CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 GABIJAN
NAME EXTENSION (JR., SR)
FIRST NAME AMALIA

MIDDLE NAME BALASBAS

3. DATE OF BIRTH
(mm/dd/yyyy)
FEBRUARY/24/1973 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH MAC ARTHUR LEYTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 47 AREA 4C NAWASA LINE STREET

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
REPUBLIC AVENUE BARANGAY HOLY SPIRIT
Other/s:
Subdivision/Village Barangay
QUEZON CITY
7. HEIGHT (m) 5'3
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 1127

18. PERMANENT ADDRESS 47 AREA 4C NAWASA LINE STREET

9. BLOOD TYPE A
House/Block/Lot No. Street
REPUBLIC AVENUE BARANGAY HOLY SPIRIT
10. GSIS ID NO. N/A
Subdivision/Village Barangay
QUEZON CITY
11. PAG-IBIG ID NO. 12165891170
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 1127

13. SSS NO. 33-1655831-1 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 0910-000-8857

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) amalia.gabijan@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) TWITY B. GABIJAN
FIRST NAME 10/27/1995
MARK JOSEPH G. HIJARA
MIDDLE NAME 2/28/2000
RUBEN G. HIJARA
OCCUPATION N/A 11/14/2001
ARA ANNA GABIJAN
EMPLOYER/BUSINESS NAME N/A 10/29/2002
ARO JOAQUIN GABIJAN
BUSINESS ADDRESS N/A 10/29/2002

TELEPHONE NO.

24. FATHER'S SURNAME GABIJAN

NAME EXTENSION (JR., SR)
FIRST NAME JESSIE

MIDDLE NAME EBIAS

25. MOTHER'S MAIDEN NAME

SURNAME BALASBAS

FIRST NAME CRESENCIA

MIDDLE NAME AVILA (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
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
RECEIVED
From To

ELEMENTARY QUIRINO ELEMENTARY SCHOOL PRIMARY 1981 1987 GRADUATED 1987 N/A

SECONDARY QUIRINO HIGH SCHOOL SECONDARY 1991 1991 GRADUATED 1991 N/A

VOCATIONAL / BY HERBERT BAUTISTA UNDER BY SOCIAL

TRADE COURSE SERVICE DEVELOPMENT DEPARTMENT (SSDD)
HOTEL & RESRTAURANT SERVICES 1994 1994 GRADUATED 1994 N/A

FIRST YEAR,
COLLEGE SYSTEM TECHNOLOGY INSTITUTE (STI) COMPUTER PROGRAMMING 1991 1991 FIRST N/A N/A
SEMESTER

GRADUATE STUDIES

(Continue on separate sheet if necessary)

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