CS Form No.

212
Revised 2017
PERSONAL DATA SHEET
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 1. CS ID (Do not fill up. For CSC use
NOT ABBREVIATE. ( No. only)

I. PERSONAL INFORMATION
2. SURNAME
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 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

6 CIVIL STATUS Single Married 17. RESIDENTIAL

ADDRESS House/Block/Lot Street
Widowed Separated No.
Other/s:
Subdivision/ Baranga
Village y
7. HEIGHT (m)
City/ Province
Municipality
ZIP
8. WEIGHT (kg)
CODE
18. PERMANENT ADDRESS
9. BLOOD TYPE
House/Block/Lot Street
No.

10. GSIS ID NO.

Subdivision/ Baranga
Village y

11. PAG-IBIG ID NO.

ZIP City/ Province
CODE Municipality
12. PHILHEALTH NO.

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO.

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

any)
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH
(mm/dd/yyyy)
FIRST NAME NAME EXTENSION (JR., SR)

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS
NAME
BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND
HIGHEST
SCHOLARSHI
26. PERIOD OF ATTENDANCE LEVEL/
NAME OF BASIC UNITS
YEAR P/
LEVE GRADUATED ACADEMIC
SCHOOL EDUCATION/DEGREE/COURSE EARNED
L Fro To (if not HONORS
(Write in full) (Write in full)
m RECEIVED

ELEMENTARY

SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE

GRADUATE STUDIES
(Continue on separate sheet if
necessary)

SIGNATURE DAT
E
CS FORM 212 (Revised 2017), Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) DATE OF LICENSE (if applicable)
RATING EXAMINATI PLACE OF EXAMINATION /
UNDER Date
(If ON / CONFERMENT NUMBER
SPECIAL LAWS/ CES/ CSEE of
BARANGAY ELIGIBILITY / DRIVER'S Applicable) CONFERME
NT Validi
LICENSE
ty

(Continue on separate sheet if

necessary)

V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet.
SALARY/
28. INCLUSIVE JOB/ PAY GOV'T
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / MONTH STATUS OF
SERVIC
DATES LY
GRADE (if
APPOINTMEN
(Write in full/Do not COMPANY applicable)& E (Y/ N)
(mm/dd/yyyy) SALAR STEP (Format T
abbreviate) (Write in full/Do not abbreviate) Y "00-0")/
From T INCREMENT
o

(Continue on separate sheet if

necessary)

SIGNATURE DAT
E
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY
ORGANIZATION/S
NAME & ADDRESS OF INCLUSIVE DATES
29.
ORGANIZATION POSITION / NATURE OF WORK
(mm/dd/yyyy) NUMBER OF
(Write in HOURS
full) Fro T
m o

(Continue on separate sheet if

necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial
positions)
INCLUSIVE DATES Type of
TITLE OF LEARNING AND OF LD (
30. DEVELOPMENT NUMBER OF CONDUCTED/
INTERVENTIONS/TRAINING ATTENDANCE HOURS Managerial
PROGRAMS (mm/dd/yyyy) / SPONSORED BY
(Write in Fro T Supervisory (Write in full)
full) m o /
Technical/etc)

(Continue on separate sheet if

necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES (Write in full) 33. ASSOCIATION/ORGANIZATION
(Write in full)

(Continue on separate sheet if

necessary)

SIGNATU DAT
RE E
CS FORM 212 (Revised 2017), Page 3 of 4
 34.
Are you related by consanguinity or affinity to the appointing or recommending
authority, or to chief of bureau or office or to the person who has immediate
supervision over you in the Bureau or Department where you will be apppointed,
a. within the third degree? YES N
b. within the fourth degree (for Local Government Unit - Career Employees)? YES O
If YES, give N
details:
O

35. a. Have you ever been found guilty of any administrative offense? YES NO
If YES, give
details:
b. Have you been criminally charged before any court?
YES NO
If YES, give
details:
Date
Filed: Status
36. Have you ever been convicted of any crime or violation of any law, decree,
YES NO
ordinance or regulation by any court or tribunal?
If YES, give
details:

37. Have you ever been separated from the service in any of the following modes: YES NO
resignation, retirement, dropped from the rolls, dismissal, termination, end of If YES, give
term, finished contract or phased out (abolition) in the public or private sector? details:
38. a. Have you ever been a candidate in a national or local election held within the YES NO
last year (except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month YES NO
period before the last election to promote/actively campaign for a national or local If YES, give details:
candidate?
39. Have you acquired the status of an immigrant or permanent resident of another
YES NO
country? If YES, give details (country):

40.
Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for
Disabled Persons (RA 7277); and (c) Solo Parents Welfare Act of 2000 (RA
8972), please answer the following YES NO
a.
Are you a member of any indigenous group? If YES, please specify:
YES NO
b.
Are you a person with disability?
If YES, please specify ID No:
c.
Are you a solo parent? YES NO
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAM ADDRES TEL. NO. ID picture taken within

E S the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten name

tag and signature over printed
name

Computer generated or
photocopied picture is
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a not acceptable
true, correct and complete statement pursuant to the provisions of pertinent laws, rules and
regulations of the Republic of the Philippines. I authorize the agency head/authorized PHOTO
representative to verify/validate the contents stated herein. I agree that any
misrepresentation made in this document and its attachments shall cause the filing of
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License,

etc.)

Government Issued ID:

ID/License/Passport No.: Signature (Sign inside the box)

Date/Place of Issuance:
Date Right Thumbmark
Accomplished

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering
Oath

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