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PDS CS Form No. 212 Personal Data Sheet

This document is a personal data sheet that collects an individual's personal and employment information. It begins with a warning that any misrepresentation made will result in administrative or criminal charges. It requests information such as the individual's personal details like name, date of birth, address, education and work experience. It also asks for family details including spouse's name and occupation as well as parents' names. The collected information is used to verify an applicant or employee's credentials and suitability for employment or records.

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Crystal Renz Tibayan
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363 views1 page

PDS CS Form No. 212 Personal Data Sheet

This document is a personal data sheet that collects an individual's personal and employment information. It begins with a warning that any misrepresentation made will result in administrative or criminal charges. It requests information such as the individual's personal details like name, date of birth, address, education and work experience. It also asks for family details including spouse's name and occupation as well as parents' names. The collected information is used to verify an applicant or employee's credentials and suitability for employment or records.

Uploaded by

Crystal Renz Tibayan
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 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 EBREO
NAME EXTENSION (JR., SR) N/A
FIRST NAME JEANE
MIDDLE NAME GABUTE
3. DATE OF BIRTH
(mm/dd/yyyy)
08/10/1984 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH ODIONGAN,ROMBLON If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS BLOCK 2 LOT 16 N/A


6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
ALEGRIA HOMES PUTTING BATO EAST
Other/s:
Subdivision/Village Barangay
CALACA BATANGAS
7. HEIGHT (m) 5'1
City/Municipality Province
8. WEIGHT (kg) 65kg ZIP CODE 4212

18. PERMANENT ADDRESS BLOCK 2 LOT 16 N/A


9. BLOOD TYPE A+
House/Block/Lot No. Street
ALEGRIA HOMES PUTTING BATO EAST
10. GSIS ID NO. 021-1369-0036-1
Subdivision/Village Barangay
CALACA BATANGAS
11. PAG-IBIG ID NO. 1211-5850-1052
City/Municipality Province

12. PHILHEALTH NO. 09-000087469-7 ZIP CODE 4212

13. SSS NO. N/A 19. TELEPHONE NO. N/A

14. TIN NO. 437-642-353 20. MOBILE NO. 0905-788-0026

15. AGENCY EMPLOYEE NO. 0000089 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME EBREO 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME ANACLITO


NAME EXTENSION (JR., SR) CLEANNE JEAN G. EBREO 27/04/2011
N/A

MIDDLE NAME NEDIC CLINT JAKE G. EBREO 12/07/2019

OCCUPATION SALES ASSOCIATE


EMPLOYER/BUSINESS NAME CITY SAVINGS BANK
BUSINESS ADDRESS P. BURGOS ST. CORNER OSMENA BLVD.CEBU CITY,6000
TELEPHONE NO. 0935 732 7228
24. FATHER'S SURNAME GABUTE
NAME EXTENSION (JR., SR)
FIRST NAME RIZAL N/A

MIDDLE NAME VENUS


25. MOTHER'S MAIDEN NAME

SURNAME FOYO
FIRST NAME ROTIDA
MIDDLE NAME FORMON (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) GRADUATED HONORS
(if not graduated)
From To RECEIVED

ODIONGAN SOUTH CENTRAL ELEMENTARY


ELEMENTARY
SCHOOL
Elementary 1990 1997 N/A 1997 N/A

SECONDARY ROMBLON NATIONAL HIGH SCHOOL High School 1997 2001 N/A 2001 N/A

VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A

COLLEGE ROMBLON STATE UNIVERSITY TIRTIARY 2001 2005 N/A 2005 N/A

GRADUATE STUDIES PHILIPPINE CHRISTIAN UNIVERSITY MASTERAL DEGREE( 36 UNITS) 2016 2018 N/A N/A N/A
(Continue on separate sheet if necessary)

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

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