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. (D

I. PERSONAL INFORMATION
2. SURNAME SASIS
NAME EXTENSION (JR., SR)
FIRST NAME DANA LOU

MIDDLE NAME SALVACION

3. DATE OF BIRTH
(mm/dd/yyyy) 03/14/1982 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by

4. PLACE OF BIRTH MATI,DAVAO ORIENTAL If holder of dual citizenship, Pls. indicate coun
please indicate the details.
5. SEX Male ✘ Female

✘ Single Married 17. RESIDENTIAL ADDRESS 021

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
LOWE
Other/s:
Subdivision/Village Ba
TALISAY CITY C
7. HEIGHT (m) 1.65 m.
City/Municipality Pr
8. WEIGHT (kg) 90 KG. ZIP CODE 6045
18. PERMANENT ADDRESS 021
9. BLOOD TYPE B+
House/Block/Lot No. S
LOWE
10. GSIS ID NO. NA
Subdivision/Village Ba
TALISAY CITY
11. PAG-IBIG ID NO. 121036870554
City/Municipality Pr

12. PHILHEALTH NO. 120507125676 ZIP CODE 6045

13. SSS NO. 0626276713 19. TELEPHONE NO. NA

14. TIN NO. 268848949 20. MOBILE NO. 0929-6935519

15. AGENCY EMPLOYEE NO. APPLIED 21. E-MAIL ADDRESS (if any)
N/A
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) ALEXANDRA MIONETTE SASIS
FIRST NAME N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME SASIS

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

MIDDLE NAME MATARLO

25. MOTHER'S MAIDEN NAME

SURNAME SALVACION

FIRST NAME LISA

MIDDLE NAME PATALINGHUG (Continue on separate sheet if necessa

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY CEBU STATE COLLEGE ELEMENTARY 1988 1995 N/A

SECONDARY UNIVERSITY OF SOUTHERN PHILS. HIGH SCHOOL 1995 1999 N/A

VOCATIONAL /

TRADE UNIVERSITY OF SAN CARLOS/UNIVERSITY

COLLEGE
COURSE OFCEBU
AB HISTORY/BS NURSING 1999 2004 92 UNITS

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE JUNE

CS FOR
L DATA SHEET
perience Sheet shall cause the filing of administrative/criminal case/s against the person

BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) N/A

Dual Citizenship

by naturalization

Pls. indicate country:

Street
LOWER MOHON
Barangay
CEBU
Province
6045

Street
LOWER MOHON
Barangay
CEBU
Province

NA

0929-6935519

DATE OF BIRTH (mm/dd/yyyy)

02/29/2004

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1995 N/A

1999 N/A
 N/A N/A

eparate sheet if necessary)

JUNE 28,2018
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

N/A N/A N/A 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. SALARY/ JOB/ PAY
INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
MONTHLY
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

03/15/2018 06/00/2019 PRIVATE SECRETARY 1 SYKES ASIA INC. 20,754.00 11

CUSTOMER SERVICE
08/20/2018 03/10/2019 SYKES ASIA INC. 18,000.00 N/A
REPRESENTATIVE
ADMIN ASSISTANT/MARKETING &
02/01/2007 03/15/2018 MARKETWORKS ASIA, INC. 10,000.00 N/A
SALES ASSISTANT
11/15/2005 01/30/2007 MARKETING ASSISTANT ABOITIZLAND INC. 8,000.00 N/A

06/10/2003 05/15/2005 PRODUCTION ASSISTANT EVENTS WORKING CREW 1,000.00 N/A

 (Continue on separate sheet if necessary)

SIGNATURE DATE June 28,2019

CS FORM 2
 LICENSE (if applicable)

NUMBER Date of
Validity

N/A N/A

on separate sheet if necessary)

duties should be indicated in the attached Work Experience sheet. GOV'T

SERVICE

STATUS OF
APPOINTMENT

(Y/
N)
CASUAL YES

REGULAR NO

REGULAR NO

TEMPORARY NO

ON CALL NO
on separate sheet if necessary)

June 28,2019

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

THE FILIPINO ART OF BREAKTHROUGH SELLING 03/21/2007 03/21/2007 8 HOURS SALES MR. JUN G

THE STRATEGIC ACCOUNT MANAGEMENT WITH NEGOTIATING SKILLS 02/26/2009 02/26/2007 8 HOURS SALES MR. JUN G

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

3MEMBERSH
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 3
(Write in full)
.
PRO
COOKING N/A
ASSOCI
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FO
ENT / PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

N/A

separate sheet if necessary)

G PROGRAMS ATTENDED
he last five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

MR. JUN GARING

MR. JUN GARING

separate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)
PROVINCIAL EMPLOYEES
ASSOCIATION OF CEBU (PEACE)
separate sheet if necessary)

June 28,2019

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:
________________________________

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
MARIA CECILLE TO TALISAY CITY 0917-6284988 3.5 cm. X 4.5 cm
(passport size)
CARLO TUMULAK LAPU-LAPU CITY 0922-8480123 With full and handwritten
name tag and signature over
printed name
CHARINA PENAFLOR MANDAUE CITY 0966-3568033
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: SSS

ID/License/Passport No.: 0626276713

Signature (Sign inside the box)
JUNE 28, 2019
Date/Place of Issuance: CEBU CITY
Date Accomplished Right Thumbmark

JUNE 28,2019
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