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.

I. PERSONAL INFORMATION

1. SURNAME SIMBOL

NAME EXTENSION (JR., SR)

FIRST NAME VIRGINIA

MIDDLE NAME ESPINOSA

2. DATE OF BIRTH

15. CITIZENSHIP

(mm/dd/yyyy) 06/14/1960 Filipino Dual Citizenship

by by

birth naturalization

3. PLACE OF BIRTH MANILA If holder of dual citizenship, Pls. indicate country:

please indicate the details.

4. SEX Male Female

5 CIVIL STATUS Single Married

16. RESIDENTIAL ADDRESS 2403 W 115TH STREET HAWTHORNE

Street

Widowed Separate

Other/s: d

Los Angeles CA 90250

`

6. HEIGHT (m) 5'2

7. WEIGHT (kg) 120 ZIP CODE

8. BLOOD TYPE O+

17. PERMANENT ADDRESS 2403 W 115TH STREET HAWTHORNE

Los Angeles CA 90250

9. Social Security No.

***-**-****

10. Green Card No. IOE627527312

11. California ID F8292438 ZIP CODE 90250-1960

12. Home Tel. No. 323-***-****

13. Celphone No. 090*-*******

14. E-MAIL ADDRESS (if any) adwsag@r.postjobfree.com

II. FAMILY BACKGROUND

18. SPOUSE'S SURNAME SIMBOL 19. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR) DEO PAOLO ESPINOSA SIMBOL

FIRST NAME PETER PAU L 8/8/1988

MIDDLE NAME OBLENA VANESSA ESPINOSA SIMBOL 1/3/1990

OCCUPATION RETIRED JESUS MIGUEL ESPINSA SIMBOL 12/12/1995

EMPLOYER/BUSINESS NAME N/A/

BUSINESS ADDRESS N/A/

TELEPHONE NO.

20. FATHER'S SURNAME ESPINOSA

FIRST NAME VICTOR SR.

MIDDLE NAME CAMAYA

21. MOTHER'S MAIDEN NAME

SURNAME CORDERO

FIRST NAME LUCENA

MIDDLE NAME CANLAS (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/

22. BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE

UNITS YEAR

LEVEL (Write in (Write in full)

DIPLOMA

full) EARNED GRADUATED

(if not graduated)

From To

ELEMENTARY MAKATI ELEMENTARY SCHOOL PRIMARY EDUCATION 6/1/1967 3/30/1973 N/A 1973 Yes

SECONDARY MAKATI HIGH SCHOOL HIGH SCHOOL 6/1/1973 3/30/1977 N/A 1977 Yes

PHILIPPINE CHRISTIAN BACHELOR OF SCIENCE IN

College Graduate

UNIVERSITY SECRETARIAL 6/1/1979 3/30/1981 N/A 1981 Yes

ADMINISTRATION

College Graduate MAKATI COLLEGE BACHELOR OF SCIENCE IN 6/1/1985 3/30/1987 N/A 1987 Yes

BUSINESS ADMINISTRATION

Vocational Course

ASIA BEST CAREER TRAINING CAREGIVER COURSE 5/6/2003 11/6/2003 N/A 2003 Yes

CORPORATION

(Continue on separate sheet if necessary)

SIGNATURE DATE March 13, 2023

Page 1 of 4

IV. CIVIL SERVICE ELIGIBILITY

23. LICENSE (if applicable)

CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF

SPECIAL LAWS/ CES/ CSEE RATING EXAMINATION / PLACE OF EXAMINATION / CONFERMENT

(If Applicable) NUMBER

BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

CAREER SERVICE SUB-PROFESSIONAL 72.38 ((Passed) 7/26/1987 QUEZON CITY N/A

CAREER SERVICE PROFESSIONAL 80.0 (Passed) 9/12/1998 QUEZON CITY N/A/

***NOTHING FOLLOWS***

(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.

