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 VILLAMOR
NAME EXTENSION (JR., SR)
FIRST NAME CLARICE
MIDDLE NAME SABEJON
3. DATE OF BIRTH
(mm/dd/yyyy)
01/13/2000 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH SINONOC, SINACABAN, MISAMIS OCCIDENTAL If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PIAPE

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
SINONOC
Other/s:
Subdivision/Village Barangay
SINACABAN MISAMIS OCCIDENTAL
7. HEIGHT (m) 1.50 m.
City/Municipality Province
8. WEIGHT (kg) 52 kg. ZIP CODE

18. PERMANENT ADDRESS PIAPE

9. BLOOD TYPE O+
House/Block/Lot No. Street
SINONOC
10. GSIS ID NO. N/A
Subdivision/Village Barangay
SINACABAN MISAMIS OCCIDENTAL
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 615-258-709-00000 20. MOBILE NO. 0948 652 6974

15. AGENCY EMPLOYEE NO. 3224376 21. E-MAIL ADDRESS (if any) clarice.villamor@ustp.edu.ph
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)

FIRST NAME
NAME EXTENSION (JR., SR) N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME VILLAMOR

NAME EXTENSION (JR., SR)
FIRST NAME MARIO
MIDDLE NAME SABEJON
25. MOTHER'S MAIDEN NAME

SURNAME SABEJON
FIRST NAME MERLYN
MIDDLE NAME SAMEJON (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) (if not graduated)
GRADUATED HONORS
From To RECEIVED

SALUTATORIA
ELEMENTARY SINONOC ELEMENTARY SCHOOL 2007 2012 2012 N

SECONDARY SINONOC NATIONAL HIGH SCHOOL 2012 2018 2018 ACHIEVER

VOCATIONAL /
N/A
TRADE COURSE

MINDANAO STATE UNIVERSITY - ILIGAN INSTITUTE BACHELOR OF SECONDARY EDUCATION MAGNA CUM
COLLEGE
OF TECHNOLOGY MAJOR IN FILIPINO 2018 2022 2022 LAUDE

GRADUATE STUDIES N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/21/2022

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