2.

SURNAME
FIRST NAME
MIDDLE NAME
4.
5. PLACE OF BIRTH
6. SEX
8. CITIZENSHIP
9. HEIGHT (m)
10. WEIGHT (kg)
11. BLOOD TYPE
12. GSIS ID NO.
13. PAG-IBIG ID NO.
14. PHILHEALTH NO.
15. SSS NO.
24. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
26.
27.
From To
20. E-MAIL ADDRESS (if any)
DATE OF BIRTH (mm/dd/yyyy)
MIDDLE NAME
(Continue on separate sheet if necessary)
22. AGENCY EMPLOYEE NO.
23. TIN
19. TELEPHONE NO.
FATHER'S SURNAME
ZIP CODE
| | | | | | | | | | | | | | | | |
Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary.
I. PERSONAL INFORMATION
| | | | | | | | | | | | | | | | |
16. RESIDENTIAL ADDRESS
ZIP CODE
3. NAME EXTENSION (e.g. Jr., Sr.)
CIVIL STATUS
18. PERMANENT ADDRESS
17. TELEPHONE NO.
III. EDUCATIONAL BACKGROUND
21. CELLPHONE NO. (if any)
II. FAMILY BACKGROUND
(Continue on separate sheet if necessary)
SURNAME
MOTHER'S MAIDEN NAME
25. NAME OF CHILD (Write full name and list all)
PERSONAL DATA SHEET
CS FORM 212 (Revised 2005)
1. CS ID No. (to be filled up by CSC)
28.
| | | | | | | | | | |
DATE OF BIRTH (mm/dd/yyyy)
7.
LEVEL
FIRST NAME
SECONDARY
ELEMENTARY
VOCATIONAL /
TRADE COURSE
NAME OF SCHOOL
(Write in full)
MIDDLE NAME
FIRST NAME
GRADUATE STUDIES
(Continue on separate sheet if necessary)
INCLUSIVE DATES OF
ATTENDANCE DEGREE COURSE
(Write in full)
YEAR GRADUATED
(if graduated)
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
COLLEGE
Page 1 of 4
DATE OF BIRTH (mm/dd/yyyy)
| | | | | | | | | | | | | | | | |
I. PERSONAL INFORMATION
| | | | | | | | | | | | | | | | |
III. EDUCATIONAL BACKGROUND
II. FAMILY BACKGROUND
(Continue on separate sheet if necessary)
PERSONAL DATA SHEET
CS FORM 212 (Revised 2005)
(to be filled up by CSC)
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
(Continue on separate sheet if necessary)
29.
NUMBER
DATE OF
RELEASE
30.
To
2014 CS FORM 212 (Revised 2005), Page 2 of 4
CAREER SERVICE/ RA 1080 (BOARD/
BAR) UNDER SPECIAL LAWS/ CES/ CSEE
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
LICENSE (if applicable)
RATING
POSITION TITLE
(Write in full)
IV. CIVIL SERVICE ELIGIBILITY
INCLUSIVE DATES
(mm/dd/yyyy)
From
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
MONTHLY
SALARY
DEPARTMENT /
AGENCY / OFFICE /
COMPANY
(Continue on separate sheet if necessary)
STATUS
GOV'T
SERVICE
(Yes / No)
SALARY
GRADE &
STEP
From To


From To
33.
SPECIAL
SKILLS /
HOBBIES:
34. 35.
TITLE OF
SEMINAR/CONFERENCE/WORKSHOP/
SHORT COURSES (Write in full)
31.
VII. TRAINING PROGRAMS (Start from the most recent training.)
32.
NAME & ADDRESS OF
ORGANIZATION
INCLUSIVE DATES
(mm/dd/yyyy)
NUMBER OF
HOURS
POSITION / NATURE OF WORK
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NON-ACADEMIC DISTINCTIONS / RECOGNITION:
(Write in full)
(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
(Continue on separate sheet if necessary)
NUMBER OF
HOURS
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
CONDUCTED/ SPONSORED BY
(Write in full)
INCLUSIVE DATES OF
ATTENDANCE
VII. TRAINING PROGRAMS (Start from the most recent training.)
POSITION / NATURE OF WORK
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
(Continue on separate sheet if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
CS FORM 212 (Revised 2005), Page 3 of 4
(Continue on separate sheet if necessary)
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
CONDUCTED/ SPONSORED BY
(Write in full)
36.
a.
Yes
b.
Yes
37 Yes
Yes
38. Yes
39. Yes
If YES, give details:
40. Yes
41.
a.
Yes
b.
Yes
c.
Yes
42.
NAME ADDRESS
PHOTO
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT
ISSUED ON (mm/dd/yyyy) RIGHT THUMBMARK
Are you related by consanguinity or
affinity to any of the following :
If YES, give details:
___________________________________________________________________
_____________________________________
Within the fourth degree (for Local
Government Employees):
appointing authority or recommending
authority where you will be appointed?
Within the third degree (for National
Government Employees):
appointing authority, recommending
authority, chief of
TEL. NO.
REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
No
No
No
No
No
If YES, give details: ________________________________________________
Are you a member of any indigenous
group?
Are you differently abled?
If YES, give details: ____________________________
No
No
No
No
No
a. Have you ever been formally
charged?
b. Have you ever been guilty of any
administrative offense?
SIGNATURE (Sign inside the box)
CS FORM 212 (Revised 2012), Page 4 of 4
I also authorize the agency head / authorized representative to verify / validate
the contents stated herein. I trust that this information shall remain confidential.
DATE ACCOMPLISHED
I declare under oath that this Personal Data Sheet has been accomplished by
If YES, give details: ____________________________
________________________________
Have you ever been convicted of any
crime or violation of any law, decree,
ordinance or regulation by any court or
tribunal?
If YES, please specify: ____________________
If YES, give details: ____________________________
________________________________
Have you ever been separated from the
service in any of the following modes:
resignation, retirement, dropped from
the rolls, dismissal, termination, end of
If YES, please specify: ____________________
Pursuant to: (a) Indigenous People's Act
(RA 8371); (b) Magna Carta for
Are you a solo parent?
If YES, please specify: ____________________
Have you ever been a candidate in a
national or local election (except
Barangay election)?
If YES, give details: ____________________________
________________________________