CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

WARNING: Any misinterpretation 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 BUENO
NAME EXTENSION (JR., SR)
FIRST NAME TEOFILO

MIDDLE NAME SIM

3. DATE OF BIRTH
(mm/dd/yyyy)
OCTOBER 20, 1965 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

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

please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PUROK 4 SITIO BASAK

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
MINTAL
Other/s:
Subdivision/Village Barangay
DAVAO CITY DAVAO DEL SUR
7. HEIGHT (m) 173 CM
City/Municipality Province
8. WEIGHT (kg) 62.3 KG ZIP CODE

18. PERMANENT ADDRESS PUROK 4 SITIO BASAK

9. BLOOD TYPE "A"
House/Block/Lot No. Street
MINTAL
10. GSIS ID NO. 2002818513
Subdivision/Village Barangay
DAVAO CITY DAVAO DEL SUR
11. PAG-IBIG ID NO. 188001387466
City/Municipality Province

12. PHILHEALTH NO. 1605044849780 ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 101-157-311 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 5016640 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME BUENO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) JOHN PAUL B. BUENO i
FIRST NAME CRISANTA 11/03/1992
MIDDLE NAME BILLONES
OCCUPATION N/A
EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME BUENO SR.

NAME EXTENSION (JR., SR)
FIRST NAME WILFREDO
MIDDLE NAME BELVIS
25. MOTHER'S MAIDEN NAME BARRIOS

SURNAME BUENO

FIRST NAME ELIZABETH

MIDDLE NAME SIM (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) (if not graduated)
GRADUATED HONORS
RECEIVED
From To

ELEMENTARY MINTAL ELEMENTARY SCHOOL 16/06/1972 03/271978 1978 N/A

SECONDARY HOLY CROSS OF MINTAL 06/06/1978 04/03/1982 1982 N/A

VOCATIONAL /
TRADE COURSE

BACHELOR OF SCIENCE IN INDUSTRIAL

COLLEGE UNIVERSITY OF SOUTHEASTERN PHILIPPINES 04/06/1984 04/08/1988 1988 N/A
EDUCATION

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE MAY 31, 2023

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