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 fi
person concerned.
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET(PDS) BEFORE ACCO
Print legibly. Tick appropriate boxes□) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREV

I.PERSONAL INFORMATION
2. SURNAME
FIRST NAME
MIDDLE NAME
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
If holder of duaI citizenship,
4. PLACE OF BIRTH please indicate the details.
5.SEX □Male □Female

□Single □Married
6 CIVIL STATUS □WidowedSeparated
□Other/s:
17. RESIDENTIAL ADDRESS
ZIP CODE
7. HEIGHT (m)

8. WEIGHT(kg)

9.BLOOD TYPE

10. GSIS ID NO. 18. PERMANENT ADDRESS

ZIP CODE
11. PAG-IBIG ID NO.

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
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
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME
III. EDUCATIONAL BACKG ROUND
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in full) (Write in full)
ELEMENTARY
SECONDARY
VOCATIONAL/
TRADE COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE
212
17
SHEET
ence Sheet shall cause the filing of administrative/criminal case/s against the
ned.
A SHEET(PDS) BEFORE ACCOMPLISHING THE PDS FORM.
applicable. DO NOT ABBREVIATE. 1. CS ID No. (Do not fill up. For CSC use only)

MATION

NAME EXTENSION (JR.,SR)

□Filipino □Dual Citizenship

SHIP by birth by naturalization
itizenship, Pls.indicate country:
he details.

House/Block/Lot No. Street

SubdivisionVilage Barangay

City/Municipality Province

House/Block/Lot No. Street

SubdivisionVillage Barangay

City/Municipality Province

23. NAME of CHILDREN (Write full name

DATE OF BIRTH (mm/dd/yyyy)
and list all)
 (Continue on separate sheet if necessary)
ROUND
PERIOD OF SCHOLARSHIP/
LEVEL/
GREE/COURSE ATTENDANCE YEAR ACADEMIC
UNITS
ull) From To GRADUATED HONORS
EARNED
RECEIVED

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

(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 Wor
28. INCLUSIVE DEPARTMENT/AGENCY/
DATES POSITION TITLE OFFICE/COMPANY MONTHLY
(mm/dd/yyyy) (Write in full/Do not abbreviate) (Write in full/Do not SALARY
From To abbreviate)
 (Continue on separate sheet if necessary)
SIGNATURE DATE
BILITY
LICENSE (if applicable)
OF EXAMINATION/CONFERMENT Date of
NUMBER
Validity

necessary)
E
s should be indicated in the attached Work Experience sheet.
SALARY/ JOB/
PAY GRADE (if GOVT
STATUS OF
applicable)&STEP SERVICE
APPOINTMENT
(Format"00-0")/ (Y/N)
INCREMENT
 VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC/NON-GOVERNMENT/PEOPLE/VOLUNTARY OR
INCLUSIVE DATES
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 ATTEN
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five(5) years
positions)
INCLUSIVE DATES OF
30. TITLE OF LEARNING AND DEVELOPMENT ATTENDANCE
INTERVENTIONS/TRAINING PROGRAMS (mm/dd/vvvv) NUMBER OF HOURS
(Write in full)
From To

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

31. SPECIAL SKILLS and HOBBIES NON-ACADEMIC DISTINCTIONS / RECOGNITION

(Write in full)
 (Continue on separate sheet if necessary)
SIGNATURE DATE
RNMENT/PEOPLE/VOLUNTARY ORGANIZATION/S

POSITION/NATURE OF WORK

if necessary)
ONS/TRAINING PROGRAMS ATTENDED
ning taken for the last five(5) years for Division Chief/Executive/Managerial

Type of LD
(Managerial/ CONDUCTED/SPONSORED BY
Supervisory/ (Write in full)
Technical/etc)

if necessary)
ATION
MEMBERSHIP IN
ECOGNITION
33 ASSOCIATION/ORGANIZATION
(Write in full)
te sheet if necessary)
DATE
 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?
b. within the fourth degree (for Local Government Unit-Career Employees)?

35. a. Have you ever been found guilty of any administrative offense?
b. Have you been criminally charged before any court?

36.Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement,dropped from the rolls, dismissal, termination, end of 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 last year
(except Barangay election)?
b.Have you resigned from the government service during the three (3)-mont period before
the last election to promote/actively campaign for a national or local candidate?

39. Have you acquired the status of an immigrant or permanent resident of another 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
a. Are you a member of any indigenous group?
b. Are you a person with disability?
C. Are you a solo parent?

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct a
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.
SUBSCRIBED AND SWORN to before me this ,affiant exhibiting his/her validly issued governme
Person Administering Oath
 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?
b. within the fourth degree (for Local Government Unit-Career Employees)?

35. a. Have you ever been found guilty of any administrative offense?
b. Have you been criminally charged before any court?

36.Have you ever been convicted of any crime or violation of any law, decree, ordinance or
regulation by any court or tribunal?
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement,dropped from the rolls, dismissal, termination, end of 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 last year
(except Barangay election)?
b.Have you resigned from the government service during the three (3)-mont period before
the last election to promote/actively campaign for a national or local candidate?

39. Have you acquired the status of an immigrant or permanent resident of another 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
a. Are you a member of any indigenous group?
b. Are you a person with disability?
C. Are you a solo parent?

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

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 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.:

Date/Place of lssuance:
 Date/Place of lssuance:

SUBSCRIBED AND SWORN to before me this ,affiant exhibiting his/her validly issued government ID as ind
Person Administering Oath
or to
□YES □ NO
□ YES □ NO
If YES, give details:

□YES □ NO
If YES, give details:

□YES □NO
If YES, give details:
Date Filed:
Status of Case/s:

r □YES □NO
If YES, give details:
on,
YES □NO
r
If YES, give details:

r □YES □NO
If YES, give details:
□YES □NO
If YES, give details:

y? □YES □NO
If YES, give details (country):

YES □NO
s
If YES, please specify:
g
□YES □NO
If YES, please specify ID No:
□YES □NO
If YES, please specify ID No:

ntee)
ADDRESS TEL NO.

ID picture taken within

the last 6 months
true, correct and 3.5cm.X4.5cm
Republic of the (passport size)
ntents stated With full and handwritten
l cause the name tag and signature over
printed name
Computer generated
or photocopied picture
is not acceptable
PHOTO

Signature (Sign
inside the box)
 Date Accomplished Right Thumbmark

ued government ID as indicated above.