CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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

I. PERSONAL INFORMATION
2. SURNAME FULLO
NAME EXTENSION (JR., SR)
FIRST NAME MEREDEL FE
MIDDLE NAME PAULINO
3. DATE OF BIRTH
(mm/dd/yyyy)
09/20/1995 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CAGAYAN DE ORO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS 0425

Widowed Separated House/Block/Lot No. Street
BALANGASAN
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m) 1.64 m PAGADIAN CITY ZAMBOANGA DEL SUR
City/Municipality Province
8. WEIGHT (kg) 60 kg ZIP CODE 7016
18. PERMANENT ADDRESS 0425
9. BLOOD TYPE B
House/Block/Lot No. Street
BALANGASAN
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO. PAGADIAN CITY ZAMBOANGA DEL SUR

City/Municipality Province
12. PHILHEALTH NO. ZIP CODE 7016

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09957233268

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) merdz35@gmail.com

II. FAMILY BACKGROUND

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME FULLO (deceased)

NAME EXTENSION (JR., SR)
FIRST NAME EMERCINDO JR.

MIDDLE NAME FLORES

25. MOTHER'S MAIDEN NAME SANGHANAN

SURNAME FULLO

FIRST NAME EDELYN

MIDDLE NAME PAULINO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE LEVEL/
YEAR ACADEMIC
LEVEL UNITS
(Write in full) (Write in full) EARNED
GRADUATED HONORS
From To RECEIVED
(if not
ELEMENTARY PAGADIAN CITY PILOT SCHOOL 2002 2008
ZAMBOANGA DEL SUR NATIONAL
SECONDARY
HIGH SCHOOL 2008 2012
VOCATIONAL /
TRADE COURSE
MINDANAO STATE UNIVERSITY -
COLLEGE BACHELOR OF SCIENCE IN ACCOUNTANCY 2013 2018 2018
ILIGAN INSTITUTE OF TECHNOLOGY

GRADUATE STUDIES
(Continue on separate sheet if necessary)

SIGNATURE DATE JANUARY 8, 2020

CS FORM 212 (Revised 2017), Page 1 of 4