24. INCLUSIVE DATES (mm/dd/ SALARY/ JOB/ PAY

yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if STATUS OF

(Write in full/Do not (Write in full/ applicable)& STEP

APPOINTMENT

abbreviate) Do not abbreviate) (Format "00-0")/

INCREMENT

From To

6/14/2007 11/30/2022 ADMINISTRATIVE OFFICER I PHILIPPINE HEALTH INSURANCE CORPORATION SG-11 PERMANENT

10/26/1998 6/13/2007 ADMINISTRATIVE OFFICER I PHILIPPINE HEALTH INSURANCE CORPORATION SG-8 CONTRACTUAL

COMMISSION

11/1/1996 11/1/1997 INVESTMENT CONSULTANT EMPIRE EAST HOLDINGS, INC. BASIS

CONTRACTOR

10/10/1992 12/31/1995 BANK TELLER DEVELOPMENT BANK OF THE PHILIPPINES SG-12 CASUAL

8/8/1987 9/1/1992 OFFICE CLERK DEVELOPMENT BANK OF THE PHILIPPINES N/A CONTRACTUAL

11/11/1984 2/1/1985 EXECUTIVE SECRETARY RIZAL COMMERCIAL BANK OF THE PHILIPPINES JOB ORDER CONTRACTUAL

HONGKONG AND SHANGHAI BANKING

1/1/1982 8/1/1983 ASSISTANT SECRETARY JOB ORDER CONTRACTUAL

CORPORATION

3/1/1981 6/1/1981 OFFICE CLERK M.L. CRUZ AND ASSOCIATES N/A PERMANENT

NOTHING FOLLOWS

(Continue on separate sheet if necessary)

SIGNATURE DATE March 3, 2023

Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

INCLUSIVE DATES

25 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

(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

26 TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUCTED/ SPONSORED BY

NUMBER OF HOURS

(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)

Technical/etc)

From To

FORUM ON POLICY UPDATES, QUALITY MANAGEMENT SYSTEMS AND RISK

MANAGAMENT 12/6/2021 12/6/2021 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

12/16-17/2020 12/16-17/2020 16 HOURS GENERAL

COACHING SKILLS FOR SUPERVISORS PHILIPPINE HEALTH INSURACE CORPORATION

11/28/2019 11/28/2019 8 HOURS GENERAL

STRESS AND TIME MANAGEMENT PHILIPPINE HEALTH INSURACE CORPORATION

11/23/2019 11/23/2019 8 HOURS GENERAL

FORUM ON POLICY UPDATES 2019 PRO NCR SOUTH BRANCH PHILIPPINE HEALTH INSURACE CORPORATION

11/21/2019 11/21/2019 8 HOURS GENERAL

RE-ORIENTATION OF FINANCIAL ACCOUNTING & REPORTING UTILITY (FARU) PHILIPPINE HEALTH INSURACE CORPORATION

11/14-15/2019 11/14-15/2019 16 HOURS GENERAL

PRO NCR SOUTH BRANCH QMS FOUM PHILIPPINE HEALTH INSURACE CORPORATION

10/24-25/2019 10/24-25/2019 16 HOURS GENERAL

PRO NCR SOUTH BRANCH SUPPORT GROUP FORUM PHILIPPINE HEALTH INSURACE CORPORATION

06/24/2019 06/24/2019 8 HOURS GENERAL

DISASTER RISK REDUCTION & MANAGEMENT ORIENTATION FOR PUBLIC SECTOR PHILIPPINE HEALTH INSURACE CORPORATION

11/10/2018 12/10/2018 8 HOURS GENERAL

PRO NCR 'S ADMIN. AND MSD FORUM PHILIPPINE HEALTH INSURACE CORPORATION

12/21/2018 12/21/2018 8 HOURS GENERAL

PRO NCR SOUTH BRANCH INFORMATION CARAVAN 2018 PHILIPPINE HEALTH INSURACE CORPORATION

ADMINISTRATIVE UNIT AND IT WORKSHOP 11/19/2018 11/19/2018 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

BENEFITS ADMINISTRATION SECTION (BAS) RETOOLING 11/9/2018 11/9/2018 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

