Documente Academic
Documente Profesional
Documente Cultură
212
Revised 2017
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
7. HEIGHT (m)
Subdivision/Village Barangay
8. WEIGHT (kg)
City/Municipality Province
9. BLOOD TYPE ZIP CODE
18. PERMANENT ADDRESS
Subdivision/Village Barangay
MIDDLE NAME / /
OCCUPATION / /
EMPLOYER/BUSINESS NAME / /
BUSINESS ADDRESS / /
TELEPHONE NO. / /
MIDDLE NAME / /
SURNAME / /
FIRST NAME / /
ELEMENTARY
SECONDARY
GRADUATE STUDIES
SIGNATURE DATE
CS FORM 212 (Revised 2017) Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
27.
CAREER SERVICE / RA 1080 (BOARD/BAR) DATE OF LINCENSE (if applicable)
UNDER SPECIAL LAWS/ CES/ CSEE RATING EXAMMINATION/ PLACE OF EXAMINIATION / CONFERMENT
CONFERMENT DATE OF
NUMBER
RELEASE
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(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 / VOLUTARY ORGANIZATION/S
29. INCLUSIVE DATES
NAME & ADDRESS OF ORGANIZATION NUMBER OF
(mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To
/ / / /
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(Continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start form the most recent training.)
30.
INCLUSIVE DATES OF ATTENDANCE
TITLE OF SEMINAR/CONFERENCE/WORKSHOP/SHORT COURSES NUMBER OF CONDUCTED/ SPONSORED BY
(mm/dd/yyyy)
(Write in full) HOURS (Write in full)
From To
SIGNATURE DATE
CS FORM 212 (Revised 2005) Page 3 of 4
34. Are you related to consanguinity or affinity to any of the following:
a. Within the third degree (for National Government Employee) YES NO
If YES, give details:
Appointing authority, recommending authority, chief of office/bureau/department or person who has immediate _____________________________________________________
supervision over you in the Office, Bureau or Department where you will be appointed? _____________________________________________________
_____________________________________________________
b. Within the fourth degree (for Local Government Employee) YES NO
If YES, give details:
Appointing authority or recommending authority where you will be appointed? _____________________________________________________
_____________________________________________________
_____________________________________________________
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by any court or YES NO
If YES, give details:
tribunal? _____________________________________________________
_____________________________________________________
_____________________________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the YES NO
If YES, give details:
rolls, dismissal, termination, end of term, finish contract, AWOL or phased out, in the public or private sector? For (1) personal matters, (2) work environment, (3)
salary, and (4) the opportunity for advancement.
38. Have you ever been a candidate in a national or local election (except Barangay election)? YES NO
If YES, give details:
_____________________________________________________
_____________________________________________________
_____________________________________________________
39. Pursuant to: (a) Indigenous People’s Act (RA 8371); (b) Magna Carta for Disabled Persons (RA 7277); and (c) Solo Parents
Act 2000 (RA 8972), please answer the following items:
YES NO
a. Are you a member of any indigenous group? If YES, please specify: ___________________________________
YES NO
b. Are you differently abled? If YES, please specify: ___________________________________
YES NO
c. Are you a solo parent? If YES, please specify: ___________________________________
SUBSCRIBED AND SWORN to before me this ________________________________ , affiant exhibiting his / her validly issued Government ID as indicated above.