032117 CS Form No. 212 Revised Personal Data Sheet_new

CS Form No. 212 Revised 2017

PERSONAL DATA SHEET WARNING: Any misreresen!"!i#n m"$e in !%e Pers#n"& D"!" S%ee! "n$ !%e W#r' Eeriene S%ee! s%"&& "*se !%e +i&in, #+ "$minis!r"!i-erimin"& "ses ","ins! !%e ers#n #nerne$. READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.

rint le9i@ly. Ti8 -ppropri-te @oes (

) -n, use sep-r-te s+eet if neess-ry. neess-ry. In,i-te N?A if not -ppli-@le. DO NOT ABBREVIATE.

1. CS ID No.

(Do not fill up. For CSC use only)

I. PERSONAL INFORMA INFORMATION  TION  2. SURNAME SURNAME NAME EXTENSIN (!R." SR)

FIRST NAME MIDD#E NAME $. DATE F *IRT' (55?,,?yyyy)

1%. CITI&ENS'I

. #ACE F *IRT'

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If +ol,er of ,u-l iti/ens+ip" ple-se in,i-te t+e ,et-ils.

.SEX

13. RESIDENTIA# ADDRESS

% CII# STATUS STATUS

House/Block/Lot No.

Street  

Subdivision/Village

Barangay  

3. 'EI4'T 'EI4'T (5) City/Municipality 6. 7EI4'T (89)

Province

&I CDE 16. ERMANENT ADDRESS

:. *# *#D D T;E T;E

House/Block/Lot No.

Street  

Subdivision/Village

Barangay  

1S MAIDEN MAIDEN NAME NAME SURNAME FIRST NAME MIDD#E NAME

(Continue on sepaate s!eet i" ne#essa

%$III. EDUCATIONAL BACKGROUND NAME F SC'#

2%.

#EE#

(7rite in full)

E#EMENTAR;

*ASIC EDUCATIN?DE4REE?CUR EDUCATIN?DE4REE?CURSE SE (7rite in full)

ERID F ATTENDANCE

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To

HIGHEST LEVEL/ YEAR UNITS GRADUATED EARNED (if not graduated)

SC'#ARS'I? ACADEMIC 'NRS RECEIED

I&. CI&IL SER&ICE ELIGIBILITY  23.

CAREER SERICE? RA 1S #ICENSE

RATIN4 (If Appli-@le)

#ICENSE (if -ppli-@le)

DATE F EXAMINATIN ? CNFERMENT

#ACE F EXAMINATIN ? CNFERMENT

CAREER SERVICE PROFESSIONAL EXAMINATION 6$.1B