CS Form No. 212 Revised Personal Data Sheet 2 Blank Form
CS Form No. 212 Revised Personal Data Sheet 2 Blank Form
CS Form No. 212 Revised Personal Data Sheet 2 Blank Form
212
Revised 2017
PERSONAL DATA SHEET
WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s aga
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
I. PERSONAL INFORMATION
2. SURNAME
FIRST NAME NAME EXTENSION (JR., SR)
MIDDLE NAME
3. DATE OF BIRTH 8/11/1982 16. CITIZENSHIP
(mm/dd/yyyy)
Filipino Dual Citizenship
SECONDARY
VOCATIONAL /
TRADE
COURSE
COLLEGE
GRADUATE STUDIES
Dual Citizenship
Street
Barangay
Province
Street
Barangay
Province
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
ROGRAMS ATTENDED
st five (5) years for Division Chief/Executive/Managerial positions)
CONDUCTED/ SPONSORED BY
(Write in full)
separate sheet if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
Speaker
Writer
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. Have you ever been separated from the service in any of the following modes: resignation,
YES NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
out (abolition) in the public or private sector? ________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
YES NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the YES NO
last election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES NO
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. Are you a member of any indigenous group?
YES NO
If YES, please specify:
b. Are you a person with disability? YES NO
If YES, please specify ID No:
c. Are you a solo parent? YES NO
If YES, please specify ID No:
Computer gene
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete or photocopied p
is not accepta
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I
authorize the agency head / authorized representative to verify/validate the contents stated herein. I agree that any
misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s PHOTO
against me.
Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License,
etc.) PLEASE INDICATE ID Number and Date of Issuance
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicate
NO
If YES, give details:
________________________________
________________________________
NO
If YES, give details:
________________________________
________________________________
NO
NO
NO
If YES, give details (country):
NO
NO
NO
Computer generated
or photocopied picture
is not acceptable
PHOTO
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