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 Batausa
NAME EXTENSION (JR., SR)
FIRST NAME Priscilla Grace

MIDDLE NAME Amora

3. DATE OF BIRTH
(mm/dd/yyyy)
12/21/1985 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH San Isidro San Francisco Agusan Del Sur If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS Purok 6

Widowed Separated House/Block/Lot No. Street
San Isidro
Other/s:
Subdivision/Village Barangay
San Francisco
7. HEIGHT (m) 1.57
City/Municipality Province
8. WEIGHT (kg) 54 ZIP CODE Agusan Del Sur 8501

18. PERMANENT ADDRESS Purok 6

9. BLOOD TYPE B+
House/Block/Lot No. Street
San Isidro
10. GSIS ID NO.
Subdivision/Village Barangay
San Francisco Agusan Del Sur
11. PAG-IBIG ID NO. 121062561598
City/Municipality Province

12. PHILHEALTH NO. 120508503607 ZIP CODE 8501

13. SSS NO. 0624900146 19. TELEPHONE NO.

14. TIN NO. 435629492 20. MOBILE NO. 09474807014

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

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) N/A

FIRST NAME N/A N/A
N/A
MIDDLE NAME N/A N/A

OCCUPATION Clinical Admin Supervisor

EMPLOYER/BUSINESS NAME Optum Global Solutions

BUSINESS ADDRESS W. Geonzon St. Asiatown IT Park Apas Lahug Cebu City 6000

TELEPHONE NO. 63285883200

24. FATHER'S SURNAME Batausa

NAME EXTENSION (JR., SR)
FIRST NAME Eduardo

MIDDLE NAME Senillo

25. MOTHER'S MAIDEN NAME

SURNAME Batausa

FIRST NAME Teresita

MIDDLE NAME Amora (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE HIGHEST LEVEL/
YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) (if not graduated)
GRADUATED HONORS
RECEIVED
From To

ELEMENTARY San Francisco Pilot Elementary School Jun-92 Mar-98 Mar-98

SECONDARY Agusan Del Sur National High School Jun-98 Mar-02 Mar-02

VOCATIONAL /
TRADE COURSE

COLLEGE University of Cebu Banilad Bachelor of Science in Nursing Jun-02 Apr-09 Apr-09

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE January 11, 2025

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