CS Form No. 212 Personal Data Sheet revised
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PERSONAL DATA SHEET
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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.
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READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM.
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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)
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I. PERSONAL INFORMATION
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2.SURNAMEBIALA
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FIRST NAMEERNEST BIALANAME EXTENSION (JR., SR)
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MIDDLE NAMEPASALOSDOS
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3.DATE OF BIRTH
(mm/dd/yyyy)
12/14/1993
16. CITIZENSHIP
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4.PLACE OF BIRTHSan Fernando City La UnionIf holder of dual citizenship, Pls. indicate country:
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5.SEXMaleplease indicate the details.
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6CIVIL STATUSsingle
17. RESIDENTIAL ADDRESS
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House/Block/Lot No.Street
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Subdivision/VillageBarangay
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7.HEIGHT (m)1.81m
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City/MunicipalityProvince
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8.WEIGHT (kg)76kgZIP CODE
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9.BLOOD TYPEAb
18. PERMANENT ADDRESS
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House/Block/Lot No.Street
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10.GSIS ID NO.
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Subdivision/VillageBarangay
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11.PAG-IBIG ID NO.
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City/MunicipalityProvince
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12.
PHILHEALTH NO.ZIP CODE
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13.
SSS NO.
19. TELEPHONE NO.
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14. TIN NO.
20. MOBILE NO.
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15. AGENCY EMPLOYEE NO.
21. E-MAIL ADDRESS (if any)
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II. FAMILY BACKGROUND
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22.
SPOUSE'S SURNAME
23. NAME of CHILDREN (Write full name and list all)DATE OF BIRTH (mm/dd/yyyy)
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FIRST NAMENAME EXTENSION (JR., SR)
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MIDDLE NAME
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OCCUPATION
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EMPLOYER/BUSINESS NAME
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BUSINESS ADDRESS
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TELEPHONE NO.
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24.
FATHER'S SURNAME
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FIRST NAMENAME EXTENSION (JR., SR)
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MIDDLE NAME
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MOTHER'S MAIDEN NAME
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SURNAME
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FIRST NAME
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MIDDLE NAME(Continue on separate sheet if necessary)
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III. EDUCATIONAL BACKGROUND
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26.LEVELNAME OF SCHOOL (Write in full)BASIC EDUCATION/DEGREE/COURSE (Write in full) PERIOD OF ATTENDANCEHIGHEST LEVEL/ UNITS EARNED
(if not graduated)
YEAR GRADUATED SCHOLARSHIP/ ACADEMIC HONORS RECEIVED
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FromTo
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ELEMENTARY
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SECONDARY
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VOCATIONAL / TRADE COURSE
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COLLEGE
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GRADUATE STUDIES
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(Continue on separate sheet if necessary)
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SIGNATUREDATE
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CS FORM 212 (Revised 2017), Page 1 of 4
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