CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 MANALO
NAME EXTENSION (JR., SR)
FIRST NAME LORINA N/A

MIDDLE NAME CRUZ

3. DATE OF BIRTH
(mm/dd/yyyy) 11/25/1971 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH MORONG, RIZAL If holder of dual citizenship, Pls. indicate country:

Female please indicate the details.

5. SEX Male ✘

Single ✘ Married 17. RESIDENTIAL ADDRESS ATIS STREET

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
Other/s: SAMPALOC
Subdivision/Village Barangay
7. HEIGHT (m) 1.50 m. TANAY RIZAL
City/Municipality Province
8. WEIGHT (kg) 56 kg.

9. BLOOD TYPE B+
18. PERMANENT ADDRESS ATIS STREET
House/Block/Lot No. Street

10. GSIS ID NO. N/A SAMPALOC

Subdivision/Village Barangay

11. PAG-IBIG ID NO. 107001505370 TANAY RIZAL

City/Municipality Province

12. PHILHEALTH NO. 19-051310278-3

13. SSS NO. 33-3396998-3 19. TELEPHONE NO. N/A

14. TIN NO. 175-820-795 20. MOBILE NO. 0905-6057672

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) lorinamanalo25@gmail.com
MANALO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
N/A
NAME EXTENSION (JR., SR)
TEOFILO PHILIP LOUISE C. MANALO 02/09/1996

MIDDLE NAME ALMANON RHENIER JOHN C. MANALO 01/28/2001

OCCUPATION DRIVER PIOLO JOSHUA C. MANALO 08/04/2003

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS SAMPALOC, TANAY, RIZAL

TELEPHONE NO. N/A

24. FATHER'S SURNAME CRUZ

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

MIDDLE NAME BAUTISTA

25. MOTHER'S MAIDEN NAME

SURNAME UNIDA

FIRST NAME VIRGINIA

MIDDLE NAME SANTOS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

TOMAS CLAUDIO MEMORIAL

ELEMENTARY ELEMENTARY 1980 1985 GRADUATED 1985 N/A
ELEMENTARY SCHOOL
RIZAL TECHNOLOGICAL AND
SECONDARY /
VOCATIONAL SECONDARY 1986 1989 GRADUATED 1989 N/A
POLYTECHNIC INSTITUTE

N/A
TRADE
TOMAS CLAUDIO MEMORIAL BACHELOR OF SCIENCE IN
COURSE
COLLEGE 1990 1993 GRADUATED 1993 N/A
COLLEGE COMMERCE

GRADUATE STUDIES TOMAS CLAUDIO COLLEGES SUPPLEMENTAL 2017 2017 27 UNITS 2017 N/A
(Continue on separate sheet if necessary)

DATE MAY 27, 2019

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

LICENSURE EXAMINATION FOR TEACHERS 81.20% MARCH 25, 2018 MANILA 1646767 11/25/2021

(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
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
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)
ALTERNATIVE LEARNING SYSTEM LOCAL GOVERNMENT
01/20/2017 12/20/2017 4000.00 CONTRACTUAL Y
INSTRUCTIONAL MANAGER UNIT/DEPARTMENT OF EDUCATION
08/11/1998 05/15/2010 FINANCE OFFICER EMILIO S. LIM APPLIANCES 10000.00 PROBATIONARY N

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 27, 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 NUMBER OF
(Write in full) (mm/dd/yyyy) HOURS POSITION / NATURE OF WORK
From To

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 NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) HOURS Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

CODE OF ETHICS FOR TEACHERS AND GRADING SYSTEM 10/13/2017 10/13/2017 8 TECHNICAL TOMAS CLAUDIO COLLEGES

MOST FUNCTIONAL COMMUNITY LEARNING CENTER 12/08/2017 12/08/2017 8 TECHNICAL ALTERNATIVE LEARNING SYSTEM

COMPUTER SYSTEMS SERVICING 11/27/2017 02/07/2018 360 TECHNICAL TECHNICAL EDUCATION AND SKILLS

DEVELOPMENT AUTHORITY

(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)

COOKING N/A N/A

COMPUTER LITERATE

DANCING

SINGING

READING

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 27, 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 ✘

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
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? ________________________________
FINISHED CONTRACT
________________________________
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
MARY ANN A. RUBIO PILILLA, RIZAL 0915-3799069 3.5 cm. X 4.5 cm
(passport size)

CORAZON MARTINEZ TANAY, RIZAL 0947-1179470 With full and handwritten

name tag and signature over
printed name
ANTONETT M. DELOS REYES TANAY, RIZAL 0917-5688701
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: PRC
ID/License/Passport No.: 1646767 Signature (Sign inside the box)
MAY 27, 2019
Date/Place of Issuance: JUNE 25, 2018/MANILA Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this 27TH DAY OF MAY 2019 , affiant exhibiting his/her validly issued government ID as indicated above.

SEVERO E. VALDEZ
Person Administering Oath

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