10/11/2018 10/11/2018 8 HOURS GENERAL

COLLECTING OFFICERS CONFERENCE of PRO NCR PHILIPPINE HEALTH INSURACE CORPORATION

09/14/2018 09/15/2018 16 HOURS GENERAL

PRO NCR'S CUSTOMER SERVICE SKILLS & ATTITUDE TRAINING PHILIPPINE HEALTH INSURACE CORPORATION

09/06/2018 09/06/2018 8 HOURS GENERAL

EFFECTIVE BUSINESS WRITING PHILIPPINE HEALTH INSURACE CORPORATION

02/03/2018 02/03/2018 8 HOURS GENERAL

COLLEDTING OFFICERS CONFERENCE PHILIPPINE HEALTH INSURACE CORPORATION

01/17/2018 01/17/2018 8 HOURS GENERAL

PRO NCR'S GENDER SENSITIVITY TRAINING PHILIPPINE HEALTH INSURACE CORPORATION

CONFLICT MANAGEMENT TRAINING 11/25/2017 11/25/2017 8 HOURS GENERAL

PHILIPPINE HEALTH INSURACE CORPORATION

FORUM ON CASH AND RELATED ACCOUNTABILITIES 12/10/2016 12/10/2016 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

INTERPERSONAL CLIENT EFFECTIVENESS TRAINING 9/13/2016 9/14/2016 16 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

RISK MANAGEMENT ORIENTATION 8/16/2016 8/16/2016 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

IST INFORMATION CARAVAN 2016 OF PRO NCR - SOUTH BRANCH 6/17/2016 6/17/2016 8 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

PHILIPPINE QUALITY MANAGEMENT SYSTEMS (QMS) TRAINING/ORIENTATION 6/2/2015 6/3/2015 16 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

COMPONENT I - VALUING WHO WE ARE WHAT WE DO: UNDERSTANDING PHILHEALTH'S

CORPORATE RE-ENGINEERING VIS-À-VIS BUSINESS STRATEGIES. 4/23/2009 4/24/2009 16 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

ENRICHING CUSTOMERS SERVICE EXPERIENCE 9/6/2015 9/7/2005 16 HOURS GENERAL PHILIPPINE HEALTH INSURACE CORPORATION

FIRST AID TRAINING STANDASRD 9/15/2003 9/20/203 48 HOURS GENERAL ASIA BEST CAREER TRANING CORPORATION

BASIC LIFE SUPPORT, CPR HEALTH CARE PROVIDERS 9/15/2003 9/16/2003 16 HOURS GENERAL ASIA BEST CAREER TRANING CORPORATION

COMPLETE TRAINING PROGRAM COURSE 8/27/1997 8/27/1997 8 HOURS GENERAL PRIMANILA PLANS INCORPORATION

DEVELOPMENT BANK OF THE PHILIPPINES (BANK

BANK FRAUDS (ATM AND CHECK CLEARING FRAUDS) 6/11/1905 6/11/1905 8 HOURS GENERAL ADMIN. INSTITUTE)

FOUNDATION COMPONENTS OF CORPORATE CULTURE 7/3/1999 7/5/1989 24 HOURS GENERAL DEVELOPMENT BANK OF THE PHILIPPINES - HRD

Nothing Follows

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

27. Special Skills and Hobbies

SPECIAL SKILLS: KNOWLEDGED TO OPERATE VARIOUS OFFICE MACHINES, EQUIPMENTS; ADMIN. TASKS; CASHIERING; BUSINESS WRITING; DESK INFORMATION; PROCESSING OF MEDICAL CLAIMS; & CAREGIVER. HOBBIES:

COOKINGS; PARENTING; AND TRAVELING.

Nothing Follows

(Continue on separate sheet if necessary)

SIGNATURE DATE March 13, 2023

Page 3 of 4

28. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) YES

YES

YES NO

NONO

NO

NO

NO

NAME ADDRESS TEL. NO.

UNIT 6126 FLORA VISTA CONDO, ID picture taken within

the last 6 months

ERLINDA BARLISAN PEACOCK ST., EAST FAIRVIEW QUEZON 917-***-**** 3.5 cm. X 4.5 cm

CITY, PHILS. (passport size)

With full and handwritten

name tag and signature over

202 MARCELINO TAWIRAN ST.,

ROSANIE L. SANTOS SANTOLAN PASIG CITY, PHILS. 975-***-**** printed name

Computer generated

or photocopied picture

C.F. NATIVIDAD ST., MAPULANG is not acceptable

LIEZEL F. PLACIO LUPA, VALENZUELA CITY, PHILS. 932-***-****

29. 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 against me.

30. Government Issued ID

California ID No. F8292439

Green Card No. IOE627527312 Signature (Sign inside the box)

Page 4 of 4

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