ecCS Form No.

212
Revised 20
L DATA SHEET
W
A
R
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
NI (Do not fill up. For
Print
N legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. CSC use only)
G:
I.A
P
ny
mi 2. SURNAME SANTO
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si
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nt FIRST NAME NELIA NAME EXTENSION (JR., SR) N/A
er
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pr
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et MIDDLE NAME TOBIAS
N3. DATE OF BIRTH
ati
o
A 08/23/1963 16. CITIZENSHIP FILIPINO
n (mm/dd/yyyy)
L
m pls. indicate country:
ad
IN
e4. PLACE OF BIRTH DAGAMI, LEYTE If holder of dual citizenship, Pls. indicate country:
Fin
O
th please indicate the details.
e5. SEX FEMALE
R
P
M
er6 CIVIL STATUS MARRIED 17. RESIDENTIAL ADDRESS 858 STO. NIÑO
so
A
na House/Block/Lot No. Street
lTI LUSAD
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N
a 7. HEIGHT (m) 1.6m DAGAMI LEYTE
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he
et8. WEIGHT (kg) 67kg ZIP CODE
an
d9. BLOOD TYPE A 18. PERMANENT ADDRESS 858 STO. NIÑO
th House/Block/Lot No. Street
e
10.
W GSIS ID NO. B63RPNTS013 LUSAD
or Subdivision/Block/Village Barangay
k
11. PAG-IBIG ID NO.
E N/A DAGAMI LEYTE
xp City/Municipality Province
er
12. PHILHEALTH NO.
ie 19-000307337-1 ZIP CODE 6515
nc
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13. SSS NO.
S N/A 19. TELEPHONE NO. N/A
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et
14. TIN NO.
sh
902-658-673 20. MOBILE NO. 0915-748-3501
all
ca
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) santobias63@gmail.com
us
e
II.
th
FAMILY BACKGROUND 23. NAME of DATE OF
e CHILDREN BIRTH
22. SPOUSE'S SURNAME
fili SANTO (Write full name (mm/dd/yyy
n NAME and list all) y)
g FIRST NAME DANTE EXTENSION N/A DANN WINSTON T. SANTO 5/18/1990
of (JR., SR) N/A
ad MIDDLE NAME DE PAZ DAN NELSON T. SANTO 7/21/1991
mi
ni
st OCCUPATION MARIA AILENE T.SANTO 3/28/1993
ra
tiv EMPLOYER/BUSINESS NAME DALMACIO DANTE T. SANTO JR. 6/18/1995
e/
cr BUSINESS ADDRESS
im
MA. DANYLENE T. SANTO 5/28/1997
in
al TELEPHONE NO.
ca
se
24. FATHER'S SURNAME TOBIAS
/s
ag NAME
ai
FIRST NAME DALMACIO EXTENSION
N/A
ns (JR., SR)
t MIDDLE NAME PERIDO N/A
th
e
pe
rs
o
n
co
nc
er
ne
d.
 NAME EXTENSION (JR., SR) N/A

