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

MIDDLE NAME DILAO

3. DATE OF BIRTH
(mm/dd/yyyy) 03/18/1976 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BORONGAN, EASTERN SAMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS

Widowed Separated House/Block/Lot No. Street
HINDANG
Other/s:
Subdivision/Village BARANGAY
BORONGAN EASTERN SAMAR
7. HEIGHT (m) 1.54
City/Municipality Province
8. WEIGHT (kg) 60
18. PERMANENT ADDRESS
9. BLOOD TYPE "B"
House/Block/Lot No. Street
HINDANG
10. GSIS ID NO. CRN-0081-7589-2
Subdivision/Village Barangay
BORONGAN EASTERN SAMAR
11. PAG-IBIG ID NO. 1700-0014-5643
City/Municipality Province

12. PHILHEALTH NO. 13-0000512-126 ZIP CODE 6800

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 926-415-766 20. MOBILE NO. 09453379756

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) leteciadamosco@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME AMOSCO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR.,) N/A CARL NINO D. AMOSCO
FIRST NAME MATHEW 01/14/2004
MIDDLE NAME CASPE CHARLES MATHEW D. AMOSCO 12/11/2009
OCCUPATION SELF-EMPLOYED CHARLLY D. AMOSCO 11/19/2015
EMPLOYER/BUSINESS NAME CARL & CHARLES ENTERPRISES CARYLLE D. AMOSCO 10/10/2019
BUSINESS ADDRESS HINDANG, BORONGAN CITY, EASTERN SAMAR

TELEPHONE NO. 9772552198

24. FATHER'S SURNAME DILAO

NAME EXTENSION (SR.)
FIRST NAME SULPECIO
MIDDLE NAME SESO
25. MOTHER'S MAIDEN NAME
SURNAME BALDOS
FIRST NAME ADELINA
MIDDLE NAME CABALLA (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 HINDANG ELEMENTARY SCHOOL ELEMENTARY 1984 1989 GRADUATED 1989 N/A
VOCATIONAL / EASTERN SAMAR NATIONALCOMPREHENSIVE HIGH
SECONDARY
SCHOOL HIGH SCHOOL 1989 1993 GRADUATED 1993 N/A

TESDA N/A N/A N/A N/A N/A N/A

BACHELOR OF SCIENCE IN AGRICULTURE
COLLEGE TRADE EASTERN SAMAR STATE UNIVERSITY 1993 1997 GRADUATED 1997 N/A
COURSE MAJOR IN AGRICULTURAL ENGINEERING

GRADUATE STUDIES

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised 2017), Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE BARANGAY EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity
CSC - RESOLUTION No. 93-3666 AS AMENDED/BRGY CERTIFICATE
N/A 05/09/2002 CSC - TACLOBAN CITY 05/09/2002
ELIGIBILITY NO. 21080033

(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
SALARY/ JOB/ SERVICE
28. INCLUSIVE DATES
DEPARTMENT / AGENCY / OFFICE / COMPANY PAY GRADE
(mm/dd/yyyy) POSITION/TITLE (Write MONTHLY (if applicable)& STATUS OF
(Write in
in full/ Do not abbreviate) SALARY STEP (Format APPOINTMENT
full/Do not abbreviate) "00-0")/
From To INCREMENT
(Y/ N)
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2017 10/17/2018 SANITATION INSPECTOR 1 13750.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
09/05/2015 12/31/2016 SANITATION INSPECTOR 1 13500.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2013 09/04/2015 SANITATION INSPECTOR 1 13445.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2012 12/31/2012 SANITATION INSPECTOR 1 12462.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2011 12/31/2011 SANITATION INSPECTOR 1 11612.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2010 12/31/2010 SANITATION INSPECTOR 1 10761.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
09/05/2009 09/04/2009 SANITATION INSPECTOR 1 9911.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
07/01/2008 06/30/2009 SANITATION INSPECTOR 1 9670.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
07/01/2007 06/30/2008 SANITATION INSPECTOR 1 8791.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
01/01/2006 06/30/2007 SANITATION INSPECTOR 1 7796.00 PERMANENT Y
SAMAR
PROVINCIAL GOVERNMENT OF EASTERN
09/05/2002 12/31/2005 SANITATION INSPECTOR 1 7606.00 PERMANENT Y
SAMAR

(Continue on separate sheet if necessary)

SIGNATURE DATE 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
GENERAL FEDERATED PARENTS TEACHERS ASSOCIATION, BORONGAN CITY
8/5/2019 PRESENT N/A PRESIDENT
DIVISION, BORONGAN CITY, EASTERN SAMAR
GENERAL FEDERATED PARENTS TEACHERS ASSOCIATION - EASTERN SAMAR
NATIONAL COMPREHENSIVE HIGH SCHOOL, BORONGAN CITY, EASTERN 7/28/2017 PRESENT N/A PRESIDENT
SAMAR
CATARACT OPERATION MISSION (BULIG KABLAS), PROVINCIAL HEALTH
6/18/2004 6/23/2004 N/A VOLUNTEER
OFFICE, BORONGAN CITY, EASTERN SAMAR

SANGGUNIANG KABATAAN FEDERATION, BORONGAN, EASTERN SAMAR 5/1/1995 5/31/2000 N/A SK CHAIRMAN

(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

PROVINCIAL GOVERNMENT OF EASTERN SAMAR -

MANAGING WASH IN EMERGENCIES TRAINING 08/10/2015 08/13/2015 32 HOURS PARTICIPANT PROVINCIAL HEALTH OFFICE/ A SINGLE PROP
FOR SAFE WATER- UNICEF/ PLAN PHILS.
PROVINCIAL GOVERNMENT OF EASTERN SAMAR -
PHILIPPINE APPROACHES TO TOTAL SANITATION (PHATS) TRAINING OF TRAINERS (TOT) 04/20/2015 04/24/2015 40 HOURS PARTICIPANT PROVINCIAL HEALTH OFFICE/ UNICEF/ WASH/
RED CROSS

(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
(Write in full)
in full)

COMPUTER LITERATE N/A N/A

DRIVING N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/18/17 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:
________________________________
✘
________________________________
YES NO
b. Have you been criminally charged before any court?
If YES, give details:
________________________________
Date Filed: 11-21-2014
________________________________
Status of Case/s: Dismessed
YES NO
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by
any court or tribunal?
If YES, give details:
________________________________
YES________________________________
✘ NO
37. Have you ever been separated from the service in any of the following modes: resignation, retirement,
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in If YES, give details:
the public or private sector? YES________________________________
✘ NO
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? ✘ YES NO CANDIDATE CITY COUNCILOR
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
election to promote/actively campaign for a national or local candidate? ✘ YES If YES, give details:
NO

39. Have you acquired the status of an immigrant or permanent resident of another country?
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277);YES ✘ NO
and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
YES ✘ NO
a. Are you a member of any indigenous group?
If YES, please specify:
YES ✘ NO
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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
PROVINCIAL HEALTH OFFICE, SONCO, the last 6 months
DR. MARIAN EPEFANIA R. ISIDERIO BORONGAN CITY
9196706521 3.5 cm. X 4.5 cm
(passport size)

ATTY. CELESTINO CABATO MAYPANGDAN, BORONGAN CITY 9151726709 With full and handwritten
name tag and signature over
printed name
RUDITO CAPITO BORONGAN CITY
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied picture
is not acceptable
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 PHOTO
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: LTO DRIVERS LICENSE

ID/License/Passport No.: H04-20-000418

Signature (Sign inside the box)

Date/Place of Issuance:03/18/2024
10/18/17 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