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 CANABE
NAME EXTENSION (JR., SR)
SURNAME ELFIE
MIDDLE NAME SAYSON
3. DATE OF BIRTH
(mm/dd/yyyy)
07/ 31/1996 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH PASIG CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS BLOCK 3 LOT 2 QUARRY

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
RICANATI HOMES MINUYAN PROPER
Other/s:
Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
7. HEIGHT (m) 1.79832
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 3023

18. PERMANENT ADDRESS BLOCK 3 LOT 2 QUARRY

9. BLOOD TYPE TYPE O
House/Block/Lot No. Street
RICANATI HOMES MINUYAN PROPER
10. GSIS ID NO.
Subdivision/Village Barangay
SAN JOSE DEL MONTE BULACAN
11. PAG-IBIG ID NO. 1211-9816-6076
City/Municipality Province

12. PHILHEALTH NO. 210257260-5 ZIP CODE

13. SSS NO. 346729110-3 19. TELEPHONE NO. N/A

14. TIN NO. 338-753-066 20. MOBILE NO. 0993 - 758 - 9253

15. AGENCY EMPLOYEE NO. 5404391 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) N/A
FIRST NAME N/A
N/A
MIDDLE NAME N/A
N/A
OCCUPATION N/A
N/A
EMPLOYER/BUSINESS NAME N/A
N/A
BUSINESS ADDRESS N/A
N/A
TELEPHONE NO. N/A
N/A
24. FATHER'S SURNAME CANABE
NAME EXTENSION (JR., SR) N/A
FIRST NAME ELVER
N/A
MIDDLE NAME OMBAY
N/A
25. MOTHER'S MAIDEN NAME
N/A
SURNAME SAYSON
N/A
FIRST NAME PRECILA
MIDDLE NAME QUIMZON (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) (if not graduated)
GRADUATED HONORS
From To RECEIVED

ELEMENTARY MINUYAN ELEMENTARY SCHOOL ELEMENTARY GRADUATE 2003 2009 2009

SECONDARY MINUYAN HIGH SCHOOL HIGH SCHOOL GRADUATE 2010 2013 2013

VOCATIONAL /
TRADE COURSE
BACHELOR OF SECONDARY EDUCATION
COLLEGE LA CONCEPCION COLLEGE
MAJOR IN FILPINO 2014 2017 2017

GRADUATE STUDIES

(Continue on separate sheet if necessary)

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