032117 CS Form No. 212 revised Personal Data Sheet_new.xlsx - CS Form No 212 Revised 2017 PERSONAL DATA SHEET WARNING Any misrepresentation made in the

032117 CS Form No. 212 revised Personal Data Sheet_new.xlsx...

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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 ROLDAN FIRST NAME MARIO Jr. MIDDLE NAME RUSTIA 3. 4/5/1993 16. CITIZENSHIP 4. PLACE OF BIRTH Quezon City If holder of dual citizenship, Pls. indicate country: 5. SEX please indicate the details. 6 CIVIL STATUS 17. RESIDENTIAL ADDRES 128 F. Mariano Avenue House/Block/Lot No. Street Dela Paz Subdivision/Village Barangay 7. HEIGHT (m) 1.77 Pasig City City/Municipality Province 8. WEIGHT (kg) 85 ZIP CODE 1600 9. BLOOD TYPE O 18. PERMANENT ADDRES House/Block/Lot No. Street 10. GSIS ID NO. Ambulong Subdivision/Village Barangay 11. PAG-IBIG ID NO. 1211-225-83152 Magdiwang Romblon City/Municipality Province 12. PHILHEALTH NO. 03-02549-83094 ZIP CODE 5507 13. SSS NO. 04-2436-4979 19. TELEPHONE NO. None 14. TIN NO. 444-559-133 20. MOBILE NO. 09163363189 15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if a II. FAMILY BACKGROUND 22.SPOUSE'S SURNAME FIRST NAME N/A N/A N/A MIDDLE NAME OCCUPATION EMPLOYER/BUSINESS NAME BUSINESS ADDRESS TELEPHONE NO. 24.FATHER'S SURNAME ROLDAN FIRST NAME MARIO MIDDLE NAME ROJAS 25.MOTHER'S MAIDEN NAME SURNAME RUSTIA FIRST NAME EMPERATRIZ MIDDLE NAME CANULO (Continue on separate sheet if necessary) III. EDUCATIONAL BACKGROUND 26. LEVEL From To ELEMENTARY San Diego Elementary School 1999 2005 2005 SECONDARY Magdiwang National High School 2005 2009 2009 Quezon City Polytechnic University 2009 2013 2013 COLLEGE GRADUATE STUDIES (Continue on separate sheet if necessary) SIGNATURE DATE CS FORM 212 (Revised 2017), Page 1 of 4 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.
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