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
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy)
by birth by naturalization
4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
5. SEX Male Female please indicate the details.
6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS
House/Block/Lot No. Street
Widowed Separated
Other/s: Subdivision/Village Barangay
7. HEIGHT (m)
City/Municipality Province
8. WEIGHT (kg)
ZIP CODE
9. BLOOD TYPE 18. PERMANENT ADDRESS
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
(Continue on separate sheet if necessary)
MIDDLE NAME
III. EDUCATIONAL BACKGROUND
SCHOLARSHIP/
26. PERIOD OF ATTENDANCE HIGHEST LEVEL/
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) (if not graduated)
GRADUATED HONORS
From To RECEIVED
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if
necessary)
SIGNATURE DATE
IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity
CS FORM 212 (Revised 2017), Page 1 of 4
(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 DATES SALARY/ JOB/ PAY
28.
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/
APPOINTMENT
(Y/ N)
From To INCREMENT
(Continue on separate sheet if
necessary)
SIGNATURE DATE
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF INCLUSIVE DATES
29.
ORGANIZATION (Write in (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
full) From To
CS FORM 212 (Revised 2017), Page 2 of 4
(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 Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS OF ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
(Continue on separate sheet if
necessary)
VIII. OTHER INFORMATION
NON-ACADEMIC DISTINCTIONS / MEMBERSHIP IN ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. RECOGNITION (Write in full) 33. (Write in full)
(Continue on separate sheet if
necessary)
SIGNATUR DATE
E
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, YES NO
a. within the third degree?
YES NO
b. within the fourth degree (for Local Government Unit - Career Employees)? If YES, give details:
CS FORM 212 (Revised 2017), Page 3 of 4
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 YES NO
by any court or tribunal? If YES, give details:
37. YES NO
Have you ever been separated from the service in any of the following modes: resignation, If YES, give details:
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased
out (abolition) in the public or private sector?
38. YES NO
a. Have you ever been a candidate in a national or local election held within the last year
If YES, give details:
(except Barangay election)?
YES NO
b. Have you resigned from the government service during the three (3)-month period before the If YES, give details:
last election to promote/actively campaign for a national or local candidate?
39. YES NO
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 items:
a. YES NO
Are you a member of any indigenous group? If YES, please specify:
b. YES NO
Are you a person with disability? If YES, please specify ID No:
c. YES NO
Are you a solo parent? If YES, please specify ID No:
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
ADDRESS TEL. NO.
NAME
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
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied
picture is not
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the acceptable
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein. PHOTO
I agree that any misrepresentation made in this document and its attachments shall cause the filing of
administrative/criminal case/s against me.
CS FORM 212 (Revised 2017), Page 4 of 4
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
