CS FORM 212 (Revised 2005

)

PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes

with "

(to be filled up by CSC)

1. CS ID No.

" and use separate sheet if necessary.

I. PERSONAL INFORMATION
MAGNO

2. SURNAME
FIRST NAME

MARY ANN

MIDDLE NAME

RIEGO

3. NAME EXTENSION (e.g. Jr., Sr.)

08/10/1993

4. DATE OF BIRTH (mm/dd/yyyy)
5. PLACE OF BIRTH

16. RESIDENTIAL ADDRESS

Blk 22, L11, Queen of Family St., Our Lady of Lourdes
Subdivision, Cupang, Antipolo, Rizal

STA. CRUZ, MARINDUQUE
Male

6. SEX
7. CIVIL STATUS

Female

Single

Widowed

Married

Separated

Annulled

Others, specify ___________ 18. PERMANENT ADDRESS

ZIP CODE

1870
N/A

17. TELEPHONE NO.

Blk 22, L11, Queen of Family St., Our Lady of Lourdes
Subdivision, Cupang, Antipolo, Rizal

8. CITIZENSHIP

FILIPINO

9. HEIGHT (m)

5'1

10. WEIGHT (kg)

52

11. BLOOD TYPE

B

19. TELEPHONE NO.

12. GSIS ID NO.

N/A

20. E-MAIL ADDRESS (if any)

riegomaryann@yahoo.com

13. PAG-IBIG ID NO.

N/A

21. CELLPHONE NO. (if any)

09102664058

14. PHILHEALTH NO.

N/A

22. AGENCY EMPLOYEE NO.

15. SSS NO.

N/A

23. TIN

ZIP CODE

1870

456-150-483

II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME

MAGNO

25. NAME OF CHILD (Write full name and list all)

FIRST NAME

JOHN CHRISTIAN

JANN CHRISTEVEN R. MAGNO

MIDDLE NAME

PINZON

OCCUPATION

DATA ANALYST

EMPLOYER/BUS. NAME

ACCENTURE INC.

BUSINESS ADDRESS

QUEZON CITY

TELEPHONE NO.

N/A

DATE OF BIRTH (mm/dd/yyyy)

05/12/2015

(Continue on separate sheet if necessary)
26. FATHER'S SURNAME

RIEGO

FIRST NAME

MAGDALENO

MIDDLE NAME

BELARMINO

27. MOTHER'S MAIDEN NAME
SURNAME

BERMOY

FIRST NAME

TARCISIA

MIDDLE NAME

AMPER

(Continue on separate sheet if necessary)
YEAR
GRADUATED

III. EDUCATIONAL BACKGROUND
28.

NAME OF SCHOOL
LEVEL

(Write in

HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)

DEGREE COURSE
(Write in full)

full)
ELEMENTARY

BOTILAO ELEM. SCHOOL

SECONDARY
VOCATIONAL /

STA. CRUZ INSTITUTE

COLLEGE
COURSE

TRADE

ROOSEVELT COLLEGE SYSTEM

BSIT

INCLUSIVE DATES OF
ATTENDANCE
From

To

(if
graduated)
2006

2001

2006

2010

2006

2010

2014

2010

2014

SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED

SALUTATORIAN

GRADUATE STUDIES

(Continue on separate sheet if necessary)
Page 1 of 4

600.00 SALARY GRADE & STEP INCREMENT (Format "00-0") STATUS OF APPOINTMENT JOB ORDER (Yes / No) (Continue on separate sheet if necessary) CS FORM 212 (Revised 2005). Page 2 of 4 . CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL LAWS/ CES/ CSEE RATING DATE OF EXAMINATION / CONFERMENT LICENSE (if applicable) PLACE OF EXAMINATION / CONFERMENT NUMBER DATE OF RELEASE N/A (Continue on separate sheet if necessary) V. CIVIL SERVICE ELIGIBILITY 29. INCLUSIVE DATES (mm/dd/yyyy) From To 07/06/1905 PRESENT POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY (Write in full) DATA CONTROLLER II (Write in full) INFORMATION AND COMMUNICATIONS TECHNOLY SERVICE GOV'T SERVICE MONTHLY SALARY 16. Start from your current work) 30.IV. WORK EXPERIENCE (Include private employment.

