZEM KHIAN MIANO ETCOBANEZ 08/13/2009

MIDDLE NAME BRANZUELA ZED MIANO ETCOBANEZ 10/16/2010

OCCUPATION COLLECTOR AVRIL CHLOE MIANO ETCOBANEZ 4/27/2013

EMPLOYER/BUSINESS NAME MCD CREDIT CORPORATION

BUSINESS ADDRESS P.DEL ROSARIO ST., SAMBAG EXTENSION, CEBU CITY

TELEPHONE NO. 253-9815

24. FATHER'S SURNAME MIANO

NAME EXTENSION (JR., SR)
FIRST NAME ERNESTO

MIDDLE NAME NAILON

25. MOTHER'S MAIDEN NAME

SURNAME MICARSOS

FIRST NAME LUCILA

MIDDLE NAME OLIAMOT (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL BASIC EDUCATION/DEGREE/ SCHOLARSHIP/
PERIOD OF HIGHEST LEVEL/
26. COURSE YEAR ACADEMIC
LEVEL ATTENDANCE UNITS EARNED
GRADUATED HONORS
From To (If not graduated)
(Write in full) (Write in full) RECEIVED
GUADALUPE ELEMENTARY
ELEMENTARY BASIC EDUCATION 1996 2002 N/A 2002 WITH HONORS
SCHOOL

DON POTENCIANO CATARATA

SECONDARY MEMORIAL NATIONAL HIGH HIGH SCHOOL 2002 2006 N/A 2006 WITH HONORS
SCHOOL
VOCATIONAL /
CEBU ROOSEVELT MEMORIAL
VOCATIONAL 2008 2008 N/A 2008 N/A
COLLEGES
TRADE COURSE NORTHERN CEBU COLLEGES BACHELOR OF SECONDARY
COLLEGE 2014 2018 N/A 2018 N/A
INCORPORATED EDUCATION
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
CAREER SERVICE/ RA 1080 (BOARD/ BAR) LICENSE (if applicable)
27. DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE RATING
EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / (If Applicable) Date of
CONFERMENT NUMBER
DRIVER'S LICENSE Validity

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

(Continue on separate sheet if necessary)

V. WORK EXPERIENCE GOV'T
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. SERVICE
INCLUSIVE DEPARTMENT / AGENCY / OFFICE / SALARY/ JOB/ PAY
28. DATES POSITION TITLE
COMPANY MONTHLY GRADE (if applicable)& STATUS OF
(mm/dd/yyyy) (Write in full/Do not SALARY STEP (Format "00-0")/ APPOINTMENT
(Write in full/Do not abbreviate)
From To abbreviate) INCREMENT
(Y/
PHILIPPINE STATISTICS AUTHORITY
10/18/2020 12/31/2020 REGISTRATION OFFICER 1 28, 000 10 CONTRACTUAL N)
Y
( PHILSYS)
MAKE IT EZ EDUCATIONAL PROGRAM
10/08/2019 3/8/2020 ACCOUNT OFFICER 11, 000 0-0 CONTRACTUAL N
CORPORATION
LAYESE - CORTES REVIEW AND
09/21/2019 3/1/2020 PART TIME TUTOR 1, 200.00 0-0 N/A N
TUTORIAL CENTER

08/09/2018 08/10/2019 PRODUCTION OPERATOR MINEBEAMITSUMI 12, 500.00 0-0 CONTRACTUAL N

(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 NUMBER OF
(Write in full) POSITION / NATURE OF WORK
(mm/dd/yyyy) HOURS
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 relevantINCLUSIVE
L&D/trainingDATES
taken for
OF
the last five (5) years for Division Chief/Executive/Managerial positions)
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT
NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS
HOURS Supervisory/ (Write in full)
(Write in full) (mm/dd/yyyy)To
From Technical/etc)
SEMINAR WORKSHOP ON PREPARING JOBSEEKERS FOR THE
09/06/2008 09/06/2008 6 TECHNICAL MR. VICENTE C. MAGLASANG
FUTURE
ON-THE-JOB HANDS-ON TRAINING ON HOUSEKEEPING AND FOOD
09/08/2008 09/27/2008 126 TECHNICAL MR. MARK ANTHONY A. YNOC
BEVERAGES DEPARTMENT

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in
full)
SINGING N/A N/A

READING BOOKS N/A N/A

MARKETING N/A N/A

(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:

If
YE
35. a. Have you ever been found guilty of any administrative offense? S, YES √ NO
giv If YES, give details:
e
det
ail
s:
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 __ YES √ NO
rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private sector? __ If YES, give details:
______________________
__
__
__
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 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:

c. Are you a solo parent? YES √ NO

If YES, please specify:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.
MR. JAN AXEL LAYESE CORTES BOGO CITY, CEBU 09351209683
MR. ARGIE C. BRIGOLA BOGO CITY, CEBU 9995046229
MS. JOCELYN PIAÑAR GUADALUPE, BOGO CITY, CEBU 9352477884
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.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC,

Driver's License, etc.)
PLEASE INDICATE ID Number and Date of Issuance

Government Issued ID: SSS/UMID

ID/License/Passport No.: 0111-9762666-8

Signature (sign inside the box)

Date/Place of Issuance: 03/8/2019

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