CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
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 ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME BAYAN
NAME EXTENSION (JR., SR)
FIRST NAME IAN KRISTOHPER

MIDDLE NAME BAYAN

3. DATE OF BIRTH
(mm/dd/yyyy) 7/7/1992 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH ZAMBOANGA 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 Don Basilio Navarro San Jose
Widowed Separated House/Block/Lot No. Street

Other/s:
N/A Cawa-cawa
Subdivision/Village Barangay

7. HEIGHT (m) 1.62 meters Zamboanga City Zamboanga Del Sur

City/Municipality Province
8. WEIGHT (kg) 63 kg ZIP CODE 7000
9. BLOOD TYPE B+ 18. PERMANENT ADDRESS Don Basilio Navarro San Jose
House/Block/Lot No. Street

10. GSIS ID NO. N/A

N/A Sta. Maria
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A Zamboanga City Zamboanga Del Sur

City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 7000

13. SSS NO. N/A 19. TELEPHONE NO. 062-992-4706
14. TIN NO. 281-641-443-000 20. MOBILE NO. 09063655143
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) sketch.kris@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME BAYAN N/A 09/26/1950

NAME EXTENSION (JR., SR) N/A
FIRST NAME CIPRIANO N/A

MIDDLE NAME TADEA N/A N/A

25. MOTHER'S MAIDEN NAME TADEA, LEONIDA DUQUE N/A N/A

SURNAME TADEA N/A 7/6/1954

FIRST NAME LEONIDA N/A N/A

MIDDLE NAME DUQUE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
26. PERIOD OF ATTENDANCE HIGHEST LEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS EARNED
GRADUATED
(Write in full) (Write in full) (if not graduated)
HONORS
RECEIVED
From To

ELEMENTARY PILAR COLLEGE PRIMARY EDUCATION 1998 2004 N/A 2004 N/A

SECONDARY ZAMBOANGA NATIONAL HIGH SCHOOL WEST SECONDARY EDUCATION 2004 2008 N/A 2008 N/A
VOCATIONAL /
N/A N/A N/A N/A N/A N/A N/A
TRADE COURSE
COLLEGE WESTERN MINDANAO STATE UNIVERSITY BACHELOR OF SCIENCE MAJOR IN NURSING 2008 2012 N/A 2012 N/A
GRADUATE STUDIES ATENEO DE ZAMBOANGA UNIVERSITY DOCTOR OF MEDICINE 2012 2018 N/A 2017 N/A
ATENEO DE ZAMBOANGA UNIVERSITY MASTERS IN PUBLIC HEALTH 2012 2018 N/A 2018 N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE
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