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 LECAROZ
NAME EXTENSION (JR., SR)
FIRST NAME ALYZA SHANE

MIDDLE NAME LAMPAS N/A

3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) 09/30/2001
by birth by naturalization

4. PLACE OF BIRTH DILI, GASAN, MARINDUQUE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female P hilippines

Single Married 17. RESIDENTIAL ADDRESS PUROK 5 BAGONG BAYAN

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
BAGONG BAYAN DILI
Other/s:
Subdivision/Village Barangay
GASAN MARINDUQUE
7. HEIGHT (m) 1.49
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 4905

18. PERMANENT ADDRESS PUROK 5 BAGONG BAYAN

9. BLOOD TYPE N/A
House/Block/Lot No. Street
BAGONG BAYAN DILI
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A GASAN MARINDUQUE

City/Municipality Province

12. PHILHEALTH NO. 09-202298431-6 ZIP CODE 4905

13. SSS NO. 04-4389590-8 19. TELEPHONE NO. N/A

14. TIN NO. 629-546-400-00000 20. MOBILE NO. 9285843996

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) alyzashanelecaroz@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME N/A

NAME EXTENSION (JR., SR) 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 LECAROZ
NAME EXTENSION (JR., SR)
FIRST NAME ALVIN
MIDDLE NAME RESURECION
25. MOTHER'S MAIDEN NAME

SURNAME LAMPAS
FIRST NAME SHEENA
MIDDLE NAME UY (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY GASAN CENTRAL SCHOOL ELEMENTARY SCHOOL 2007 2013 N/A 2010 N/A

SECONDARY BANGBANG NATIONAL HIGH SCHOOL SECONDARY SCHOOL 2013 2017 N/A 2016 N/A

VOCATIONAL / INFORMATION AND COMMUNICATION

TRADE COURSE
MARINDUQUE MIDWEST COLLEGE
TECHNOLOGY
2017 2019 N/A 2018 N/A
SANGGUNIANG
BACHELOR OF SCIENCE IN INFORMATION
COLLEGE MARINDUQUE STATE COLLEGE
TECHNOLOGY
2019 2023 149 2023 BAYAN
SCHOLARSHIP

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE January 24, 2024

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

Career Service (Professional Level) 80.28 March 26, 2023 Marinduque National High School 3300 6/9/2023

(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.
INCLUSIVE DATES SALARY/ JOB/ PAY
28. GOV'T
GRADE (if
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT

Department of Social Welfare and Short Term

8/8/2023 8/11/2023 Documenter 8000.00 N/A Yes
Development (DSWD) Service
Department of the Interior and Local
10/5/2023 12/31/2023 Administrative Aide IV 14993.00 N/A COS Yes
Government (DILG)

(Continue on separate sheet if necessary)

SIGNATURE DATE January 24, 2024

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

Department of the Interior and Local Government 08/16/2023 08/29/2023 20 IT Technical Support Assistant

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
Department of Information and Communications
How To Be You Po: Careers in Cybersecurity 04/21/2022 04/21/2022 4.0 Technical Technology - Region IV of
Cybersecurity Bureau
MSC College of Information and
Navigating through Cybersecurity in the Business World 5/11/2022 5/11/2022 4.0 Technical
Communications Technology Faculty
MSC College of Information and Communications
Metaverse" Modern Paradigm of Interaction 2/12/2022 2/12/2022 4.0 Technical
Technology Faculty
MSC College of Information and Communications
Artificial Intelligence: New Trends and Technologies 9/12/2022 9/12/2022 4.0 Technical
Technology Faculty
MSC College of Information and Communications
True Sight: A Dive Inside the Esport Industry 10/12/2022 10/12/2022 4.0 Technical
Technology Faculty
“Digital Literacy Webinar - Revolutionizing Connectivity: Department of Information and Communications
06/26/2023 06/26/2023 4.0 Technical
Exploring the Fundamentals of Computer Networking” Technology - MIMAROPA Region

Training on Data Visualization through Infographics 10/18/2023 10/19/2023 16.0 Technical Philippine Statistics Authority - Marindque

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full) (Write in full)

Computer Networking Pinaka-matino Award in the Department of the Interior and Local Government Sangguniang Bayan Scholars

Time Management

Computer Literate

Flexibility/adaptibility

Data Management

(Continue on separate sheet if necessary)

SIGNATURE DATE January 24, 2024

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 by YES NO
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 out If YES, give details:
(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.

Rizalie Z. Semilla Candahon Mogpog, Marinduque 9778027540

Lea Rosario M. Clemente Laon, Mogpog, Marinduque 9083709691

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 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: Passport

ID/License/Passport No.: P4884178C

Signature (Sign inside the box)
January 24, 2024
Date/Place of Issuance: August 02, 2023
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