Download as xlsx, pdf, or txt
Download as xlsx, pdf, or txt
You are on page 1of 7

rn

CS Form No. 212


Revised 2017

PERSONAL DATA SHEET


WARNING: Any misinterpretation 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 IGNACIO
NAME EXTENSION (JR., SR) NA
FIRST NAME RHEA NYKA
MIDDLE NAME ANTONIO
3. DATE OF BIRTH
(mm/dd/yyyy) 7/6/1994 16. CITIZENSHIP

4. PLACE OF BIRTH SAN MANUEL, ISABELA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS 1400 MA. CLARA COR. MACEDA ST.
House/Block/Lot No. Street
BRGY. 498
Subdivision/Village Barangay
7. HEIGHT (m) 5'1" SAMPALOC METRO MANILA
City/Municipality Province
8. WEIGHT (kg) 68 ZIP CODE 1008
9. BLOOD TYPE AB+
18. PERMANENT ADDRESS PUROK II
House/Block/Lot No. Street

10. GSIS ID NO. N/A SANDIAT CENTRO


Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121232715548 SAN MANUEL ISABELA


City/Municipality Province

12. PHILHEALTH NO. 06-025283282-6 ZIP CODE 3317


13. SSS NO. 34-7817329-4 19. TELEPHONE NO. N/A
14. TIN NO. 345-385-669-000 20. MOBILE NO. 09171396829
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) akynaignacio@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME NA NA
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME IGNACIO


NAME EXTENSION (JR., SR)
FIRST NAME RENATO NA
MIDDLE NAME PINGOL
25. MOTHER'S MAIDEN NAME ANTONIO
SURNAME IGNACIO
FIRST NAME NORA
MIDDLE NAME MARTIN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


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

ELEMENTARY SANDIAT ELEMENTARY PRIMARY 2000 2006 2006

SECONDARY LA SALETTE OF ROXAS SECONDARY 2006 2010 2010

BACHELOR OF SCIENCE IN
COLLEGE FAR EASTERN UNIVERSITY 2010 2014 2014
HOTEL AND MANAGEMENT
BACHELOR OF SCIENCE IN
COLLEGE ST. MARY'S COLLEGE QUEZON CITY 2014 2018 2018
SOCIAL WORK

GRADUATE STUDIES NA
(Continue on separate sheet if necessary)

SIGNATURE DATE July 11, 2022

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

SOCIAL WORK LICENSURE EXAMINATION N/A JULY 24-25, 2018 SAINT JUDE COLLEGE, MANILA 1 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 STATUS OF
(Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
full/Do not abbreviate) (Write in full/Do not abbreviate) INCREMENT
From To
(Y/ N)
Php
8/1/2019 4/10/2020 SOCIAL WELFARE OFFICER I OSPITAL NG MALABON SG JOB ORDER N
19,000

(Continue on separate sheet if necessary)

SIGNATURE DATE July 11, 2022

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) NUMBER OF HOURS POSITION / NATURE OF WORK
(mm/dd/yyyy)
From To
JUNIOR SOCIAL WORK ASSOCIATION OF THE PHILLIPINES ST. MARY'S
10/7/2014 PRESENT N/A MEMBER
COLLEGE CHAPTER

(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

Storm, Stress, and Resillience: Parenting Teens in the Time of Pandemic 11/4/2021 11/4/2021 2 hours Technical CPN and Unicef/ Virtual Seminar

Lesson Learned from COVID: Strengthening Individual and Organizational


11/11/2021 11/11/2021 2 hours Technical CPN and Unicef/ Virtual Seminar
Resilliency

Online Sexual Abuse and Exploitation of Children (OSAEC) 11/18/2021 11/11/2021 2 hours Technical CPN and Unicef/ Virtual Seminar

Ending Violence for, by and with the Children and Youth 11/25/2021 11/25/2021 2 hours Technical CPN and Unicef/ Virtual Seminar

(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 full)
(Write in full)
COMMUNICATION N/A NA
COMPUTER LITERATE N/A
LEADERSHIP N/A
DECISION MAKING N/A
ADAPTABILITY N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE July 11, 2022

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 theof bureau or office or to the person who has immediate supervision over you in the
chief No X
Office,
Bureau or Department where you will be apppointed,
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
________________________________
________________________________
35. a. Have you ever been found guilty of any administrative offense? No X
If YES, give details:
________________________________
________________________________
If YES, give details:
________________________________
Date Filed:
________________________________
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or No X
regulation 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, No X
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or If YES, give details:
phased 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 No X
(except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period No X
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? No X
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? No X
If YES, please specify:
b. Are you a person with disability? No X
If YES, please specify ID No:
c. Are you a solo parent? No X
If YES, please specify ID No:

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

NAME ADDRESS TEL. NO.

Isabelo Ramos San Manuel, Cetral School, Isabela 9756897540

Emelita Pasion La Salette of Roxas, Isabela 9192110716

Lourdes G. Balanon St. Mary's College QC 9218259111


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 (i.e.Passport, GSIS, SSS, PRC, Driver's License,


etc.) PLEASE INDICATE ID Number and
Date of Issuance
Government Issued ID: PRC ID
ID/License/Passport No.: 0028828
Signature (Sign inside the box)
July 11, 2022
Date/Place of Issuance: 8/6/2018 PICC Pasay 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

You might also like