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/c 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.

I. PERSONAL INFORMATION
2. SURNAME

FIRST NAME

MIDDLE NAME

3. DATE OF BIRTH 16. CITIZENSHIP

(mm/dd/yyyy) Filipino
4. PLACE OF BIRTH If holder of dual citizenship,

5. SEX please indicate the details.

Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS

House/Block/Lot No.
Widowed
Separated
Other/s:
Subdivision/Village
7. HEIGHT (m)
City/Municipality
8. WEIGHT (kg) ZIP CODE

9. BLOOD TYPE 18. PERMANENT ADDRESS

House/Block/Lot No.
10. GSIS ID NO.
Subdivision/Village
11. PAG-IBIG ID NO.
City/Municipality
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

22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and l

FIRST 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 se

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL (Write in BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE

LEVEL
full) (Write in full)
From To
ELEMENTARY

SECONDARY

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
riminal case/s against the person

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by birth by naturalization

Pls. indicate country:

Street

Barangay

Province

Street

Barangay

Province

ist all) DATE OF BIRTH (mm/dd/yyyy)

parate sheet if necessary)

HIGHEST LEVEL/ YEAR SCHOLARSHIP/

UNITS GRADUATED ACADEMIC

EARNED HONORS
(if not graduated) RECEIVED

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

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) RATING DATE OF
UNDER SPECIAL LAWS/ CES/ CSEE
BARANGAY ELIGIBILITY / DRIVER'S LICENSE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
CONFERMENT

(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 POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY SALARY/ JOB/ PAY

(mm/dd/yyyy) MONTHLY GRADE (if

(Write in full/Do not (Write in applicable)& STEP
SALARY
abbreviate) full/Do not abbreviate) (Format "00-0")/
From To INCREMENT
 (Continue on separate sheet if necessary)
SIGNATURE DATE CS FORM 2
LICENSE (if applicable)

NUMBER Date of
Validity

GOV'T
SERVICE
STATUS OF
APPOINTMENT

(Y/ N)
12 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
P
29. NAME & ADDRESS OF ORGANIZATION (mm/dd/yyyy) NUMBER OF HOURS
(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 INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE CON
NUMBER OF HOURS ( Managerial/
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES (Write in full) 33.
32. NON-ACADEMIC DISTINCTIONS / RECOGNITION

(Continue on separate sheet if necessary)

SIGNATURE DATE
OSITION / NATURE OF WORK

DUCTED/ SPONSORED BY
(Write in full)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

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 tribunal?
YES NO

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 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 YES NO
last year (except Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period YES NO
before the last election to promote/actively campaign for a national or local candidate?
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?

b. Are you a person with disability? YES NO

If YES, please specify:
c. Are you a solo parent?
YES NO
If YES, please specify ID No:
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

Wit
name

C
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, or
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 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

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

Person Administering Oath

CS FOR
picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)

h full and handwritten

tag and signature over
printed name

omputer generated
photocopied picture
is not acceptable

PHOTO
Right Thumbmark

as indicated above.

M 212 (Revised 2017), Page 4 of 4