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/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 ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT 1. CS ID No. (Do not fill up. For CSC use
boxes ABBREVIATE. only)

I. PERSONAL INFORMATION
2. SURNAME
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME
3. DATE OF BIRTH
16. CITIZENSHIP Dual Citizenship
(mm/dd/yyyy) Filipino
by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
5. SEX please indicate the details.
Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS

House/Block/Lot Street
Widow Separated No.
ed
Subdivision/Village Barangay
Other/s
:
ZIP CODE
7. HEIGHT (m)
City/ Province
Municipality
8. WEIGHT (kg)
18. PERMANENT ADDRESS
9. BLOOD TYPE
House/Block/Lot Street
No.
10. GSIS ID NO.
Subdivision/Village Barangay
11. PAG-IBIG ID NO.
City/ Province
Municipality
ZIP CODE
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 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH
(mm/dd/yyyy)
FIRST NAME NAME EXTENSION (JR., SR)

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME
(Continue on separate sheet if necessary)
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
HIGHEST
SCHOLARSHIP/
26. PERIOD OF ATTENDANCE LEVEL/
NAME OF BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS
SCHOOL (Write in full) GRADUATED HONORS
From To EARNED
(Write in full) (if not RECEIVED

ELEMENTARY

SECONDARY
VOCATIONAL /
TRADE COURSE

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) DATE OF LICENSE (if applicable)
. RATING
UNDER SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMEN Date
Applicable) NUMBER
T of
Validit
y

(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.
INCLUSIVE DATES SALARY/ JOB/
28
PAY GRADE GOV'T
. (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / MONTHL STATUS
(if SERVICE
(Write in full/Do not COMPANY Y applicable)&
OF
(Y/ N)
From To abbreviate) (Write in full/Do not abbreviate) SALARY STEP (Format APPOINTMENT
"00-0")/
INCREMENT

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
Fro To
m

(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
30. TITLE OF LEARNING AND ATTENDANCE LD ( CONDUCTED/ SPONSORED BY
DEVELOPMENT (mm/dd/yyyy) NUMBER OF HOURS
Managerial (Write in full)
INTERVENTIONS/TRAINING Fro To /
PROGRAMS m Supervisor
(Write in full) y/
Technical/
etc)

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS /
31. SPECIAL SKILLS and HOBBIES RECOGNITION 33. ASSOCIATION/ORGANIZATION
(Write in full) (Write in
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 chief of bureau or office or to the person who has immediate
supervision over you in the 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

YES NO
court?
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,
YES NO
ordinance or regulation by any court or tribunal?
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?
YES NO
38. a. Have you ever been a candidate in a national or local election held within the
last year (except Barangay election)? If YES, give details:

b. Have you resigned from the government service during the three (3)-month
YES NO
period 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
YES NO
a. Are you a member of any indigenous group? If YES, please specify:
b. Are you a person with
YES NO
disability?
If YES, please specify ID No:
YES NO
c. Are you a solo parent? 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
3.5 cm. X 4.5
cm (passport
size)

With full and

handwritten name tag
and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true,
correct and complete statement pursuant to the provisions of pertinent laws, rules and Computer
generated or
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 PHOTO

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

Date/Place of Issuance:
box) Date Right Thumbmark

Accomplished
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