CS Form 212 (Revised 2005)
PERSONAL DATA SHEET
Print legibly. Mark appropriate boxes with and use separate sheet if necessary. 1. CS 1ID No. (to be filled up by CSC)
I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME
MIDDLE NAME 3. NAME EXTENSION (e.g. Jr., Sr.)
4. DATE OF BIRTH (mm/dd/yyyy) 16. RESIDENTIAL ADDRESS
5. PLACE OF BIRTH
6. SEX Male Female
7. CIVIL STATUS Single Widowed ZIP CODE
Married Separated 17. TELEPHONE NO.
Annulled Others, specify 18. PERMANENT ADDRESS
8. CITIZENSHIP
9. HEIGHT (m)
10. WEIGHT (kg.) ZIP CODE
11. BLOOD TYPE 19. TELEPHONE NO.
12. GSIS ID. NO. 20. E-MAIL ADDRESS (if any)
13. PAG-IBIG ID. NO. 21. CELLPHONE NO. (if any)
14. PHILHEALTH NO. 22. AGENCY EMPLOYEE NO.
15. SSS NO. 23. TIN
II. FAMILY BACKGROUND
24. SPOUSE'S SURNAME 25. NAME OF CHILD (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
(Continue on separate sheet if necessary)
26. FATHER'S SURNAME
FIRST NAME
MIDDLE NAME
27. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME ( continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
28 HIGHEST INCLUSIVE DATES OF
LEVEL YEAR GRADE/LEVEL/ SCHOLARSHIP/
NAME OF SCHOOL DEGREE COURSE ATTENDANCE
GRADUATED UNITS EARNED
ACADEMIC
(Write in full) (Write in full) (if not
(if graduated) HONORS
graduated) From To
RECEIVED
ELEMENTARY
SECONDARY
VOCATIONAL/ TRADE
COURSE
COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)
Page 1 of 4
IV. CIVIL SERVICE ELIGIBILITY
29 LICENSE (if applicable)
DATE OF
CAREER SERVICE/RA 1080 (BOARD/BAR)
UNDER SPECIAL LAWS/CES/CSEE RATING EXAMINATION/ PLACE OF EXAMINATION / CONFERMENT DATE OF
CONFERMENT NUMBER
RELEASE
(continue on separate sheet if necessary)
V. WORK EXPERIENCE (Include private employment. Start from your current work)
30 INCLUSIVE DATES
SALARY GRADE GOV'T
(mm/dd/yyyy) DEPARTMENT / AGENCY / OFFICE / MONTHLY STATUS OF
POSITION TITLE & STEP
APPOINTMENT
SERVICE
COMPANY (Write in full) SALARY (Format "00-0") (Yes / No)
From To
(continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES (mm/dd/yyyy) NUMBER OF
31 (Write in full) HOURS
POSITION / NATURE OF WORK
From To
(continue on separate sheet if necessary)
VII. TRAINING PROGRAMS (Start from the most recent training)
INCLUSIVE DATES OF
32 TITLE OF SEMINAR / CONFERENCE / WORKSHOP/ ATTENDANCE (mm/dd/yyyy) NUMBER OF CONDUCTED / SPONSORED BY
SHORT COURSES
HOURS (Write in full)
(Write in Full)
From To
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
35. MEMBERSHIP IN
34. NON-ACADEMIC DISTINCTIONS / RECOGNITION
33 SPECIAL SKILLS / HOBBIES ASSOCIATION/ORGANIZATION
(Write in full)
(Write in full)
(Continue on separate sheet)
CS FORM 212 (Revised 2005), Page 3 of 4
36 Are you related by consanguinity or affinity to any of the following:
a. Within the third degree (for National Government Employees): 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 Employees): YES NO
appointing authority or recommending authority where you will be appointed? If YES, give details:
37 a. Have you ever been formally charged? YES NO
If YES, give details:
b. Have you ever been guilty of any administrative offense? YES NO
If YES, give details:
38 Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation by YES NO
any court or tribunal? If YES, give details:
39 Have you ever been separated from the service in any of the following modes: YES NO
resignation, retirement, dropped from the rolls, dismissal, termination, end of term, If YES, give details:
finished contract, AWOL or phased out, in the public or private sector?
40 Have you ever been a candidate in a national or local ( except Barangay election)? YES NO
If YES, give details:
41 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. Are you a member of any Indigenous group? YES NO
If YES, give specify:
b. Are you differently abled? YES NO
If YES, give specify:
c. Are you a solo parent? YES NO
If YES, give specify:
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee)
NAME ADDRESS TEL. NO.
ID picture taken within the
last 6 months
3.5 cm. X 4.5 cm
(passport size)
Computer generated or
43. I declare under oath that this Personal Data Sheet has been accomplished by me and is a true, correct and complete xerox copy of picture is
statement pursuant to the provisions of pertinent laws rules and regualtions of the Republic of the Philippines. not acceptable.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein.
I turst that this information shall remain confidential. PHOTO
COMMUNITY TAX CERTIFICATE NO.
ISSUED AT SIGNATURE (Sign inside the box)
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED RIGHT THUMBMARK
CSC FORM 212 (Revised 2005), Page 4 of 4
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