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 MIJARES
NAME EXTENSION (JR., SR)
FIRST NAME MARGELYN

MIDDLE NAME BEROS

3. DATE OF BIRTH
(mm/dd/yyyy)
9/19/2003 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH MANILA If holder of dual citizenship, Pls. indicate country:

please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 1269 labores st

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
847
Other/s:
Subdivision/Village Barangay
Manila
7. HEIGHT (m) 157
City/Municipality Province
8. WEIGHT (kg) 45 ZIP CODE 1011

18. PERMANENT ADDRESS 1269 labores st

9. BLOOD TYPE N/A
House/Block/Lot No. Street
847
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1267015569 manila

City/Municipality Province

12. PHILHEALTH NO. 02-027344990-7 ZIP CODE 1011

13. SSS NO. 34-9178545-2 19. TELEPHONE NO.

14. TIN NO. 362-564-832-00000 20. MOBILE NO. 09672019672

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) mijaresmarge@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (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 MIJARES

NAME EXTENSION (JR., SR)
FIRST NAME MANUEL

MIDDLE NAME GLOBIO

25. MOTHER'S MAIDEN NAME

SURNAME BEROS

FIRST NAME ANALYN

MIDDLE NAME BAJASAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY JACINTO E ZAMORA ELEMENTARY SCHOOL GRADE 6 2015

SECONDARY CARLOS P GARCIA HIGH SCHOOL GRADUATED 2019

VOCATIONAL /
TRADE COURSE

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE AUGUST 08,2022

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