Beruflich Dokumente
Kultur Dokumente
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
3. DATE OF BIRTH
16. CITIZENSHIP Dual Citizenship
(mm/dd/yyyy) Filipino
by
by natu
birth
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
Other/s:
Subdivision/Village Barang
7. HEIGHT (m)
City/Municipality Provinc
8. WEIGHT (kg) ZIP CODE
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS N
BUSINESS ADDRESS
TELEPHONE NO.
24.FATHER'S SURNAME
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
SURNAME
FIRST NAME
ELEMENTARY
SECONDARY
COLLEGE
COLLEGE
GRADUATE STUDIES
SIGNATURE DATE
CS FORM 212
AL DATA SHEET
e Work Experience Sheet shall cause the filing of administrative/criminal case/s against the
Widow/er
Others
Angola
Street Antigua and Barbuda
Argentina
Armenia
Barangay Aruba
Australia
Province Austria
Azerbaijan
Bahamas, The
Street Bahrain
Bangladesh
Barangay Barbados
Belarus
Province Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
DATE OF BIRTH (mm/dd/yyyy) Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burma
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
(Continue on separate sheet if necessary) Chile
China
SCHOLARSHIP/ Colombia
YEAR ACADEMIC
GRADUATED HONORS Comoros
RECEIVED
SCHOLARSHIP/
YEAR ACADEMIC
GRADUATED HONORS
RECEIVED
Congo, Democratic Republic of the
Congo, Republic of the
Costa Rica
Cote d'Ivoire
Croatia
Cuba
on separate sheet if necessary) Curacao
Cyprus
CS FORM 212 (Revised 2017), Page 1 of 4 Czech Republic
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
SIGNATURE DATE
CS FORM 2
LICENSE (if applicable)
PLACE OF EXAMINATION / CONFERMENT
NUMBER Date of
Validity
Description of duties should be indicated in the attached Work Experience sheet. GOV'T
SERVICE
SALARY/ JOB/ PAY
GRADE (if
STATUS OF
applicable)& STEP
(Format "00-0")/ APPOINTMENT
INCREMENT
(Y/
N)
(Continue on separate sheet if necessary)
SIGNATURE DATE
ERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
(Write in full)
35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES NO
If YES, give
Datedetails:
________________________________
Filed:
________________________________
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation YES NO
by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, YES NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except YES NO
Barangay election)?
f YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES NO
election to promote/actively campaign for a national or local candidate? f YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? YES NO
If YES, give details (country):
40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
a. Are you a member of any indigenous group? YES NO
If YES, please specify:
b. Are you a person with disability? YES NO
If YES, please specify ID No:
c. Are you a solo parent? YES NO
If YES, please specify ID No:
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.
ID/License/Passport No.:
Signature (Sign inside the box)
Date/Place of Issuance:
Date Accomplished Right Thumbmark
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.
Person Administering Oath