CS Form No.

212

Revised 2017
PERSONAL DATA SHEET
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 NO1. CS ID No. (Do not fill up. For CSC use only)

I. PERSONAL INFORMATION
2. SURNAME

NAME EXTENSION (JR., SR)

FIRST NAME

MIDDLE NAME

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

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

please indicate the details.
5. SEX

17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
House/Block/Lot No. Street

Subdivision/Village Barangay

7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE
House/Block/Lot No. Street

10. GSIS ID NO.

Subdivision/Village Barangay

11. PAG-IBIG ID NO.

City/Municipality Province
12. PHILHEALTH NO. ZIP CODE

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

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

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 SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR P/ ACADEMIC
LEVEL UNITS
(Write in full) (Write in full) GRADUATED HONORS
EARNED
From To RECEIVED
(if not

ELEMENTARY

SECONDARY
VOCATIONAL /
TRADE COURSE

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

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

(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.

28. INCLUSIVE DATES SALARY/ JOB/

DEPARTMENT / AGENCY / OFFICE / PAY GRADE (if
(mm/dd/yyyy) POSITION TITLE MONTHLY STATUS OF GOV'T SERVICE
COMPANY applicable)&
(Write in full/Do not abbreviate) SALARY STEP (Format "00 APPOINTMENT (Y/ N)
(Write in full/Do not abbreviate)
From To -0")/ INCREMENT
 (Continue on separate sheet if necessary)

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

(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 OF Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS (mm/dd/yyyy) NUMBER OF HOURS
Supervisory/ (Write in full)
(Write in full) Technical/etc)
From To

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 33. ASSOCIATION/ORGANIZATION
(Write in full)
(Write in full)
 (Continue on separate sheet if necessary)

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

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details: ________________________________

b. Have you been criminally charged before any court?

If YES, give details: ________________________________
Date Filed:
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree,
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:
resignation, retirement, dropped from the rolls, dismissal, termination, end of If YES, give details: ________________________________
term, finished contract or phased out (abolition) in the public or private sector?

38. a. Have you ever been a candidate in a national or local election held within the
last year (except Barangay election)?
If YES, give details:

b. Have you resigned from the government service during the three (3)-month
period before the last election to promote/actively campaign for a national or If YES, give details:
local candidate?
39. Have you acquired the status of an immigrant or permanent resident of another
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 items:
a. Are you a member of any indigenous group?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:

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

ID picture taken within

NAME ADDRESS TEL. NO.
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 not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a
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
representative to verify/validate the contents stated herein. I agree that any PHOTO
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.) PLEASE INDICATE ID Number
and Date of Issuance
Government Issued ID:

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

Date/Place of Issuance:
Date Accomplished Right Thumbmark
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

Yes/No Cstat Gender
Yes Single Male
No Married Female
Separated
Widowed