CGHRMS-RB FORM 2017-02
Department of Transportation
Philippine Coast Guard
COAST GUARD HUMAN RESOURCE MANAGEMENT SERVICE
139 25th St., Port Area, South Harbor
1018 Manila
PERSONAL INFORMATION SHEET
(Write all entries in ALL CAPS legibly and accurately. Use BLUE BALLPEN only. Tick appropriate boxes □ and indicate N/A if not applicable. DO NOT ABBREVIATE)
PERSONAL DATA
LAST NAME
FIRST NAME NAME EXT.
MIDDLE NAME
GENDER ☐ MALE ☐ FEMALE CURRENT AGE RELIGION
MARITAL STATUS CITIZENSHIP
BIRTH DATE day-month-year HEIGHT (in feet) WEIGHT (in kgs)
BIRTH PLACE
House/Block/Lot No Street House/Block/Lot No Street
Subdivision/Village/Sitio Barangay Subdivision/Village/Sitio Barangay
PRESENT ADDRESS
HOME ADDRESS
City/Municipality Province City/Municipality Province
Region Zip code Region Zip code
☐ Living with Parents ☐ Living with Relative / Guardian ☐ Home Address ☐ Living with Relative / Guardian
☐ Renting ☐ Others(Specifiy ___________) ☐ Renting ☐ Others(Specifiy ___________)
FAMILY BACKGROUND
LAST NAME LAST NAME
NAME
FIRST NAME FIRST NAME
EXT.
MOTHER
FATHER
MIDDLE MIDDLE
NAME NAME
OCCUPATION OCCUPATION
CURRENT CURRENT
AGE
BIRTH DATE dd-mm-yyyy AGE
BIRTH DATE dd-mm-yyyy
NO. OF BROTHERS NO. OF SISTERS
SIBLING POSITION ☐ 1ST ☐ 2ND ☐ 3RD ☐4TH ☐ (Specify_________) ARE YOU A BREADWINNER ☐ YES ☐ NO
LAST NAME LAST NAME
NEAREST RELATIVE IN
NEAREST RELATIVE IN
NAME
SERVICE (RETIRED)
SERVICE (ACTIVE)
FIRST NAME FIRST NAME
EXT.
MIDDLE MIDDLE
NAME NAME
RELATIONSHIP RELATIONSHIP
BRANCH OF BRANCH OF
RANK RANK
SERVICE SERVICE
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SIGNATURE DATE dd-mm-yyyy
EDUCATIONAL BACKGROUND
PERIOD OF HIGHEST LEVEL
ACADEMIC
BASIC EDUCATION / DEGREE / COURSE ATTENDANCE / UNITS YEAR
LEVEL NAME OF SCHOOL HONORS
(Write in Full) EARNED GRADUATED
FROM TO RECEIVED
(if not graduated)
SECONDARY
COLLEGE
GRADUATE
STUDIES
VOCATIONAL /
TRADE
TESDA
RATING
ELIGIBILITY ☐ PRC ☐ CSE – PROFESSIONAL ☐ CSE – SUB PROFESSIONAL ☐ OTHERS (SPECIFY: ___________________ ) (for CSE):
OTHER INFORMATION
BODY BUILT SKIN COLOR
COLOR OF HAIR COLOR OF EYE
BLOOD TYPE IDENTIFYING MARKS
FOOD
ALLERGIES
RESTRICTIONS
SPORTS HOBBIES
ORGANIZATION
JOINED
SKILLS
(Give at least THREE (3))
MID #
PHILHEALTH #
(PAG-IBIG)
TIN GSIS #
MOBILE # 1 MOBILE # 2
CONTACT PERSON IN CASE OF EMERGENCY:
NAME
RELATIONSHIP CONTACT NUMBER:
ADDRESS
PLEASE ANSWER THE FOLLOWING TRUTHFULLY:
1. Have you been involved in any case / investigation pending against you? ☐ YES ☐ NO If yes, what is its nature and status?
_______________________________________________________________________________________________________________
2. Have you ever been charged in any Administrative / Criminal case ? ☐ YES ☐ NO If yes, what is its nature and status?
_______________________________________________________________________________________________________________
3. Do you have any history of drug abuse? ☐ YES ☐ NO If yes, where and when did you undergo rehabilitation?
_______________________________________________________________________________________________________________
THIS IS TO CERTIFY that all entries above are true and correct and that I support all information contained herein with original or authenticated
documentary proofs. Any false information/statement or failure to enclose any material fact may cause the filing of administrative / criminal case/s
against me.
THUMB MARKS
2 X 2 Picture
(Taken within 3 months with name
tag and white background)
LEFT RIGHT
__________________________________________________ ___________________
Signature over Printed Name Date
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