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 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
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME
3. DATE OF BIRTH
(mm/dd/yyyy) 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male Female
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
Single House/Block/Lot No. Street
Widowed Married
Separat
Other/s: ed Subdivision/Village Barangay

7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg) ZIP CODE

18. PERMANENT ADDRESS

9. BLOOD TYPE
House/Block/Lot No. Street

10. GSIS ID NO.

Subdivision/Village Barangay

11. PAG-IBIG ID NO.

City/Municipality Province

12. PHILHEALTH NO. ZIP CODE

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)
NAME EXTENSION (JR., SR)
FIRST NAME

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

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

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. LICENSE (if applicable)
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER RATING DATE OF
SPECIAL LAWS/ CES/ CSEE (If Applicable) EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT NUMBER Date of
Validity

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

(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
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
INCLUSIVE DATES OF
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE Type of LD
NUMBER OF HOURS
( Managerial/ CONDUCTED/ SPONSORED BY
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
ENHANCING LEARNERS'READING AND NUMERACY SKILLS IN APPLYING DIFFERENT 11/18/2022 11/18/2022 4 TECHNICAL PAYANGAN INTEGRATED SCHOOL
EFFECTIVE STRATEGIES

ADVANCED TRAINING COURSE FOR TROOP LEADERS WITH COURSE NO.22-541 10/17/2022 10/24/2022 64 TECHNICAL BOYS SCOUT OF THE PHILIPPINES BATAAN
COUNCIL

BASIC TRAINING COURSE FOR TROOP LEADERS 06//10/2022 8/6/2022 24 TECHNICAL BOYS SCOUT OF THE PHILIPPINES BATAAN
COUNCIL
“RPMS Tool for Proficient Teachers in the time of Covid-19” 02-14-2022 02-14-2022 8 TECHNICAL PAYANGAN INTEGRATED SCHOOL

Music Webinar Training for Grades 4-6 Teachers 07-14-15-2021 07-22,23-2021 32 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN
Online Division Training on Multiple Intelligences and Exploring New 11- 24-2021 11- 26,2021 24 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
Thinking in Adapting our Teaching in the New Normal OF BATAAN

INTERNATIONAL WEBINAR ON DIGITAL CAPACITY IN THE 21ST CENTURY EDUCATION 04-10-2021 04-17-24-2021 24 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN
DIVISION WEBINAR SERIES FOR TECHNOLOGICAL UPSKILLING AND RESKILLING FOR
TEACHING, NON TEACHING, AND DIVISION OFFICE EMPLOYEES USING GOOGLE APPS 09-15-2020 09-18-2020 12 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN
AND GSUITE FOR EDUCATION
DIVISION WEBINAR SERIES FOR TECHNOLOGICAL UPSKILLING AND RESKILLING ON 08-31-2020 09-04-2020 12 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
ONLINE LEARNING MODALITY USING ZZISH AND QUIZZALIZE OF BATAAN

Division Online Capacity Building Math Webinar 2020 08-12-2020 08-14-2020 12 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN
Division Online Orientation on the Standards,Management and Development Process of SDO- 06-16-2020 06-16-2020 4 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
Bataan LRMDS-ADM Learning Resource Modules OF BATAAN

ENVIRONMENTAL FORUM AND NIGHT PATROL 11/23/2019 11/23/2019 8 TECHNICAL PROVINCIAL TOURISM OFFICE

INTEGRATION OF GENDER CORE MESSAGES AND RELATIVE VALUES ACROSS THE K12 10/23/2019 10/25/2019 24 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
CURRICULUM OF BATAAN

DIVISION RETOOLING FOR TEACHERS,SCHOOL HEADS SGOD PERSONNEL ON IPED 11/15/2018 11/16/2018 16 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN

CLUSTERED SCHOOLS TRAINING ON GAD AND RELATED VALUES 10/25/2018 10/25/2018 8 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN

SEMINAR ON CAMPUS JOURNALISM 10/24/2018 10/24/2018 8 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
OF BATAAN
PHILIPPINE PROFESSIONAL STANDARDS FOR TEACHERS (PPST) AND RPMS MANUAL 07/2/2018 07/03/2018 16 TECHNICAL DEPARTMENT OF EDUCATION SCHOOLS DIVISION
TEACHERS AND SCHOOL HEADS OF BATAAN
2017 DIVISION ORIENTATION ON DISASTER RISK AND REDUCTION,MANAGEMENT ,BOMB DEPARTMENT OF EDUCATION-SCHOOLS DIVISION
THREAT MANAGEMENT AND PROTOCOLS AND THE 7.2 MAGNITUDE WEST VALLEY 12/19/2017 12/19/2017 8 TECHNICAL OFFICE OF BATAAN
FAULT EARTHQUAKE
DISTRICT ICT LITERACY TRAINING WORKSHOP 10/24/2017 10/26/2017 24 TECHNICAL DEPARTMENT OF EDUCATION-SCHOOLS DIVISION
OFFICE OF BATAAN

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. NON-ACADEMIC DISTINCTIONS / RECOGNITION (Write in full) 33. (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 the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree?
YES
b. within the fourth degree (for Local Government Unit - Career Employees)?
YES
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 court? YES NO

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, ordinance or regulation
by any court or tribunal? YES NO
If YES, give details:
________________________________
________________________________
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 YES NO
out (abolition) in the public or private sector? If YES, give details:
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)? YES NO
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES
election to promote/actively campaign for a national or local candidate? NO
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 items:
a. Are you a member of any indigenous group?
YES specify:
If YES, please NO
b. Are you a person with disability?
YES NO
If YES, please specify ID No:
c. Are you a solo parent?
YES NO
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
4.5 cm. X 3.5 cm
(passport size)

Computer generated
or photocopied picture
is not acceptable

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. PHOTO

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 box)

Date/Place of Issuance:
Date Accomplished Right Thumbmark

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