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 pers
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 ABB1. CS ID (DoNo
not fill up. For C

I. PERSONAL INFORMATION
2. SURNAME

NAME EXTENSION (JR., SR)

FIRST NAME

MIDDLE NAME

3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturaliz
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street

Other/s:
Subdivision/Village Barangay

7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) ZIP CODE

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 NO. ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any

II. FAMILY BACKGROUND

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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24.FATHER'S SURNAME

NAME EXTENSION (JR., SR)

FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY

SECONDARY

VOCATIONAL /
TRADE COURSE
COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 201
rson

CSC use only)

lization

OF BIRTH
dd/yyyy)

SCHOLARSHIP
/ ACADEMIC
HONORS
RECEIVED
017), Page 1 of 4
 IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF LICENSE (if applicable)
RATING
UNDER SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

(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 she SALARY/ JOB/
28. INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / PAY GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE MONTHLY applicable)& STATUS OF
COMPANY STEP (Format
SERVICE
(Write in full/Do not abbreviate) SALARY APPOINTMENT
(Write in full/Do not abbreviate) "00-0")/ (Y/ N)
From To INCREMENT
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
 VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
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 DATES OF
30. ATTENDANCE Type of LD
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
PROGRAMS (Write in full) (mm/dd/yyyy) HOURS Supervisory/ (Write in full)
Technical/etc)
From To

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. ASSOCIATION/ORGANIZATION
(Write in full)
(Write in full)
 (Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 3 of 4
34. Are you related by consanguinity or affinity to the appointing or recommending
chief of bureau or office or to the person who has immediate supervision over
you
Bureau or Department where you will be apppointed,
a. within the third YES NO
degree?
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
If YES, give details:

35. a. Have you ever been found guilty of any administrative YES NO
offense?
If YES, give details:

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

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

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

NAME ADDRESS TEL. 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 a or photocopied picture
is not acceptable
true, correct and complete statement pursuant to the provisions of pertinent laws, rules
and
regulations of the
representative Republic of the
to verify/validate thePhilippines.
contents Istated
authorize the agencythat
I agree head/authorized
any PHOTO
herein.
misrepresentation made in this document and its attachments shall cause the filing of

(i.e.Passport, GSIS, SSS, PRC, Driver's

License, etc.) PLEASE INDICATE ID

Government Issued ID

ID/License/Passport N
Signature (Sign inside the box)

Date/Place of Issuance
Date Accomplished Right Thumbmark

SCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated
ab
Person Administering Oath

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