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 Dantes
NAME EXTENSION (JR., SR)
FIRST NAME Marcial
MIDDLE NAME Paulmitan JR
3. DATE OF BIRTH
(mm/dd/yyyy)
08/26/1995 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH Las Piñas City If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS Blk 31 Lot 12

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
Queens Row S Molino 3
Other/s:
Subdivision/Village Barangay
Bacoor City Cavite
7. HEIGHT (m) 5'4
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 4102

18. PERMANENT ADDRESS

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

11. PAG-IBIG ID NO. 121-1700-6697-6

City/Municipality Province

12. PHILHEALTH NO. 08-026123578-5 ZIP CODE

13. SSS NO. 34-5681552-9 19. TELEPHONE NO.

14. TIN NO. 500-851-845-000 20. MOBILE NO. 09462094892

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) marcial.dantes0608@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 dantes

NAME EXTENSION (JR., SR)
FIRST NAME marcial
MIDDLE NAME merial Sr.
25. MOTHER'S MAIDEN NAME

SURNAME paulmitan
FIRST NAME susan
MIDDLE NAME ducado (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

ELEMENTARY Queens Row Elementary School 2004 2010

SECONDARY Eastern Bacoor National High School 2010 2014

VOCATIONAL /
TRADE COURSE
Dr. Filemon C. Aguilar Information Technology and
COLLEGE
Training Institute 2014 2017

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE June 09, 2021

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