INCLUSIVE DATES NAME & ADDRESS OF ORGANIZATION (Write in full) NUMBER OF HOURS (mm/dd/yyyy) From POSITION / NATURE OF WORK To N/A / / / / / / / / / / / / / / / / (Continue on separate sheet if necessary) VII. TRAINING PROGRAMS (Include only those undertaken in the past 5 years. TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES (Write in full) WRITING WITH CONFIDENCE (mm/dd/yyyy) From To 6/1/2016 7/1/2016 NUMBER OF HOURS 12 CONDUCTED/ SPONSORED BY (Write in full) DA-ICTS .VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S 31.) INCLUSIVE DATES OF ATTENDANCE 32. Start from the most recent training.

Page 3 of 4 . SPECIAL SKILLS / HOBBIES: 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION: (Write in full) 35. MEMBERSHIP IN ASSOCIATION/ORGANIZATION (Write in full) N/A (Continue on separate sheet if necessary) CS FORM 212 (Revised 2005).(Continue on separate sheet if necessary) VIII. OTHER INFORMATION 33.

Have you ever been guilty of any administrative offense? NO If YES. give details: ________________________________ ________________________________ YES NO If YES. finished contract.36. give details: _________________ _______________________________________ _____________________________________ YES NO If YES. ISSUED AT SIGNATURE (Sign inside the box) 07/22/2016 ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK CS FORM 212 (Revised 2005). give details: _____________________________________ _____________________________________ _____________________________________ b. chief of office/bureau/department or person who has immediate supervision over you in the Office. X 4. recommending authority. Have you ever been formally charged? YES NO If YES. please answer the following items: a. and (c) Solo Parents Welfare Act of 2000 (RA 8972). dismissal. (b) Magna Carta for Disabled Persons (RA 7277). Within the third degree (for National Government Employees): appointing authority. in the public or private sector? 40. AWOL or phased out. rules and regulations of the Republic of the Philippines. dropped from the rolls. give details: ________________________________ ________________________________ 41. Are you differently abled? c. please specify: ____________________ 42. end of term. Within the fourth degree (for Local Government Employees): appointing authority or recommending authority where you will be appointed? YES NO If YES. decree. Pursuant to: (a) Indigenous People's Act (RA 8371). please specify: ____________________ YES NO If YES. and is a true. ID picture taken within the last 6 months 3. give details: ________________________________ ________________________________ YES b. NO. Are you a member of any indigenous group? b. give details: _____________________________________ _____________________________________ _____________________________________ 37 a. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO If YES. termination. please specify: ____________________ YES NO If YES. Are you related by consanguinity or affinity to any of the following : a. JAIME SY QUEZON CITY 919534569 ROWEE VILLOSO ANTIPOLO RIZAL 9162416193 43. I also authorize the agency head / authorized representative to verify / validate the contents stated herein. Are you a solo parent? YES NO If YES. Have you ever been separated from the service in any of the following modes: resignation. retirement. ordinance or regulation by any court or tribunal? 39. I trust that this information shall remain confidential. Have you ever been convicted of any crime or violation of any law. Bureau or Department where you will be appointed? YES NO If YES.5 cm. I declare under oath that this Personal Data Sheet has been accomplished by me. give details: ________________________________ ________________________________ 38. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) NAME ADDRESS TEL. Page 4 of 4 .5 cm (passport size) Computer generated or xerox copy of picture is not acceptable PHOTO COMMUNITY TAX CERTIFICATE NO. correct and complete statement pursuant to the provisions of pertinent laws.