CSC Form 212 Revised 2017 - Fill, Sign Online, Download & Print - No Signup
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
FIRST NAME
NAME EXTENSION (JR., SR)
MIDDLE NAME
3. DATE OF BIRTH
(mm/dd/yyyy)
16. CITIZENSHIP
4. PLACE OF BIRTH
If holder of dual citizenship,
Pls. indicate country:
5. SEX
please indicate the details.
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS
House/Block/Lot No.
Street
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)
FIRST NAME
NAME EXTENSION (JR., SR)
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME
FIRST NAME
NAME EXTENSION (JR., SR)
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME
MIDDLE NAME
(Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
26.
LEVEL
NAME OF SCHOOL
(Write in full)
BASIC EDUCATION/DEGREE/COURSE
(Write in full)
PERIOD OF ATTENDANCE
HIGHEST LEVEL/
UNITS EARNED
(if not graduated)
YEAR
GRADUATED
SCHOLARSHIP/
ACADEMIC
HONORS
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
CS Form No. 212
Revised 2017
Filipino
Dual Citizenship
Male
Female
Single
Married
Widowed
Other/s:
Separated
by birth
by naturalization
IV. CIVIL SERVICE ELIGIBILITY
27.
CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER
SPECIAL LAWS/ CES/ CSEE
BARANGAY ELIGIBILITY / DRIVER'S LICENSE
RATING
(If Applicable)
DATE OF
EXAMINATION /
CONFERMENT
PLACE OF EXAMINATION / CONFERMENT
LICENSE (if applicable)
NUMBER
Date of
Validity
(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.
28.
INCLUSIVE DATES
(mm/dd/yyyy)
POSITION TITLE
(Write in full/Do not abbreviate)
DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full/Do not abbreviate)
MONTHLY
SALARY
SALARY/ JOB/ PAY
GRADE (if
applicable)& STEP
(Format "00-0")/
INCREMENT
STATUS OF
APPOINTMENT
GOV'T
SERVICE
(Y/ N)
From
To
(Continue on separate sheet if necessary)
SIGNATURE
DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
29.
NAME & ADDRESS OF ORGANIZATION
(Write in full)
INCLUSIVE DATES
(mm/dd/yyyy)
NUMBER OF HOURS
POSITION / NATURE OF WORK
From
To
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
30.
TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
(Write in full)
INCLUSIVE DATES OF
ATTENDANCE
(mm/dd/yyyy)
NUMBER OF HOURS
Type of LD
( Managerial/
Supervisory/
Technical/etc)
CONDUCTED/ SPONSORED BY
(Write in full)
From
To
(Continue on separate sheet if necessary)
VIII. OTHER INFORMATION
31.
SPECIAL SKILLS and HOBBIES
32.
NON-ACADEMIC DISTINCTIONS / RECOGNITION
(Write in full)
33.
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full)
(Continue on separate sheet if necessary)
SIGNATURE
DATE
CS FORM 212 (Revised 2017), Page 3 of 4
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,
a. within the third degree?
b. within the fourth degree (for Local Government Unit - Career Employees)?
If YES, give details:
35.
a. Have you ever been found guilty of any administrative offense?
If YES, give details:
b. Have you been criminally charged before any court?
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
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,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased
out (abolition) in the public or private sector?
If YES, give details:
38.
a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the 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?
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?
If YES, please specify:
b.
Are you a person with disability?
If YES, please specify ID No:
c.
Are you a solo parent?
If YES, please specify ID No:
41. REFERENCES
(Person not related by consanguinity or affinity to applicant /appointee)
NAME
ADDRESS
TEL. NO.
42.
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
complete 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
