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 COMBOY
NAME EXTENSION (JR., SR)
FIRST NAME LEI N/A
MIDDLE NAME PITALLANO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 05/31/1989 ✘ Filipino Dual Citizenship
✘ by birth by naturalization
4. PLACE OF BIRTH STA ROSA 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 32 M.H. Del Pilar St.,
House/Block/Lot No. Street
Widowed Separated
N/A Kalumpang
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.57 m Marikina Metro Manila
City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 1801

9. BLOOD TYPE O+
18. PERMANENT ADDRESS 32 M.H. Del Pilar St.,
House/Block/Lot No. Street
10. GSIS ID NO. N/A N/A Kalumpang
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121106596908 Marikina Metro Manila

City/Municipality Province

12. PHILHEALTH NO. 01-051851134-9 ZIP CODE 1801

13. SSS NO. 34-3294358-3 19. TELEPHONE NO. N/A

14. TIN NO. 316-040-591-000 20. MOBILE NO. 09773641753 / 09620553671

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) leipitallano29@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME COMBOY 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME JESSIE N/A N/A N/A

MIDDLE NAME MANILAG

OCCUPATION TRANSACTION ASSOCIATE ANALYST

EMPLOYER/BUSINESS NAME ACCENTURE INC.

BUSINESS ADDRESS BGC TAGUIG

TELEPHONE NO.

24. FATHER'S SURNAME PITALLANO

NAME EXTENSION (JR., SR)
FIRST NAME LEONARDO N/A
MIDDLE NAME TIANES

25. MOTHER'S MAIDEN NAME SANDRA MALAGAD RAMIRA

SURNAME PITALLANO

FIRST NAME SANDRA

MIDDLE NAME RAMIRA (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 SAN JUAN ELEMENTARY SCHOOL ELEMENTARY 1995 2001 N/A 2001 N/A

SECONDARY
VOCATIONAL / TAYTAY NATIONAL HIGHSCHOOL SECONDARY 2001 2005 N/A 2005 N/A

TESDA BREAD AND PASTRY PRODUCTION 2018 2018 N/A 2018 N/A
TRADE
BACHELOR OF SCIENCE IN BUSINESS
COURSE
COLLEGE UNIVERSITY OF RIZAL SYSTEM BINANGONAN
ADMINISTRATION 2009 2012 N/A 2012 N/A

CERTIFICATE OF TEACHING PROGRAM FOR

GRADUATE STUDIES ICCT COLLEGES OF THE PHILIPPINES
SECONDARY EDUCATION 2017 2018 18 UNITS 2018 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE 05/25/2023

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
BOARD LICENSURE EXAMINATION FOR
79.8 10/22/2022 SAN BEDA UNIVERSITY MANILA 1961217 05/31/2026
PROFESSIONAL TEACHER

(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)

5/7/2016 10/11/2023 ELEMENTARY TEACHER CHEON KWANG CHRISTIAN SCHOOL 8000.00 N/A REGULAR N

12/13/2013 05/13/2015 CUSTOMER SERVICE REPRESENTATIVE SPi CRM Inc. 15000.00 N/A REGULAR N

" NOTHING FOLLOWS"

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/14/2023

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

PHILIPPINE ASSOCIATION FOR TEACHERS AND EDUCATORS (PAFTE), IN.C. 01/29/2023 PRESENT N/A MEMBER

AMAZING GRACE GLOBAL OUTREACH MISSION 10/15/2017 PRESENT N/A GROUP LEADER

GATES OF PRAISE GLOBAL OUTREACH, INC. 12/18/2005 PRESENT N/A GROUP LEADER

PHILIPPINE MARKETING ASSOCIATION 4/9/2009 3/3/2012 N/A MEMBER

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

ADVANCED COMPUTER SKILLS TRAINING 4/3/2023 03/13/2023 80.0 TECHNICAL CPDCFT TRAINING CENTER

EDUCATIONAL INNOVATION, PEDAGOGY & PRACTICES IN THE NEW AGE OF TEACHING

02/18/2023 02/27/2023 80.0 TECHNICAL CPDCFT TRAINING CENTER
& LEARNING ONLINE SEMINAR

UPSKILLING EDUCATIONAL SKILLS INTERNATIONAL SEMINAR 8/2/2023 02/17/2023 80.0 TECHNICAL CPDCFT TRAINING CENTER

BREAD AND PASTRY PRODUCTION NCII 09/30/2018 10/30/2018 141.0 TECHNICAL TESDA

(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)

SINGING N/A N/A

DANCING

"NOTHING FOLLOWS"

(Continue on separate sheet if necessary)

SIGNATURE DATE 11/14/2023

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
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
the last 6 months
ALEXIS NIEVA KALUMPANG, MARIKINA 9178216558 4.5 cm. X 3.5 cm
(passport size)

RACHEAL GONZALES KALUMPANG, MARIKINA 9054552482

Computer generated
or photocopied picture
LOURDES CASTILLO KALUMPANG, MARIKINA 9672386698 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: PASSPORT

ID/License/Passport No.: P2447712C

Signature (Sign inside the box)
11/14/2023
Date/Place of Issuance: DFA 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