Print legibly. Tick appropriate boxes and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE. 1. CS ID No. 2.
3.
16. CITIZENSHIP
4. PLACE OF BIRTH
5. SEX
17. RESIDENTIAL ADDRESS
8.
18. PERMANENT ADDRESS
12. PHILHEALTH NO.
13. SSS NO. 19. TELEPHONE NO.
20. MOBILE NO.
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME
FIRST NAME
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
From To
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
PERIOD OF ATTENDANCE
READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM. Street
Subdivision/Village
10.
11.
6
7.
CIVIL STATUS
DATE OF BIRTH
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
please indicate the details.
If holder of dual citizenship, Pls. indicate country: House/Block/Lot No. Street
Subdivision/Village Barangay
House/Block/Lot No.
23. NAME of CHILDREN (Write full name and list all) 9.
HEIGHT (m)
WEIGHT (kg)
BLOOD TYPE
GSIS ID NO.
PAG-IBIG ID NO.
PERSONAL DATA SHEET
I. PERSONAL INFORMATION
(Do not fill up. For CSC use only)
SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED
DATE OF BIRTH (mm/dd/yyyy)
26. YEAR
GRADUATED
SURNAME
FIRST NAME
MIDDLE NAME
ZIP CODE
NAME EXTENSION (JR., SR)
14. TIN NO.
WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s against the person concerned.
LEVEL
NAME OF SCHOOL
(Write in full)
Barangay
City/Municipality Province
City/Municipality Province
ZIP CODE
CS FORM 212 (Revised 2017), Page 1 of 4
SIGNATURE
(Continue on separate sheet if necessary)
DATE
HIGHEST
LEVEL/
UNITS
EARNED
(if not
NAME EXTENSION (JR., SR)
BASIC EDUCATION/DEGREE/COURSE
(Write in full)
CS Form No. 212
Revised 2017
Filipino Dual Citizenship
Male Female
Single Married
Widowed
Other/s:
Separated
by birth by naturalization
27.
NUMBER
Date of
Validity
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. 28.
To
DATE
STATUS OF
APPOINTMENT
SIGNATURE
(Continue on separate sheet if necessary)
INCLUSIVE DATES
(mm/dd/yyyy)
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full/Do not abbreviate)
MONTHLY
SALARY
CS FORM 212 (Revised 2017), Page 2 of 4
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER
SPECIAL LAWS/ CES/ CSEE
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
LICENSE (if applicable)
RATING
(If Applicable)
IV. CIVIL SERVICE ELIGIBILITY
GOV'T
SERVICE
(Y/ N)
SALARY/ JOB/
PAY GRADE (if
applicable)& STEP
(Format "00-0")/
From INCREMENT
POSITION TITLE
(Write in full/Do not abbreviate)
From To
From To
31. SPECIAL SKILLS and HOBBIES 33.
CS FORM 212 (Revised 2017), Page 3 of 4
30.
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED NUMBER OF HOURS
TITLE OF LEARNING AND DEVELOPMENT
INTERVENTIONS/TRAINING PROGRAMS
(Write in full)
(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) Type of LD
( Managerial/
Supervisory/
Technical/etc)
29. NAME & ADDRESS OF ORGANIZATION
(Write in full)
(Continue on separate sheet if necessary)
POSITION / NATURE OF WORK
INCLUSIVE DATES
(mm/dd/yyyy)
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S CONDUCTED/ SPONSORED BY
(Write in full)
INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yyyy)
SIGNATURE
VIII. OTHER INFORMATION
(Continue on separate sheet if necessary)
NUMBER OF HOURS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
(Write in full)
MEMBERSHIP IN
ASSOCIATION/ORGANIZATION
(Write in full)
DATE
(Continue on separate sheet if necessary)
a.
If YES, please specify:
b.
If YES, please specify ID No:
c.
If YES, please specify ID No:
REFERENCES (Person not related by consanguinity or affinity to applicant /appointee) ADDRESS
35. a. Have you ever been found guilty of any administrative offense? If YES, give details:
Are you related by consanguinity or affinity to the appointing or recommending authority, or to Bureau or Department where you will be apppointed, Are you a person with disability?
Are you a solo parent?
40.
Have you acquired the status of an immigrant or permanent resident of another country? 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: Are you a member of any indigenous group?
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? 34.
If YES, give details:
chief of bureau or office or to the person who has immediate supervision over you in the a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)? 36.
PHOTO
NAME TEL. NO.
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. a. Have you ever been a candidate in a national or local election held within the last year
(except Barangay election)?
37.
b. Have you resigned from the government service during the three (3)-month period before the last election to promote/actively campaign for a national or local candidate? 38.
If YES, give details:
If YES, give details:
CS FORM 212 (Revised 2017), Page 4 of 4
Person Administering Oath
SUBSCRIBED AND SWORN to before me this, affiant exhibiting his/her validly issued government ID as indicated above. Date Accomplished Right Thumbmark
Date/Place of Issuance:
Government Issued ID:
ID/License/Passport No.:
Date Filed:
Status of Case/s:
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.) PLEASE INDICATE ID Number and Date of Issuance
Signature (Sign inside the box)
39.
41.
If YES, give details (country):
b. Have you been criminally charged before any court? If YES, give details:
If YES, give details:
If YES, give details:
Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or tribunal?
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
Computer generated
or photocopied picture
is not acceptable
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES NO
YES
YES
YES
NO
NO
NO
YES NO
YES NO