CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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.
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 (Do not fill up. For CSC use
ABBREVIATE. 1. CS ID No. only)

I. PERSONAL INFORMATION

2. SURNAME
NAME EXTENSION (JR., SR)
FIRST
NAME

MIDDLE
NAME
16.
3. DATE OF Filipino Dual Citizenship
CITIZENSHIP
BIRTH
by birth by naturalization
(mm/dd/yyyy)

4. PLACE OF If holder of dual citizenship, Pls. indicate country:

BIRTH

please indicate the details.

5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL
STATUS

Widowed Separated House/Block/Lot Street

No.
Other/s:
Barangay
Subdivision/Vill
7. HEIGHT age
(m) Province

ZIP CODE City/Municipali

8. WEIGHT ty
(kg) 18. PERMANENT
ADDRESS
9. BLOOD
TYPE

House/Block/Lot No. Street

10. GSIS ID
NO. Subdivision/Village Barangay

11. PAG-IBIG ID
NO. City/Municipality Province

12. PHILHEALTH ZIP CODE

NO.

13. SSS NO. 19. TELEPHONE NO.

14. TIN 20. MOBILE NO.
NO.

15. AGENCY EMPLOYEE NO. 21. E-MAIL

ADDRESS (if any)

II. FAMILY BACKGROUND

23. NAME of CHILDREN (Write full name DATE OF BIRTH
22. SPOUSE'S SURNAME and list all) (mm/dd/yyyy)

25. AME SURNAME

FIRST
M FIRST NAME
NAME
O MIDDLE NAME
MIDDLE
T III. EDUCATIONAL BACKGROUND
NAME
H
OCCUPATIO
E
N
R
EMPLOYER/BUSINESS
'
NAME BUSINESS
S
ADDRESS TELEPHONE
M
NO.
A
24. FATHER'S
I
SURNAME FIRST
D
NAME
E
MIDDLE NAME
N

N CS FORM 212 (Revised 2017),

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NAME EXTENSION (JR., SR)

NAME EXTENSION (JR., SR)

(Continue on
separate sheet if
necessary)
SCHOLARS
26. PERIOD OF HIGHEST
NAME OF BASIC YEAR HIP/
LEVE ATTENDANCE LEVEL/ UNITS
SCHOOL EDUCATION/DEGRE GRADUATE ACADEMIC
L EARNED (if not
(Write in full) E/COURSE (Write in D HONORS
graduated)
full) From RECEIVED
To

ELEMENTARY

SECONDAR

VOCATIONA

L/
TRADE

COURSE

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if

necessary)
SIGNATU DATE
RE

CS FORM 212 (Revised 2017),

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IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ DATE OF LICENSE (if
RATIN
BAR) UNDER SPECIAL LAWS/ EXAMINATIO PLACE OF EXAMINATION / applic
G CONFERMENT
CES/ CSEE N/
able)
Date

(If of
BARANGAY ELIGIBILITY / DRIVER'S Applicable) CONFERME NUMBE
R Validity
LICENSE NT

(Continue on separate sheet if necessary)

V. WORK
EXPERIENCE

(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work
Experience sheet.
28. INCLUSIVE SALARY/ JOB/
PAY GRADE GOV'T
DATES POSITION DEPARTMENT / AGENCY / OFFICE / MONTH STATUS
(if applicable)& SERVIC
(mm/dd/yyyy) TITLE COMPANY (Write in full/Do not LY OF
STEP (Format E (Y/ N)
(Write in full/Do not abbreviate) SALAR APPOINTME
"00-0")/
abbreviate) Y NT

From INCREMENT
To

CS FORM 212 (Revised 2017),

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 (Continue on separate sheet if necessary)

SIGNATU DATE
RE

CS FORM 212 (Revised 2017),

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VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF INCLUSIVE
29.
ORGANIZATION DATES NUMBER OF POSITION / NATURE OF WORK
(mm/dd/yyyy) HOURS
(Write in full)
From
To

(Continue on separate sheet if

necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

INCLUSIVE
Type of
30. TITLE OF LEARNING AND DEVELOPMENT DATES OF LD CONDUCTED/
NUMBER OF
INTERVENTIONS/TRAINING ATTENDANCE HOURS ( SPONSORED BY
PROGRAMS (Write in full) (mm/dd/yyyy) Manageria (Write in full)
l/
From
Supervisor
To
y/
Technical/
etc)

(Continue on separate sheet if necessary)

VIII. OTHER
INFORMATION

NON-ACADEMIC DISTINCTIONS / MEMBERSHIP IN

31. SPECIAL SKILLS and HOBBIES 33.
RECOGNITION (Write in ASSOCIATION/ORGANIZ
32.
full) ATION (Write in full)

CS FORM 212 (Revised 2017),

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 (Continue on separate sheet if
necessary)
SIGNATU DATE
RE

CS FORM 212 (Revised 2017),

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34. Are you related by consanguinity or affinity to the appointing or
recommending authority, or to the chief of bureau or office or to the person
who has immediate supervision over you in the Office, Bureau or
Department where you will be apppointed,
YES NO
a. within the third degree?
YES NO
b. within the fourth degree (for Local Government Unit - Career If YES, give details:
Employees)?

35.a. Have you ever been found guilty of any YES NO

administrative offense? If YES, give details:

b. Have you been criminally charged before any court? YES NO

If YES, give details:
Date Filed:
Status of Case/s:
36. Have you ever been convicted of any crime or violation of any law, decree,
YES NO
ordinance or regulation by any court or tribunal?
If YES, give details:

37. Have you ever been separated from the service in any of the following YES NO
modes: resignation, retirement, dropped from the rolls, dismissal, If YES, give details:
termination, end of term, finished contract or phased out (abolition) in the
38. public or private sector?
YES NO
a. Have you ever been a candidate in a national or local election held within If YES, give details:
the last year (except
YES NO
Barangay election)?
If YES, give details:
39. b. Have you resigned from the government service during the three (3)-month
YES NO
period before the last election to promote/actively campaign for a national or
local candidate? If YES, give details (country):

40 Have you acquired the status of an immigrant or permanent resident of

another country?
. a.
YES NO
If YES, please specify:
b. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for YES NO
Disabled Persons (RA If YES, please specify ID No:
c. 7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please
YES NO
answer the following items: Are you a member of any indigenous group? If YES, please specify ID No:

Are you a person with disability?

Are you a solo parent?

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRES TEL.

S NO. ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is or photocopied picture
is not acceptable
a true, correct and 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 PHOT
O
misrepresentation made in this document and its attachments shall cause the filing of
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Date/Place of

Driver's License, etc.) Issuance:
PLEASE INDICATE ID Number and Date of
Issuance
Government Issued
Signature (Sign inside the
ID:
box) Date Accomplished
ID/License/Passport

No.:
CS FORM 212 (Revised 2017),
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 Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as
indicated above.

Person Administering
Oath

CS FORM 212 (Revised 2017),

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