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CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET


Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)
I. PERSONAL INFORMATION
2. S!"#M$ % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % %
&'!S( "#M$ % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % %
M'))*$ "#M$
% % % % % % % % % % % % % % % % % % % % % % % % % % % % % % % +. "#M$ $,($"S'-" (e.g. .r./ Sr.)
0. )#($ -& 1'!(2 (334dd4yyyy) 4 4
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7. P*#C$ -& 1'!(2
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=S'S ') "-. 2>. $AM#'* #))!$SS (if any)
5+. P#=A'1'= ') "-. 25. C$**P2-"$ "-. (if any)
50. P2'*2$#*(2 "-.
22. #=$"C@ $MP*-@$$ "-.
57. SSS "-. 2+. ('"
II. FAMILY BACKGROUND
20. SP-S$BS S!"#M$ 27. "#M$ -& C2'*) (?rite full na3e and list all) )#($ -& 1'!(2 (334dd4yyyy)
&'!S( "#M$ 4 4
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$MP*-@$!41S. "#M$ 4 4
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26. &#(2$!BS S!"#M$ 4 4
&'!S( "#M$ 4 4
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28. M-(2$!BS M#')$" "#M$ 4 4
S!"#M$ 4 4
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III. EDUCATIONAL BACKGROUND
2;.
*$9$*
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52.
"#M$ -& SC2--*
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full)
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(?rite in full)

@$#!
=!#)#($)





(if graduated)
2'=2$S( =!#)$4
*$9$*4
"'(S $#!"$)
(if not graduated)
'"C*S'9$ )#($S -&
#(($")#"C$
SC2-*#!S2'P4
#C#)$M'C 2-"-!S
!$C$'9$)
9-C#('-"#* 4



(!#)$
C-!S$
#nnulled
-thers/ specify CCCCCCCCCCC
Single
Married

?idowed
Separated

Male &e3ale
I&. CI&IL SER&ICE ELIGIBILITY
2<.
!#('"= P*#C$ -& $,#M'"#('-" 4 C-"&$!M$"(
*'C$"S$ (if applicable)
"M1$!
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&. 'ORK E(PERIENCE (In#)u*e pi+ate e,p)o$,ent. Stat "o, $ou #uent -o.%
+>.
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CS &-!M 252 (!eDised 2>>7)/ Page 2 of 0
C#!$$! S$!9'C$4 !# 5>;> (1-#!)4 1#!)
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&I. &OLUNTARY 'ORK OR IN&OL&EMENT IN CI&IC / NON0GO&ERNMENT / PEOPLE / &OLUNTARY ORGANI1ATION/S
+5.
P-S'('-" 4 "#(!$ -& ?-!F
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&II. TRAINING PROGRAMS (Stat "o, t!e ,ost e#ent tainin2.%
+2.
&ro3 (o
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&III. OT3ER INFORMATION
++. SP$C'#* SF'**S 4 2-11'$SG +0. +7.
(Continue on sepaate s!eet i" ne#essa$%
CS &-!M 252 (!eDised 2>>7)/ Page + of 0
"#M$ E #))!$SS -& -!=#"':#('-"
(?rite in full)
'"C*S'9$ )#($S

(334dd4yyyy)
"M1$! -&
2-!S
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(?rite in full)
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(334dd4yyyy)
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+6.
#re you related by consanguinity or affinity to any of the following G
a.
b.
+8 a. 2aDe you eDer been for3ally chargedH
b. 2aDe you eDer been guilty of any ad3inistratiDe offenseH
+;.
+<.
0>. 2aDe you eDer been a candidate in a national or local election (except 1arangay election)H
05.
a.
#re you a 3e3ber of any indigenous groupH
'f @$S/ please specifyG CCCCCCCCCCCCCCCCCCCC
b.
#re you differently abledH
'f @$S/ please specifyG CCCCCCCCCCCCCCCCCCCC
c.
#re you a solo parentH
'f @$S/ please specifyG CCCCCCCCCCCCCCCCCCCC
02.
"#M$ #))!$SS ($*. "-.
0+.
P2-(-
C-MM"'(@ (#, C$!('&'C#($ "-.
'SS$) #(
4 4
'SS$) -" (334dd4yyyy) )#($ #CC-MP*'S2$) !'=2( (2M1M#!F
CS &-!M 252 (!eDised 2>>7)/ Page 0 of 0
?ithin the third degree (for "ational =oDern3ent $3ployees)G
appointing authority/ reco33ending authority/ chief of office4bureau4depart3ent or person who
has i33ediate superDision oDer you in the -ffice/ 1ureau or )epart3ent where you will be
appointedH
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
?ithin the fourth degree (for *ocal =oDern3ent $3ployees)G
appointing authority or reco33ending authority where you will be appointedH
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2aDe you eDer been conDicted of any cri3e or Diolation of any law/ decree/ ordinance or
regulation by any court or tribunalH
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
2aDe you eDer been separated fro3 the serDice in any of the following 3odesG resignation/
retire3ent/ dropped fro3 the rolls/ dis3issal/ ter3ination/ end of ter3/ finished contract/ #?-*
or phased out/ in the public or priDate sectorH
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
'f @$S/ giDe detailsG
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC
Pursuant toG (a) 'ndigenous PeopleBs #ct (!# ;+85)I (b) Magna Carta for )isabled Persons (!#
8288)I and (c) Solo Parents ?elfare #ct of 2>>> (!# ;<82)/ please answer the following ite3sG
!$&$!$"C$S (Person not related by consanguinity or affinity to applicant 4 appointee)
' declare under oath that this Personal )ata Sheet has been acco3plished by 3e/ and is a true/ correct and
co3plete state3ent pursuant to the proDisions of pertinent laws/ rules and regulations of the !epublic of the
Philippines.
' also authoriJe the agency head 4 authoriJed representatiDe to Derify 4 Dalidate the contents stated herein. ' trust
that this infor3ation shall re3ain confidential.
S'="#(!$ (Sign inside the box)
ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
Computer generated
or ero cop! o" picture
is not accepta#le

@$S "-
@$S "-
@$S "-
@$S "-
@$S "-
@$S "-
@$S "-
@$S "-
@$S "-
@$S "-