Personal Data Sheet Template

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CS Form No. 212
PERSONAL DATA SHEET
Revised 2017
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.
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.
(Do not fill up. For CSC use only)
1. CS ID No.
I. PERSONAL INFORMATION
SURNAME
2.
NAME EXTENSION (JR., SR)
FIRST NAME
MIDDLE NAME
3.
DATE OF BIRTH
16. CITIZENSHIP
Filipino
Dual Citizenship
(mm/dd/yyyy)
by birth
by naturalization
Pls. indicate country:
4. PLACE OF BIRTH
If holder of dual citizenship,
please indicate the details.
Female
Male
5. SEX
Single
Married
17. RESIDENTIAL ADDRESS
6
CIVIL STATUS
House/Block/Lot No.
Street
Widowed
Separated
Other/s:
Subdivision/Village
Barangay
7.
HEIGHT (m)
City/Municipality
Province
WEIGHT (kg)
ZIP CODE
8.
18. PERMANENT ADDRESS
9.
BLOOD TYPE
House/Block/Lot No.
Street
10.
GSIS ID NO.
Subdivision/Village
Barangay
11.
PAG-IBIG ID NO.
City/Municipality
Province
ZIP CODE
12. PHILHEALTH NO.
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
23. NAME of CHILDREN (Write full name and list all)
DATE OF BIRTH (mm/dd/yyyy)
22. SPOUSE'S SURNAME
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.
HIGHEST LEVEL/
PERIOD OF ATTENDANCE
NAME OF SCHOOL
BASIC EDUCATION/DEGREE/COURSE
ACADEMIC
YEAR
LEVEL
UNITS EARNED
(Write in full)
(Write in full)
HONORS
GRADUATED
(if not graduated)
RECEIVED
From
To
ELEMENTARY
SECONDARY
VOCATIONAL /
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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