CS FORM 212 (Revised 2005)

PERSONAL DATA SHEET

Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)
I. PERSONAL INFORMATION
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II. FAMILY BACKGROUND
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III. EDUCATIONAL BACKGROUND
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I&. CI&IL SER&ICE ELIGIBILITY
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CS %,!M 262 (!eEised 244:). Page 2 of /
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PERMANEN
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&I. &OLUNTARY 'ORK OR IN&OL&EMENT IN CI&IC / NON0GO&ERNMENT / PEOPLE / &OLUNTARY ORGANI1ATION/S
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&II. TRAINING PROGRAMS (Stat "o, t!e ,ost e#ent tainin2.%
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&III. OT3ER INFORMATION
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CS %,!M 262 (!eEised 244:). Page * of /
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CLUSTER ROLL OUT OF RESULT-BASED PEFORMANCE
MANAGEMENT SYSTEM
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ONLINE ENCODING AND SUBMISSION OF THE ENHANCED
BASIC EDUCATION INFORMATION SYSTEM
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*5.
#re you related by consanguinity or affinity to any of the following I
a.
b.
*9 a. 1aEe you eEer been for2ally chargedJ
b. 1aEe you eEer been guilty of any ad2inistratiEe offenseJ
*8.
*7.
/4. 1aEe you eEer been a candidate in a national or local election (except 0arangay election)J
/6.
a.
#re you a 2e2ber of any indigenous groupJ
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b.
#re you differently abledJ
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c.
#re you a solo parentJ
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CS %,!M 262 (!eEised 244:). Page / of /
?ithin the third degree (for "ational >oEern2ent $2ployees)I
appointing authority. reco22ending authority. chief of office3bureau3depart2ent or person who
has i22ediate superEision oEer you in the ,ffice. 0ureau or (epart2ent where you will be
appointedJ
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?ithin the fourth degree (for )ocal >oEern2ent $2ployees)I
appointing authority or reco22ending authority where you will be appointedJ
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1aEe you eEer been conEicted of any cri2e or Eiolation of any law. decree. ordinance or
regulation by any court or tribunalJ
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1aEe you eEer been separated fro2 the serEice in any of the following 2odesI resignation.
retire2ent. dropped fro2 the rolls. dis2issal. ter2ination. end of ter2. finished contract. #?,) or
phased out. in the public or priEate sectorJ
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Pursuant toI (a) &ndigenous PeopleBs #ct (!# 8*96)K (b) Magna Carta for (isabled Persons (!#
9299)K and (c) Solo Parents ?elfare #ct of 2444 (!# 8792). please answer the following ite2sI
!$%$!$"C$S (Person not related by consanguinity or affinity to applicant 3 appointee)
& declare under oath that this Personal (ata Sheet has been acco2plished by 2e. and is a true. correct and
co2plete state2ent pursuant to the proEisions of pertinent laws. rules and regulations of the !epublic of the
Philippines.
& also authoriLe the agency head 3 authoriLed representatiEe to Eerify 3 Ealidate the contents stated herein. & trust
that this infor2ation shall re2ain confidential.
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