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 AMBUS
NAME EXTENSION (JR., SR)
FIRST NAME JAIRO
MIDDLE NAME DACLAN
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy) 1/4/1997
by birth by naturalization
4. PLACE OF BIRTH TOLEDO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 361

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
ILIHAN PROPER
Other/s:
Subdivision/Village Barangay
TOLEDO CEBU
7. HEIGHT (m) 1.61
City/Municipality Province
8. WEIGHT (kg) 55 ZIP CODE 6038

18. PERMANENT ADDRESS 361

9. BLOOD TYPE B+
House/Block/Lot No. Street
ILIHAN PROPER
10. GSIS ID NO. N/A
Subdivision/Village Barangay
TOLEDO CEBU
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 6038

13. SSS NO. N/A 19. TELEPHONE NO. 0323836761

14. TIN NO. N/A 20. MOBILE NO. 09052973313

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

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME AMBUS N/A N/A

NAME EXTENSION (JR., SR)
FIRST NAME CESARIO SR. N/A N/A

MIDDLE NAME RANILE N/A N/A

25. MOTHER'S MAIDEN NAME ELENA VILLAERA DACLAN N/A N/A

SURNAME AMBUS N/A N/A

FIRST NAME ELENA N/A N/A

MIDDLE NAME DACLAN (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

ELEMENTARY JACINTA LAROSA ELEMENTARY SCHOOL 2003 2009 2009 2ND HONOR

SECONDARY TOLEDO CITY SCIENCE HIGH SCHOOL 2009 2013 2013

VOCATIONAL /
N/A
TRADE COURSE
BACHELOR OF SCIENCE IN MECHANICAL DEANS'S
COLLEGE CEBU INSTITUTE OF TECHNOLOGY - UNIVERSITY
ENGINEERING 2013 2018 2018 LISTER

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE September 17, 2020

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