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