1. 2. SURNAME
FIRST NAME
MIDDLE NAME
4.
5. PLACE OF BIRTH
6. SEX
17. TELEPHONE NO.
8. CITIZENSHIP
9. HEIGHT (m)
10. WEIGHT (kg)
11. BLOOD TYPE
12. GSIS ID NO.
13. PAG-IBIG ID NO.
14. PHILHEALTH NO.
15. SSS NO.
24. SPOUSE'S SURNAME
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUS. NAME
BUSINESS ADDRESS
TELEPHONE NO.
26.
27.
From To
Page 1 of 4
/ /
/ /
/ /
DATE OF BIRTH (mm/dd/yyyy)
/ /
CIVIL STATUS
(Continue on separate sheet if necessary)
/ /
/ /
25. NAME OF CHILD (Write full name and list all)
/ /
20. E-MAIL ADDRESS (if any)
/ /
LEVEL
DEGREE COURSE
(Write in full)
YEAR
GRADUATED
(if graduated)
MIDDLE NAME
(Continue on separate sheet if necessary)
22. AGENCY EMPLOYEE NO.
23. TIN
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
16. RESIDENTIAL ADDRESS
3. NAME EXTENSION (e.g. Jr., Sr.)
MOTHER'S MAIDEN NAME
SURNAME
FATHER'S SURNAME
FIRST NAME
FIRST NAME
MIDDLE NAME
NAME OF SCHOOL
(Write in full)
HIGHEST GRADE/
LEVEL/
UNITS EARNED
(if not graduated)
/ /
21. CELLPHONE NO. (if any)
ZIP CODE
19. TELEPHONE NO.
/ /
INCLUSIVE DATES OF
ATTENDANCE
PERSONAL DATA SHEET
CS FORM 212 (Revised 2005)
1. CS ID No. (to be filled up by CSC)Print legibly. Mark appropriate boxes with " " and use separate sheet if necessary.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
DATE OF BIRTH (mm/dd/yyyy)
(Continue on separate sheet if necessary)
/ /
/ /
/ /
/ /
SCHOLARSHIP/
ACADEMIC HONORS
RECEIVED
I. PERSONAL INFORMATION
7.
ZIP CODE
18. PERMANENT ADDRESS
II. FAMILY BACKGROUND
III. EDUCATIONAL BACKGROUND
COLLEGE
28.
GRADUATE STUDIES
ELEMENTARY
SECONDARY
VOCATIONAL /
TRADE COURSE
Annulled Others, specify ___________
Single
Married
Widowed
Separated
Male Female
