Personal Data Sheet

Bureau of the Treasury personal date sheet form for human resource

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PERSONAL DATA SHEET

Revised 2017

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.
(Do not fill up. For CSC use only)
1. CS ID No.
Print legibly. Tick appropriate boxes ( ) and use separate sheet if necessary. Indicate N/A if not applicable. DO NOT ABBREVIATE.

I. PERSONAL INFORMATION
2. SURNAME
NAME EXTENSION (JR., SR)

FIRST NAME
MIDDLE NAME
3. DATE OF BIRTH
(mm/dd/yyyy)

16. CITIZENSHIP

Filipino

Dual Citizenship
by birth

5. SEX

Male

Female

6 CIVIL STATUS

Single

Married

Widowed

by naturalization

Pls. indicate country:

If holder of dual citizenship,

4. PLACE OF BIRTH

please indicate the details.

Separated

17. RESIDENTIAL ADDRESS
House/Block/Lot No.
Subdivision/Village

Street

Subdivision/Village

Barangay

City/Municipality

8. WEIGHT (kg)

Province

House/Block/Lot No.

7. HEIGHT (m)

Barangay

City/Municipality

Other/s:

Street

Province

ZIP CODE
18. PERMANENT ADDRESS

9. BLOOD TYPE
10. GSIS ID NO.
11. PAG-IBIG ID NO.

ZIP CODE

12. PHILHEALTH NO.
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
23. NAME of CHILDREN (Write full name and list all)

22. SPOUSE'S SURNAME

DATE OF BIRTH (mm/dd/yyyy)

NAME EXTENSION (JR., SR)

FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME

NAME EXTENSION (JR., SR)

FIRST NAME
MIDDLE NAME
25. MOTHER'S MAIDEN NAME
SURNAME
FIRST NAME

(Continue on separate sheet if necessary)

MIDDLE NAME

III. EDUCATIONAL BACKGROUND
26.

NAME OF SCHOOL
LEVEL
(Write in full)
ELEMENTARY

BASIC EDUCATION/DEGREE/COURSE
(Write in full)

PERIOD OF ATTENDANCE

From

To

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

SCHOLARSHIP/
ACADEMIC
HONORS
RECEIVED

SECONDARY
VOCATIONAL /

COLLEGE
GRADUATE STUDIES
(Continue on separate sheet if necessary)

SIGNATURE

DATE
CS FORM 212 (Revised 2017), Page 1 of 4

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

LICENSE (if applicable)
PLACE OF EXAMINATION / CONFERMENT

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)
From

To

POSITION TITLE

DEPARTMENT / AGENCY / OFFICE / COMPANY
(Write in full/Do not
(Write in
abbreviate)
full/Do not abbreviate)

MONTHLY
SALARY

SALARY/ JOB/ PAY
GRADE (if
applicable)& STEP
(Format "00-0")/
INCREMENT

GOV'T
SERVICE
STATUS OF
APPOINTMENT

(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

INCLUSIVE DATES
(Write in full)
From

(mm/dd/yyyy)
To

POSITION / NATURE OF WORK

NUMBER OF HOURS

(Continue on separate sheet if necessary)

VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS
(Write in full)

INCLUSIVE DATES OF
ATTENDANCE
NUMBER OF HOURS

(mm/dd/yyyy)
From

To

Type of LD
( Managerial/
Supervisory/
Technical/etc)

CONDUCTED/ SPONSORED BY
(Write in full)

(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?

YES

NO

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

YES

NO

If YES, give details:
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.

37.

Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
by any court or tribunal?

YES

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?

YES

If YES, give details:

39.

a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?

NO

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?

38.

NO

If YES, give details:
________________________________

If YES, give details:

YES

YES

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

YES

NO

NO

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

YES

NO

If YES, please specify:
b.

Are you a person with disability?

If YES, please specify ID No:
c.

Are you a solo parent?

YES

NO

If YES, please specify ID No:
41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)
NAME

ADDRESS

TEL. NO.

ID picture taken within
the last 6 months
3.5 cm. X 4.5 cm
(passport size)
With full and handwritten
name tag and signature over
printed name

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
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
Issuance
Government Issued ID:
ID/License/Passport No.:
Date/Place of Issuance:

Signature (Sign inside the box)

Computer generated
or photocopied picture
is not acceptable

PHOTO

Date/Place of Issuance:

SUBSCRIBED AND SWORN to before me this

Date Accomplished

Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath
CS FORM 212 (Revised 2017), Page 4 of 4