Administrative Assistant Il

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 MIRANDO

FIRSTNAME RUBY REBECCA NAME EXTENSION (JR., SR)

MIDDLE NAME MONTEROS

3. DATE OF BIRTH 10/28/1966 16. CITIZENSHIP P Filipino £ Dual Citizenship

(mm/dd/yyyy) If holder of dual citizenship, P by birth £ by naturalization

4. PLACE OF BIRTH LOBO, BATANGAS Pls. indicate country:

5. SEX £ Male P Female please indicate the details.

6. CIVIL STATUS £ Single P Married 17. RESIDENTIAL ADDRESS 15 UPPER

£ Widowed £ Separated House/Block/Lot No. Street

£ Other/s BALSIGAN ROAD

7. HEIGHT (m) 1.524 Subdivision/Village Barangay

BAGUIO CITY BENGUET

8. WEIGHT (kg) 31.75 City/Municipality Province

ZIP CODE 2600

9. BLOOD TYPE A 18. PERMANENT ADDRESS

House/Block/Lot No. Street

10. GSIS ID NO. 200*******

Subdivision/Village Barangay

11. PAGIBIG ID NO. 129*********

City/Municipality Province

12. PHILHEALTH NO. 040********* ZIP CODE 2600

13. SSS NO. 19. TELEPHONE NO. 074-*******

14. TIN NO. 160******-**. MOBILE NO. 091********

15. AGENCY EMPLOYEE NO. 0110019 21. E-MAIL ADDRESS ( if any ) ***********@*****.***

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME MIRANDO 23. NAME of CHILDREN (Write full name and list all) "DATE OF BIRTH

(mm/dd/yyyy) "

FIRST NAME ROILAN NAME EXT (JR., SR) STEPHANIE M. MIRANDO 03/15/1997

MIDDLE NAME TAN ANDREA MONIQUE M. MIRANDO 08/22/1998

OCCUPATION MANAGER RALPH RILEY M. MIRANDO 06/04/2005

EMPLOYER/BUSINESS NAME AM CLEOFE PRINTING PRESS

BUSINESS ADDRESS STA. ANA MANILA

TELEPHONE NO.

24. FATHER'S SURNAME MONTEROS

FIRST NAME TOMAS NAME EXT (JR., SR)

MIDDLE NAME TOMOGBONG

25. MOTHER'S MAIDEN NAME CAIÑA

SURNAME MONTEROS

FIRST NAME LEONILDA

MIDDLE NAME MORGADO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

26. "NAME OF SCHOOL

(Write in full)" "BASIC EDUCATION/DEGREE/COURSE

(Write in full)" "PERIOD OF

ATTENDANCE" "HIGHEST LEVEL/

UNITS EARNED

(if not graduated)" "YEAR

GRADUATED" "SCHOLARSHIP/

ACADEMIC HONORS

RECEIVED"

LEVEL

From To

ELEMENTARY QUEZON ELEMENTARY SCHOOL 6-12-1971 6-15-1976 ELEMENTARY 1982

SECONDARY BAGUIO COLLEGES FOUNDATION 9/15/1977 4/80/1980 SECONDARY 1980

"VOCATIONAL/

TRADE COURSE"

COLLEGE SAINT LOUIS UNIVERSITY/LYCEUM NORTHERN LUZON BSN COMMERCE/NURSING COLLEGE 1987

GRADUATE STUDIES BENGUET STATE UNIVERSITY "

MASTERS IN HRM" 21 UNITS

(Continue on separate sheet if necessary)

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

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