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    Personal Data Sheet

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    De Xel

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    Personal Data Sheet

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    De Xel
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    Personal Data Sheet

    Uploaded by

    De Xel

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    © All Rights Reserved
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    of 1

    CS Form No.

    212

    PERSONAL DATA SHEET


    Revised 2017

    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 VIÑAS
    NAME EXTENSION (JR., SR)
    FIRST NAME JHONNA FAYE

    MIDDLE NAME FORTIT


    3. DATE OF BIRTH
    (mm/dd/yyyy)
    6/29/1998 16. CITIZENSHIP
    Filipino Dual Citizenship
    by birth by naturalization

    4. PLACE OF BIRTH SANTA RITA, 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
    BRGY. SALVACION
    Other/s:
    Subdivision/Village Barangay
    SANTA RITA SAMAR
    7. HEIGHT (m) 1.48
    City/Municipality Province

    8. WEIGHT (kg) 40 ZIP CODE 6718

    18. PERMANENT ADDRESS


    9. BLOOD TYPE AB
    House/Block/Lot No. Street
    BRGY. SALVACION
    10. GSIS ID NO. N/A
    Subdivision/Village Barangay
    SANTA RITA SAMAR
    11. PAG-IBIG ID NO. 919323317579
    City/Municipality Province

    12. PHILHEALTH NO. 13-025527925-5 ZIP CODE 6718

    13. SSS NO. 06-4262578-8 19. TELEPHONE NO. NONE

    14. TIN NO. 759-907-609 20. MOBILE NO. 09214075419

    15. AGENCY EMPLOYEE NO. 08-0003926 21. E-MAIL ADDRESS (if any) [email protected]
    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)
    NAME EXTENSION (JR., SR)
    FIRST NAME N/A 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 VIÑAS


    JR
    FIRST NAME
    MAXIMO
    MIDDLE NAME RENDEZA

    25. MOTHER'S MAIDEN NAME

    SURNAME FORTIT

    FIRST NAME MARILOU

    MIDDLE NAME BETASOLO (Continue on separate sheet if necessary)

    III. EDUCATIONAL BACKGROUND


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

    WITH
    ELEMENTARY STA. RITA I CENTRAL SCHOOL ELEMENTARY EDUCATION 2004 2010 N/A 2010
    HONOR
    1st Honorable
    SECONDARY STA. RITA NATIONAL HIGH SCHOOL HIGH SCHOOL EDUCATION 2010 2014 N/A 2014 mention

    VOCATIONAL /
    TRADE COURSE
    N/A N/A N/A N/A N/A N/A N/A

    COLLEGE LEYTE NORMAL UNIVERSITY BACHELOR OF SCIENCE IN SOCIAL WORK 2014 2018 N/A 2018 NONE

    GRADUATE STUDIES LEYTE COLLEGES SUPPLEMENTAL FOR TEACHER EDUCATION 2019 2021 18 UNITS N/A NONE
    (Continue on separate sheet if necessary)

    SIGNATURE DATE 07/26/2024


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

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