PDSC CSC Form - Personal Data Sheet | Assignments Technical English

PERSONAL DATA SHEET

READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.

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. 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

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

FIRST NAME

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

26. LEVEL

PERIOD OF ATTENDANCE

From To

ELEMENTARY

SECONDARY

COLLEGE

GRADUATE STUDIES

(Continue on separate sheet if necessary)

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.

Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.

DATE OF BIRTH

(mm/dd/yyyy)

NAME EXTENSION (JR., SR)

NAME OF SCHOOL

(Write in full)

BASIC EDUCATION/DEGREE/COURSE

( Write in full)

HIGHEST

LEVEL/

UNITS

EARNED

(if not

graduated)

YEAR

GRADUATED

SCHOLARSHIP/

ACADEMIC

HONORS

RECEIVED

VOCATIONAL /

TRADE

COURSE

CS Form No. 212

Revised 2017

Filipino

Dual Citizenship

Male

Female

Single

Married

Widowed

Other/s:

Separated

by

birth

by

naturalization

PDSC CSC Form - Personal Data Sheet, Assignments of Technical English

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PERSONAL DATA SHEET

I. PERSONAL INFORMATION

4. PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:

II. FAMILY BACKGROUND

III. EDUCATIONAL BACKGROUND

CS Form No. 212

SIGNATURE DATE

SIGNATURE DATE

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S

NUMBER OF HOURS POSITION / NATURE OF WORK

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED

VIII. OTHER INFORMATION

SIGNATURE DATE

NAME & ADDRESS OF ORGANIZATION

INCLUSIVE DATES

INCLUSIVE DATES OF

ATTENDANCE

CONDUCTED/ SPONSORED BY

MEMBERSHIP IN

ASSOCIATION/ORGANIZATION

Bureau or Department where you will be apppointed,

a. within the third degree?

b. within the fourth degree (for Local Government Unit - Career Employees)?

35. a. Have you ever been found guilty of any administrative offense?

Date Filed:

Status of Case/s:

If YES, give details:

If YES, give details:

39. Have you acquired the status of an immigrant or permanent resident of another country?

If YES, give details (country):

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:

NAME ADDRESS TEL. NO.

PHOTO

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

Are you related by consanguinity or affinity to the appointing or recommending authority, or to

thechief of bureau or office or to the person who has immediate supervision over you in the

Office,

If YES, give details:

________________________________

If YES, give details:

________________________________

________________________________

b. Have you been criminally charged before any court?

If YES, give details:

________________________________

________________________________

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:

________________________________

________________________________

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:

________________________________

________________________________

a. Have you ever been a candidate in a national or local election held within the last year

(except Barangay election)?

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?

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:

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 administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of