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 ag
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

I. PERSONAL INFORMATION
2. SURNAME AUSTRIA
N/A
FIRST NAME REBECCA RUTCHELLE

MIDDLE NAME QUETULIO

3. DATE OF BIRTH
(mm/dd/yyyy) 1/26/1981 16. CITIZENSHIP Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH CITY OF MANILA If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS BLOCK 1, LOTS 38-40 NEW YO

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
SOUTHPLAINS EXECUTIVE VILLAGE SA
Other/s:
Subdivision/Village Ba
DASMARINAS CITY CA
7. HEIGHT (m) 1.6256
City/Municipality Pr
8. WEIGHT (kg) 104.326 ZIP CODE 4114

18. PERMANENT ADDRESS BLOCK 1, LOTS 38- 40 NEW YO

9. BLOOD TYPE TYPE "O"
House/Block/Lot No. S
SOUTHPLAINS EXECUTIVE VILLAGE SA
10. GSIS ID NO. N/A
Subdivision/Village Ba
DASMARINAS CITY CA
11. PAG-IBIG ID NO. 121089816959
City/Municipality Pr

12. PHILHEALTH NO. 190896266547 ZIP CODE 4114

13. SSS NO. 33-8097225-3 19. TELEPHONE NO. 046 6864523

14. TIN NO. 221-470-453-000 20. MOBILE NO. 9988858651

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) rebeccarutchelle@gmail.co
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
N/A N/A
FIRST NAME N/A

MIDDLE NAME N/A N/A

OCCUPATION N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A

BUSINESS ADDRESS N/A N/A

TELEPHONE NO. N/A N/A

24. FATHER'S SURNAME AUSTRIA

N/A
FIRST NAME CONRADO
 MIDDLE NAME IBANEZ

25. MOTHER'S MAIDEN NAME

SURNAME QUETULIO

FIRST NAME PURISIMA

MIDDLE NAME DIMALANTA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

PRIMARY
ELEMENTARY CASA DE BAMBINI MONTESSORI SCHOOL GRADE SCHOOL/ ELEMENTARY 1988-1994
EDUCATION

SECONDARY /
VOCATIONAL SAINT MARY'S ACADEMY HIGH SCHOOLS 1994-1998 HIGH SCHOOL

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

TRADE
COURSE 1998- COLLEGE
COLLEGE UNIVERSITY OF SANTO TOMAS BACHELOR OF ARTS IN LITERATURE
2002 DEGREE
LYCEUM OF THE PHILIPPINES UNIVERSITY-
GRADUATE STUDIES
MAKATI
BACHELOR OF LAWS 2004- ### LAW DEGREE
(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

N/A

Dual Citizenship

by naturalization

Pls. indicate country:

NEW YORK STREET

Street
SABANG
Barangay
CAVITE
Province
4114

NEW YORK STREET

Street
SABANG
Barangay
CAVITE
Province

046 6864523

9988858651

rebeccarutchelle@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

N/A

N/A

N/A

N/A

N/A

N/A
 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

SEE SHEET
1994 ATTACHED AS
ANNEX " A"

SEE SHEET
1998 ATTACHED AS
ANNEX " A"

N/A N/A

2002 N/A

2010 N/A
parate sheet if necessary)

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

BAR PASSER ( R.A.1080) 5/3/2017 UNIVERSITY OF SANTO TOMAS, MANILA N/A

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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

2/13/2013 PRESENT PARALEGAL RENTA PE CAUSING & SABARRE LAW FIRM PHP 11,400 N/A PERMANENT

10/7/2002 7/31/2003 CUSTOMER SERVICE ASSOCIATE ITOUCHPOINT TECHNOLOGIES, LTD. PHP 16,000 N/A PERMANENT

SEE ATTACHED SHEET AS ANNEX "PDS- B"

 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
arate sheet if necessary)

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 /
From To

LPU LAW STUDENT GOVERNMENT, MAKATI CITY 6/20/2005 3/30/2006 N/A ELECTED SECOND YEAR BATCH

LPU LAW STUDENT GOVERNMENT, MAKATI CITY 6/20/2004 3/30/2005 N/A APPOINTED FIRST YEAR BATCH

PI SIGMA DELTA SORORITY - LPU CHAPTER, MAKATI CITY 7/16/2006 8/15/2008 N/A BURSAR

PI SIGMA DELTA SORORITY - LPU CHAPTER, MAKATI CITY 9/22/2004 8/15/2006 N/A MEMBER

BAR OPERATIONS COMMITTEE, MAKATI 6/20/2004 9/30/2008 N/A EX OFICIO MEMBER

UST LITERARY SOCIETY, MANILA 6/21/2001 3/30/2002 N/A TREASURER

UST LITERARY SOCIETY, MANILA 6/20/2000 6/20/2001 N/A MEMBER

(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/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

N/A
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

READING N/A PI S

COLLECTING BOOKS INTEGR

SOLVING WORD PUZZLES

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

ELECTED SECOND YEAR BATCH REPRESENTATIVE

APPOINTED FIRST YEAR BATCH REPRESENTATIVE

BURSAR

MEMBER

EX OFICIO MEMBER

TREASURER

MEMBER
eparate sheet if necessary)
ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

PI SIGMA DELTA SORORITY

INTEGRATED BAR OF THE PHILIPPINES -

CAVITE CHAPTER

eparate sheet if necessary)

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
METALS INDUSTRY RESEARCH AND DEVELOPMENT 02 8370431 LOC. the last 6 months
ATTY. TRIXIE HAZEL C. VELUZ CENTER, 401 3.5 cm. X 4.5 cm
(passport size)

TAGUIG CITY With full and handwritten

name tag and signature over
RENTA PE CAUSING & SABARRE LAW FIRM, printed name
ATTY. RONALDO E. RENTA DASMARINAS CITY 9195148015
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4