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 GABOR
NAME EXTENSION (JR., SR) N/A
FIRST NAME MARIEL MAE
MIDDLE NAME CASIMSIMAN
3. DATE OF BIRTH
(mm/dd/yyyy) 12/31/1997 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BUTUAN 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 P-3

Widowed Separated House/Block/Lot No. Street

Other/s: AMBANGAN, BRGY. AMBAGO

Subdivision/Village Barangay
7. HEIGHT (m) 5'4 BUTUAN CITY AGUSAN DEL NORTE
City/Municipality Province
8. WEIGHT (kg) 40 ZIP CODE

9. BLOOD TYPE O+ 18. PERMANENT ADDRESS P-3

House/Block/Lot No. Street
10. GSIS ID NO. N/A AMBANGAN, BRGY. AMBAGO
Subdivision/Village Barangay
11. PAG-IBIG ID NO. 1212-1582-5308 BUTUAN CITY AGUSAN DEL NORTE
City/Municipality Province
12. PHILHEALTH NO. 03-0262602601 ZIP CODE 8600
13. SSS NO. 08-2808906-7 19. TELEPHONE NO. N/A
14. TIN NO. 733-829-599-000 20. MOBILE NO. 09386586524 / 09667941455
15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) gabormarielmae04@gmail.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) N/A
FIRST NAME N/A N/A N/A
MIDDLE NAME N/A
OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME GABOR
NAME EXTENSION (JR., SR) N/A
FIRST NAME RENATO
MIDDLE NAME HERMOSO
25. MOTHER'S MAIDEN NAME CASIMSIMAN
SURNAME GABOR
FIRST NAME MARIVIC
MIDDLE NAME CASIMSIMAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
HIGHEST LEVEL/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
RECEIVED
From To
LIBERTAD CENTRAL 5TH
ELEMENTARY ELEMENTARY 2005 2010 GRADUATED 2010
ELEMENTARY SCHOOL HONOR
LIBERTAD NATIONAL HIGH 7TH
SECONDARY HIGH SCHOOL 2010 2013 GRADUATED 2013
SCHOOL HONOR
VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A
BACHELOR OF SCIENCE IN
COLLEGE ACLC COLLEGE OF BUTUAN 2013 2017 GRADUATED 2017 N/A
INFORMATION TECHNOLOGY
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
(Continue on separate sheet if necessary)

SIGNATURE DATE January 3, 2022

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