santobias63@gmail.com

5/18/1990

7/21/1991

3/28/1993

6/18/1995

5/28/1997
 ecCS Form No. 212
Revised 20
ONAL DATA SHEET
W
A
R
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
NI
Print
N legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No.
G:
I.A
P
ny
mi 2. SURNAME SANTO
E
si
R
nt FIRST NAME NELIA
er
S
pr
O
et MIDDLE NAME TOBIAS
N3. DATE OF BIRTH
ati
o
A 08/23/1963 16. CITIZENSHIP FILIPINO
n (mm/dd/yyyy)
L
m pls. indicate country:
ad
IN
e4. PLACE OF BIRTH DAGAMI, LEYTE If holder of dual citizenship,
Fin
O
th please indicate the details.
e5. SEX FEMALE
R
P
M
er6 CIVIL STATUS MARRIED 17. RESIDENTIAL ADDRESS 858
so
A
na House/Block/Lot No.
lTI
D
O Subdivision/Block/Village
at
N
a 7. HEIGHT (m) 1.6m DAGAMI
S City/Municipality
he
et8. WEIGHT (kg) 67kg ZIP CODE
an
d9. BLOOD TYPE A 18. PERMANENT ADDRESS 858
th House/Block/Lot No.
e
10. GSIS ID NO.
W B63RPNTS013
or Subdivision/Block/Village
k
11. PAG-IBIG ID NO.
E N/A DAGAMI
xp City/Municipality
er
12. PHILHEALTH NO.
ie 19-000307337-1 ZIP CODE 6515
nc
e
13. SSS NO.
S N/A 19. TELEPHONE NO. N/A
he
et
14. TIN NO.
sh
902-658-673 20. MOBILE NO. 0915-748-3501
all
ca
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) santobias63@gmail.com
us
e
II.
th
FAMILY BACKGROUND 23. NAME of
e CHILDREN
22. SPOUSE'S SURNAME
fili SANTO (Write full name
n NAME and list all)
g FIRST NAME DANTE EXTENSION N/A DANN WINSTON T. SANTO
of (JR., SR) N/A
ad MIDDLE NAME DE PAZ DAN NELSON T. SANTO
mi
ni
st OCCUPATION MARIA AILENE T.SANTO
ra
tiv EMPLOYER/BUSINESS NAME DALMACIO DANTE T. SANTO JR.
e/
cr BUSINESS ADDRESS
im
MA. DANYLENE T. SANTO
in
al TELEPHONE NO.
ca
se
24. FATHER'S SURNAME TOBIAS
/s
ag NAME
ai
FIRST NAME DALMACIO EXTENSION
N/A
ns (JR., SR)
t MIDDLE NAME PERIDO N/A
th
e
25. MOTHER'S MAIDEN NAME
pe
rs
o
SURNAME SALVATIERRA
n
co FIRST NAME RICARDA
nc (Continue on
er MIDDLE NAME SUDARIO separate sheet if
ne necessary)
d.
III. EDUCATIONAL BACKGROUND NAME OF SCHOOL
BASIC EDUCATION/DEGREE/COURSE PERIOD OF
26. LEVEL ATTENDANCE
(Write in full)
(Write in full)
 CAREER
SERVICE
/ RA 1080
(BOARD/
BAR)
UNDER
SPECIAL
LAWS/
IV. CIVIL
CES/ SERVICE ELIGIBILITY DATE OF
EXAMINAT
CSEE RATING PLACE OF EXAMINATION /
27. ION / LICENSE (if applicable)
(If Applicable) CONFERMENT
CONFERM
ENT NUMBER Date of
Validity
BARANG
AY
CAREER SERVICE PROFESSIONAL
ELIGIBILI N/A N/A N/A
TY /
DRIVER'
S
LICENSE

DEPARTM
(Continue on separate sheet if necessary) ENT /
AGENCY /
V. WORK EXPERIENCE POSITION TITLE OFFICE / GOV'T
INCLUSI COMPANY SERVICE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
VE
SALARY/ JOB/ PAY
GRADE (if
MONTHLY STATUS OF
28. DATES SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
(mm/dd/y INCREMENT
yyy) (Write in full/Do
not abbreviate) (Y/ N)
From To (Write in
full/Do not
N/A N/A N/A
abbreviate) N/A N/A N/A N/A

SI
(Continue on separate sheet if necessary)
GN
AT DATE 06/03/2021
2UR
of 4
E
 INCLUSIVE
VI. VOLUNTARY WORK
NAME & ADDRESS OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / DATES
OF ORGANIZATION PEOPLE / VOLUNTARY ORGANIZATION/S
(Write in POSITION /
NUMBER OF
29. full) HOURS NATURE OF
WORK

