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 PAMINTUAN
NAME EXTENSION (JR., SR)
FIRST NAME JUDIEL MARIE

MIDDLE NAME RODRIGUEZ

3. DATE OF BIRTH
(mm/dd/yyyy)
2/1/1993 16. CITIZENSHIP FILIPINO

4. PLACE OF BIRTH TARLAC CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX FEMALE

17. RESIDENTIAL ADDRESS ZONE 6

6 CIVIL STATUS MARRIED
House/Block/Lot No. Street
MAPALACSIAO
Subdivision/Village Barangay
TARLAC TARLAC
7. HEIGHT (m) 1.65
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 2300

18. PERMANENT ADDRESS ZONE 6

9. BLOOD TYPE
House/Block/Lot No. Street
MALIWALO
10. GSIS ID NO.
Subdivision/Village Barangay
TARLAC TARLAC
11. PAG-IBIG ID NO. 1212-3681-6803
City/Municipality Province
12. PHILHEALTH NO. 07-050919310-8 ZIP CODE 2300

13. SSS NO. 02-36699476 19. TELEPHONE NO. N/A

14. TIN NO. 489-990-779-000 20. MOBILE NO. 09513168194

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
N/A 21. E-MAIL ADDRESS (if any) judielmarie01@gmail.com
QUIAMBAO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
ALJON QUEEN ALEIA P. QUIAMBAO 6/21/2021

MIDDLE NAME CUNANAN N/A N/A

OCCUPATION MECHANIC N/A N/A

EMPLOYER/BUSINESS NAME MOTOR SHOP N/A N/A

BUSINESS ADDRESS LA PAZ TARLAC N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME PAMINTUAN N/A N/A

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

MIDDLE NAME TORRES N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME RODRIGUEZ N/A N/A

FIRST NAME GLICERIA N/A N/A

MIDDLE NAME SOTTO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

HIGHEST
26. PERIOD OF ATTENDANCE LEVEL/ SCHOLARSHIP/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR
LEVEL UNITS ACADEMIC
(Write in full) (Write in full) EARNED
GRADUATED
HONORS RECEIVED
From To (if not
MALIWALO CENTRAL ELEMENTARY DESERVING
ELEMENTARY
SCHOOL
ELEMENTARY 2000 2005 N/A 2005
PUPILS
DESERVING
SECONDARY MALIWALO NATIONAL HIGH SCHOOL HIGH SCHOOL 2005 2009 N/A 2009
PUPILS
VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A
BACHELOR OF ELEMENTARY EDUCATION MAJOR IN GENERAL
COLLEGE TARLAC STATE UNIVERSITY EDUCATION 2010 2014 N/A 2014 N/A

GRADUATE STUDIES N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 1/5/2023

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