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 MANSUETO
NAME EXTENSION (JR., SR)
FIRST NAME RIZHELYN
MIDDLE NAME VELASCO
3. DATE OF BIRTH
(mm/dd/yyyy) 09/16/1984 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH DAVAO CITY If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male ✘ Female
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLOCK 34 PIAPI BOULEVARD
Single ✘ Married House/Block/Lot No. Street
Widowed Separate
Other/s: BARANGAY 22-C
d Subdivision/Village Barangay
7. HEIGHT (m) 1.544m DAVAO CITY DAVAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 72 kg ZIP CODE

9. BLOOD TYPE O 18. PERMANENT ADDRESS BLOCK 34 PIAPI BOULEVARD

House/Block/Lot No. Street

10. GSIS ID NO. N/A BARANGAY 22-C

Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A DAVAO CITY DAVAO DEL SUR

City/Municipality Province

12. PHILHEALTH NO. 16-025324062-5 ZIP CODE 8000

13. SSS NO.
14. TIN NO.
15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
0009-2408546-0 19. TELEPHONE NO. N/A
706-283-585-000 20. MOBILE NO. 0906-3889058 ; 0968-5752989
N/A 21. E-MAIL ADDRESS (if any) rizhmansueto@gmail.com
MANSUETO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME PAUL LESLIE

NAME EXTENSION (JR., SR)
RIHANNA LEURIZ EZRA VELASCO JUNE 15, 2008
MIDDLE NAME EMBABUENA YZZA PAULYNE V. MANSUETO OCTOBER 10, 2013
OCCUPATION SELF-EMPLOYED
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. 0928-3775813
24. FATHER'S SURNAME VELASCO
NAME EXTENSION (JR., SR)
FIRST NAME RIZAL
MIDDLE NAME GAPASIN
25. MOTHER'S MAIDEN NAME

SURNAME ANCHETA
FIRST NAME HELEN
MIDDLE NAME EUGENIO (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To
WITH
ELEMENTARY QUEZON ELEMENTARY SCHOOL N/A 1991 1997 N/A 1997
HONORS
STA. ANA NATIONAL HIGH
SECONDARY /
VOCATIONAL N/A 1997 2001 N/A 2001 N/A
SCHOOL
N/A N/A N/A N/A N/A N/A N/A
TRADE
BACHELOR OF SCIENCE IN
COURSE
COLLEGE UNIVERSITY OF MINDANAO 2001 2005 N/A 2005 N/A
COMPUTER SCIENCE
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(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 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

N/A N/A 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.
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)
ASIA BREWERY INCORPORATED
08/17/2009 02/28/2019 SETTLEMENT ANALYST (GREEN VALLEY MARKETING CORPORATION DAVAO P 15,900 N/A REGULAR N/A
SALES OFFICE ) FINANCE DEPARTMENT
MATERIALS MANAGEMENT DIVISION STANFILCO (A DIVISION OF DOLE
01/15/2007 06/30/2007 P 8,500 N/A CONTRACTUAL N/A
FACILITATOR PHILIPPINES)
STANFILCO (A DIVISION OF DOLE
8/12/2006 10/1/2007 SWITCH BOARD OPERATOR P 8,500 N/A CONTRACTUAL N/A
PHILIPPINES)
STANFILCO (A DIVISION OF DOLE
1/9/2006 5/12/2006 DATA ENCODER P 7,000 N/A CONTRACTUAL N/A
PHILIPPINES)

(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

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

WORKSHOP ON SETTLEMENT AND ANALYSIS 2/2/2011 6/2/2011 8 HOURS TECHNICAL ASIA BREWERY INCORPORATED

(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)
OFFICER - COMPANY COMMANDER (CITIZEN'S ARMY
COMMUNICATION SKILLS WITH HONORS (ELEMENTARY) TRAINING) - STA. ANA NATIONAL HIGH SCHOOL
P.I.O - COLLEGE OF ARTS AND SCIENCE STUDENT GOVERNMENT
FLEXIBILITY COMPANY COMMANDER OF THE YEAR - CITIZEN'S ARMY TRAINING (HIGH SCHOOL) OFFICER (CAS DSG) - UNIVERSITY OF MINDANAO
CSIT / REPRESENTATIVE - COMPUTER SCIENCE AND
TEAMWORK INFORMATION TECHNOLOGY DEPARTMENT
(UNIVERSITY OF MINDANAO)

ORGANIZATION SKILLS SECRETARY - SINTACCS (UNIVERSITY OF MINDANAO)

CREATIVITY

DATA ANALYSIS

COOKING AND BAKING

(Continue on separate sheet if necessary)

SIGNATURE DATE
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
by any court or tribunal? YES ✘ NO
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? RESIGNED
________________________________
(PRIVATE SECTOR) - FEBRUARY 2019
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES ✘ NO
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
ZONE 1 BRGY. TICUD, LAPAZ the last 6 months
BENEDICT ARELLANO 0917-7701201 4.5 cm. X 3.5 cm
ILO-ILO CITY (passport size)
108 AURORA ST., BRGY. 25-C DAVAO
ARLENE T. LAGARE 0933-8505344
CITY Computer generated
SAN PEDRO DOCTOR'S CLINIC GUZMAN or photocopied picture
DR. JEANNIE E. HIMAGAN ST., POBLACION DAVAO CITY
0917-7058785 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 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: DRIVER'S LICENSE
ID/License/Passport No.: L02-21-200000 Signature (Sign inside the box)

Date/Place of Issuance: 2021/01/15 ; DAVAO CITY 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