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 FIRST
NAME NAME EXTENSION (JR., SR)
MIDDLE NAME
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) Filipino Dual Citizenship
by birth by naturalization
If holder of dual citizenship, please indicate Pls. indicate country:
4. PLACE OF BIRTH
the details.
5. SEX Male Female
6 CIVIL STATUS Single 17. RESIDENTIAL ADDRESS
Married
Widowed House/Block/Lot No. Street
Separated
Other/s:
Subdivision/Village Barangay
7. HEIGHT (m)
ZIP CODE City/Municipality Province
8. WEIGHT (kg)
9. BLOOD TYPE 18. PERMANENT ADDRESS
House/Block/Lot No. Street
10. GSIS ID NO.
Subdivision/Village Barangay
11. PAG-IBIG ID NO.
ZIP CODE City/Municipality Province
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 FIRST 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME NAME EXTENSION (JR., SR)
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME FIRST
NAME NAME EXTENSION (JR., SR)
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME FIRST
NAME
MIDDLE NAME
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST LEVEL/ SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD O F ATTENDANCE UNITS YEAR ACADEMIC
LEVEL EARNED GRADUATED
(Write in full) (Write in full) HONORS
(if not graduated) RECEIVED
From To
ELEMENTARY
SECONDARY
VOCATIONAL /
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. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER SPECIAL DATE OF LICENSE (if applicable)
RATING
LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER
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/ PAY GOV'T
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if SERVICE
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in applicable)& STEP
SALARY (Format "00-0")/ APPOINTMENT
abbreviate) full/Do not abbreviate)
INCREMENT
From To
(Continue on separate sheet if necessary)
SIGNATURE DATE
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
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
ATTENDANCE Type of LD (
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write in
(Write in full)
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 authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office, Bureau or
Department where you will be apppointed,
a. within the third degree? YES NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
If YES, give details:
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 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 YES NO
tribunal? If YES, give details:
37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped YES NO
from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or private If YES, give details:
sector?
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay election)? YES NO
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 local candidate? YES NO
If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country? YES NO
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? YES NO
If YES, please specify:
b. Are you a person with disability? YES NO
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)
NAME ADDRESS TEL. NO. ID picture taken within the last
6 months
4.5 cm. X 3.5 cm (passport
size)
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
PHOTO
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 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
