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PERSONAL DATA SHEET
ARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/
W
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. D
ATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy)
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS
House/Block/Lot No. Street
Subdivision/Village Barangay
7. HEIGHT (m)
City/Municipality Province
18. PERMANENT ADDRESS
9. BLOOD TYPE
House/Block/Lot No. Street
10. GSIS ID NO.
Subdivision/Village Barangay
11. PAGIBIG ID NO.
City/Municipality Province
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14. TIN NO. 20. MOBILE NO.
15. AGENCY EMPLOYEE NO. 21. EMAIL ADDRESS (if any)
II. FAMILY BACKGROUND
3. NAME of CHILDREN (Write full name and DATE OF BIRTH (mm/
2
22. SPOUSE'S SURNAME
list all) dd/yyyy)
AME EXTENSION
N
FIRST NAME (JR., SR)
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
2 F
4.ATHER'S SURNAME
FIRST NAME
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
HIGHEST
SCHOLAR
BASIC EDUCATION/DEGREE/ ERIOD OF
P LEVEL/
26. EAR
Y SHIP/
NAME OF SCHOOL ATTENDANCE UNITS
LEVEL COURSE EARNED
GRADUAT ACADEMIC
(Write in full) ED HONORS
(Write in full) (if not
From To RECEIVED
graduated)
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ELEMENTARY
SECONDARY
OCATIONAL /
V
TRADE
COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4
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IV. CIVIL SERVICE ELIGIBILITY
CAREER SERVICE/ RA 1080 (BOARD/
27. BAR) UNDER SPECIAL LAWS/ CES/ DATE OF ICENSE (if applicable)
L
ATING
R
CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) UMBER
N Date of
BARANGAY ELIGIBILITY / DRIVER'S CONFERMENT
LICENSE 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.
INCLUSIVE ALARY/ JOB/
S
28. DATES (mm/dd/ DEPARTMENT / AGENCY / OFFICE / PAY GRADE (if
STATUS OF GOV'T
OSITION TITLE
P MONTHLY applicable)&
yyyy) COMPANY SALARY STEP (Format
APPOINTMEN SERVICE
(Write in full/Do not abbreviate) T (Y/ N)
(Write in full/Do not abbreviate) "000")/
From To INCREMENT
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(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
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VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NONGOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29. NUMBER OF
(Write in full) (mm/dd/yyyy) POSITION / NATURE OF WORK
HOURS
From To
(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 LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/ ATTENDANCE NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
TRAINING PROGRAMS (Write in full) (mm/dd/yyyy) HOURS Supervisory/ (Write in full)
Technical/etc)
From To
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(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
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MEMBERSHIP IN ASSOCIATION/
32 NONACADEMIC DISTINCTIONS / RECOGNITION 3
31. SPECIAL SKILLS and HOBBIES ORGANIZATION
. (Write in full) 3.
(Write in full)
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 3 of 4
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34. re you related by consanguinity or affinity to the appointing or
A
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?
. within the fourth degree (for Local Government Unit Career
b
Employees)?
If YES, give details:
________________________________
________________________________
35. . Have you ever been found guilty of any administrative
a
offense?
If YES, give details:
________________________________
________________________________
. Have you been criminally charged before any court?
b
If YES, give details:
________________________________
________________________________
Date
Filed:
Status of Case/s:
36. ave you ever been convicted of any crime or violation of any
H
law, decree, ordinance or regulation by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. ave you ever been separated from the service in any of the
H
following modes: resignation, retirement, dropped from the rolls,
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following modes: resignation, retirement, dropped from the rolls, If YES, give details:
dismissal, termination, end of term, finished contract or phased ________________________________
out (abolition) in the public or private sector? ________________________________
38. . Have you ever been a candidate in a national or local election
a
held within the last year (except Barangay election)?
If YES, give details:
. Have you resigned from the government service during the
b
three (3)month period before the last election to promote/ If YES, give details:
actively campaign for a national or local candidate?
39. Have you acquired the status of an immigrant or permanent
resident of another country?
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
a. Are you a member of any indigenous group?
items:
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID 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)
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, rule
PHOTO
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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
BSCRIBED 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
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