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CS FORM No.

212
Revised 2017

PERSONAL DATA SHEET


WARNING: Any misrepresentation made in the Personal Data Sheet and the Work Exoerience 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
NAME EXTENSION (JR , SR.)
FIRST NAME

MIDDLE NAME

3. DATE OF BIRTH (mm/dd/yyyy)


16. CITIZENSHIP
 Filipino  Dual Citizenship
4. PLACE OF BIRTH
If holder of dual citizenship,  by birth  by naturalization
 Male  Female please indicate the details
5. SEX
Pls. indicate country
 Single  Widowed
 Married  Separated 
6. CIVIL STATUS  Annulled  Others, specify ________ 17. RESIDENTIAL ADDRESS

House/Block/Lot No. Street

7. HEIGHT (m)
Subdivision/Village Barangay

8. WEIGHT (kg)
City/Municipality Province
9. BLOOD TYPE ZIP CODE
18. PERMANENT ADDRESS

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


22. SPOUSE’S SURNAME 23. NAME OF CHILD (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 / /


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


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

ELEMENTARY

SECONDARY

VOCATIONAL / TRADE COURSE


COLLEGE/S

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017) Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27.
CAREER SERVICE / RA 1080 (BOARD/BAR) DATE OF LINCENSE (if applicable)
UNDER SPECIAL LAWS/ CES/ CSEE RATING EXAMMINATION/ PLACE OF EXAMINIATION / CONFERMENT
CONFERMENT DATE OF
NUMBER
RELEASE

(Continue on separate sheet if necessary)


V. WORK EXPERIENCE (include private employment. Start from your current work)
28. SALARY GRADE &
POSITION TITLE GOV’T
INCLUSIVE DATES DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STEP STATUS OF
(Write in full/Do not SERVICE
(mm/dd/yyyy) (Write in full/Do not abbreviate) SALARY INCREMENT APPOINTMENT
abbreviate) (Yes/No)
From To (Format “00.0”)

/ / / /

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(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 / VOLUTARY ORGANIZATION/S
29. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION NUMBER OF
(mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To

/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
/ / / /
(Continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start form the most recent training.)
30.
INCLUSIVE DATES OF ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To

(Continue on separate sheet if necessary)


VIII. OTHER INFORMATION
31. 32. 33.
SPECIAL SKILLS / HOBBIES NON-ACADEMIC DISTINCTION / RECOGNITION: MEMBERSHIP IN
(Write in full) ASSOCIATION/ORGANIZATION
(Write in full)

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2005) Page 3 of 4
34. Are you related to consanguinity or affinity to any of the following:

a. Within the third degree (for National Government Employee) YES NO
If YES, give details:
Appointing authority, recommending authority, chief of office/bureau/department or person who has immediate _____________________________________________________
supervision over you in the Office, Bureau or Department where you will be appointed? _____________________________________________________
_____________________________________________________

b. Within the fourth degree (for Local Government Employee) YES NO
If YES, give details:
Appointing authority or recommending authority where you will be appointed? _____________________________________________________
_____________________________________________________
_____________________________________________________

35. a. Have you ever been formally charged? YES NO


If YES, give details:
_____________________________________________________
_____________________________________________________
_____________________________________________________

b. Have you been guilty of any administrative offense? YES NO


If YES, give details:
_____________________________________________________
_____________________________________________________
_____________________________________________________

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or YES NO
If YES, give details:
tribunal? _____________________________________________________
_____________________________________________________
_____________________________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the YES NO
If YES, give details:
rolls, dismissal, termination, end of term, finish contract, AWOL or phased out, in the public or private sector? For (1) personal matters, (2) work environment, (3)
salary, and (4) the opportunity for advancement.

38. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________________________
_____________________________________________________
_____________________________________________________

39. Pursuant to: (a) Indigenous People’s Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo Parents
Act 2000 (RA 8972), please answer the following items:

YES NO
a. Are you a member of any indigenous group? If YES, please specify: ___________________________________

YES NO
b. Are you differently abled? If YES, please specify: ___________________________________

YES NO
c. Are you a solo parent? If YES, please specify: ___________________________________

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)
42. I declare under oath that I personally accomplished this Personal Data Sheet which is true, correct and complete
statement pursuant to the provision of the pertinent laws, rules and regulation of the Republic of the Philippines. I With full and handwritten
name tag and signature over
authorize the agency head / authorized representative to verify / validate the contents stated herein. I agree that any PHOTO
printed name
misrepresentation made in this document and its attachments shall cause the filing of administrative / criminal case/s
Computer generated
against me. or Xerox copy of picture
is not acceptable

Government Issued ID (i.e. Passport, GSIS, SSS, PRC, Driver’s


License, etc.) PLEASE INDICATE ID Number and Date
Government Issued ID :
Signature (Sign inside the box)
ID/License/Passport No. :

Date/Place of Issuance : RIGHT THUMBMARK


Date Accomplished

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

Person Administering Oath


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