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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 LANIA
NAME EXTENSION (JR., SR)
FIRST NAME TOMASA
MIDDLE NAME TANGONAN
3. DATE OF BIRTH
(mm/dd/yyyy) 01/07/1964 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH SAN MATEO,ISABELA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female
6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS BLK.8,LOT2 MAIN STREET
Widowed Separated House/Block/Lot No. Street
Other/s: EDCO VILLAGE CASTILLO
Subdivision/Village Barangay
7. HEIGHT (m) 4'11' ECHAGUE ISABELA
City/Municipality Province
8. WEIGHT (kg) 53 ZIP CODE 3309
9. BLOOD TYPE "O" 18. PERMANENT ADDRESS
House/Block/Lot No. Street
10. GSIS ID NO. 2001971707 SALINUNGAN EAST
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 020137004410 SAN MATEO, ISABELA
City/Municipality Province
12. PHILHEALTH NO. 06-00006062-2 ZIP CODE 3318
13. SSS NO. 01-09473949 19. TELEPHONE NO. N/A

14. TIN NO. 166-307-898-0000 20. MOBILE NO. 09274663078
umayamrey@yahoo.com
15. AGENCY EMPLOYEE NO. TTL070164 21. E-MAIL ADDRESS (if any) babylania52@gmai.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME LANIA (DECEASED) 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
GREG VAN RUSSEL
FIRST NAME GREGORIO 25/07/1987
MIDDLE NAME MELOCOTONES GERBIE ANNA 31/07/1989
OCCUPATION N/A MAE RUTH 06/05/1991
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME TANGONAN (deceased)

FIRST NAME BERNARDO SR.
MIDDLE NAME ANDAYA
25. MOTHER'S MAIDEN NAME SEGUNDO (deceased)
SURNAME TANGONAN
FIRST NAME PLACIDA
MIDDLE NAME PAGUIBITAN (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
SCHOLARSHIP/
HIGHEST LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC

PERIOD OF ATTENDANCE

LEVEL UNITS EARNED
(Write in full) (Write in full) (if not graduated) GRADUATED HONORS
From To RECEIVED
ELEMENTARY MAPUROC ELE. SCHOOL,SAN MATEO,ISABELA GRADE SCHOOL 1975 1976 1976 2ND PLACE
EVELAND JUNIOR COLLEGE-NOW EVELAND
SECONDARY HIGH SCHOOL 1976 1982 1982 TOP 6
CHRISTIAN COLLEGE
VOCATIONAL /
TRADE COURSE
COLLEGE ISABELA STATE UNIVERSITY, ECHAGUE, ISABELA BACHELOR OF ARTS IN PSYCHOLOGY 1983 1989 1989 N/A
MASTER OF ARTS IN EDUCATION, EDUCTL
GRADUATE STUDIES UNIVERSITY OF LA SALETTE,SANTIAGO CITY 1989 2006 2006 N/A
MGT &
MASTER OF ARTS IN GUIDANCE & THESIS 2 ON
GRADUATE STUDIES UNIVERSITY OF LA SALETTE, SANTIAGO CITY 2013 PRESENT
COUNSELING PROCESS
(Continue on separate sheet if necessary)
SIGNATURE DATE CS FORM 212 (Revised 2017), Page 1 of 4