From
(mm/dd/yyyy) To

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

VII.
LE
AR N/A N/A N/A N/A N/A
NIN
(Start
G N/A
from N/A N/A N/A N/A
the
AN
most
D N/A
recen N/A N/A N/A N/A
DE
t
L&D/t
VE N/A
rainin N/A N/A N/A N/A
LO
g
PM
progr
am N/A N/A N/A N/A N/A CO
EN
and ND
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(L& D/
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the
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INCLUSIVE
RE
DATES OF
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rainin TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE Type of LD D
gNTI NUMBER OF ( Managerial/ BY
30. INTERVENTIONS/TRAINING PROGRAMS HOURS Supervisory/
taken
ON
for
(Write in full) Technical/etc)
S/T
the (mm/dd/yyyy)
last
RAI
five From To
NIN
(5)
GN/A
years N/A N/A N/A
for
PR
Divisi
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on (Wri
RA
Chief te in
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MS
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AT
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VIII. MEMB
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CIATI
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RGANI
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OR
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N
MAE,31. SPECIAL SKILLS and HOBBIES 32. 33.
MIC (Write in
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SIGsheet if necessary)
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NA
DATE 06/03/2021
TU \ CS FORM 212 (Revised 2017), Page 3 of 4
RE
 34. Are you related by
consanguinity
chief of bureauoror
affinity
office ortoortothe
Bureau the
appointing
person orwhere
a. withinwho
Department
recommendingthe hasthird
immediate
you will
degree? be
authority,
b. within the
supervision
apppointed, or over
to the
fourth
degree
you in the(forOffice,
Local If
Government Unit - YES
Career ,
35. Employees)?
a. Have you ever give
been found guilty detaIf
of any ils:
administrative YES
___
,
offense? ___
give
b. Have you been ___
deta
criminally charged
ils: If
___ Date
before any court? YES
___ Filed:
___
,___
Status of Case/s:
___
give
___
___
36. Have you ever deta
___
___
been convicted of ils:
___
___If
any crime or ___
___
violation of any YES
___
__
___
,___
law, decree, ___
37. Have you ever give
___
ordinance or ___
been separated
regulation by any deta
___If
___
ils:
from
court or tribunal?in
the service ___
YES
__
___
any of the ,___
38. a. Have you ever ___
___
following modes: ___
give
been a candidate ___
___
G resignation, ___
If YES, give details:
deta
o in a national or ___
___
retirement, ___
ils:
local election ___
v b. Have
dropped from held
you the ___
__
___
e within
resigned thefromlast the ___
___
rolls, dismissal, If YES, give details:
___
r year (exceptend ___
___
n
government
termination, ___
__
Barangay
Have you ___
___
39.
m service
of term, during
finished the ___
election)?
acquired ___
e three
contract orthe
(3)-month ___
___ If
status ___
n phasedof
period an the
before
out ___
___
YES
immigrant or ___
__
t last election
(abolition) in to
the ___
,__
4 I permanent
promote/actively
public or private
Pursuant to: (a) ___
___
0. s resident of give
campaign
sector? for a
Indigenous ___
___
deta
Ms another
People'scountry?
national orActlocal
(RA ___
___
ils
A u
a. Are you a member
candidate?
8371); (b) Magna ___
___
__
e of any indigenous (cou
. d Carta for Disabled ___
If YES, please specify:
__
___
group? ntry)
B
b. I Persons
Are you a(RA person ___
___
:
A D 7277);
with and (c)
disability? ___
___
If YES, please specify ID No:
B (i. Solo Parents ___
___
Ec. e. Are you a solo ___
P Welfare Act of ___
T as parent? If___
___ YES, please specify ID No:
sp 2000 (RA 8972),
D
T or please answer the not related by consanguinity or affinity to applicant /appointee) __
___
41. t, REFERENCES (Person
EI G following items: ___
N SIS, TEL.
NAME
AJ S
ADDRESS ___
NO. ecID picture taken
S ___ within
E S, TACLOBAN CITY ###
__
DL PR the last 6 months
S. C, TACLOBAN CITY ### 3.5 cm. X 4.5 cm
M Driv (passport size)
O
T s er'

L. Li
With fullprovisions
and of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agenc
ce I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement pursuant to the
42.
LI ns
N handwritten
L e,et
A
O c. name tag and
) PHOTOsignature over
R
A printed name
D
A Computer
generated
P
Government Issued ID: or photocopied
L
ID/License/Passport No.:
E picture
Signature (Sign inside the box)
A
Date/Place of Issuance: 06/03/2021
is not acceptable
S Date Accomplished Right Thumbmark
E
I
N Pe
, affiant exhibiting his/her validly issued government ID as indicated above.
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