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PDS CSCForm212 Revised2017

This document is a personal data sheet that collects an individual's personal and contact information. It requests details such as name, date of birth, citizenship, address, family background, education history, and signature. Filling out the form incorrectly or providing false information could result in administrative or criminal penalties against the applicant.

Uploaded by

Jayvee Perez
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© © All Rights Reserved
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38 views2 pages

PDS CSCForm212 Revised2017

This document is a personal data sheet that collects an individual's personal and contact information. It requests details such as name, date of birth, citizenship, address, family background, education history, and signature. Filling out the form incorrectly or providing false information could result in administrative or criminal penalties against the applicant.

Uploaded by

Jayvee Perez
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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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 PEREZ
NAME EXTENSION (JR., SR)
FIRST NAME JAYVEE
MIDDLE NAME JANABAN
3. DATE OF BIRTH
(mm/dd/yyyy)
07/14/1999 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH BULUSAN, SORSOGON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS MORALES COMPOUND


6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
SAGPON
Other/s:
Subdivision/Village Barangay
DARAGA ALBAY
7. HEIGHT (m) 1.67
City/Municipality Province
8. WEIGHT (kg) 65 ZIP CODE 4501
18. PERMANENT ADDRESS GOMEZ STREET
9. BLOOD TYPE B+
House/Block/Lot No. Street
DAPDAP
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO. BULUSAN SORSOGON


City/Municipality Province
12. PHILHEALTH NO. ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO. 09510057621

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) [email protected]
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 PEREZ


NAME EXTENSION (JR., SR)
FIRST NAME VICENTE
MIDDLE NAME MANGA
25. MOTHER'S MAIDEN NAME

SURNAME JANABAN
FIRST NAME JUVY
MIDDLE NAME LEE (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


HIGHEST
SCHOLARSHIP/
26. PERIOD OF ATTENDANCE LEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS
(Write in full) (Write in full) EARNED
GRADUATED HONORS
From To RECEIVED
(if not
ELEMENTARY BULUSAN CENTRAL SCHOOL 2006 2012 2012
SECONDARY BULUSAN NATIONAL HIGH SCHOOL 2012 2018 2018
VOCATIONAL /
TRADE COURSE
COLLEGE BICOL UNIVERSITY 2018 2022 2022 CUM LAUDE

GRADUATE STUDIES
(Continue on separate sheet if necessary)

SIGNATURE DATE 10/17/2022

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

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