PDS_CS_Form_No_212_Revised2017.xlsx - CS Form No 212...

PERSONAL DATA SHEET
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
1. CS ID No (Do not fill up. For CSC use only)
I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME
NAME EXTENSION (JR., SR)
MIDDLE NAME
3.
16. CITIZENSHIP
4. PLACE OF BIRTH If holder of dual citizenship,
Pls. indicate country:
5. SEX
please indicate the details.
6 CIVIL STATUS
17. RESIDENTIAL ADDRES
House/Block/Lot No. Street
Subdivision/Village Barangay
7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) ZIP CODE
9. BLOOD TYPE
18. PERMANENT ADDRESS
House/Block/Lot No. Street
10. GSIS ID NO.
Subdivision/Village Barangay
11. PAG-IBIG ID NO.
City/Municipality Province
12. PHILHEALTH NO. ZIP CODE
13. SSS NO. 19. TELEPHONE NO.
14. TIN NO. 20. MOBILE NO.
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if a
II. FAMILY BACKGROUND
22.SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAM
BUSINESS ADDRESS
TELEPHONE NO.
24.FATHER'S SURNAME
FIRST NAME
MIDDLE NAME
25.MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
26.
LEVEL
PERIOD OF ATTENDANCE
From To
ELEMENTARY
SECONDARY
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
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.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not app
DATE OF BIRTH
(mm/dd/yyyy)
23. NAME of CHILDREN (Write full name and
list all)
DATE OF BIRTH
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
NAME EXTENSION (JR., SR)