CS Form No.

212

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.
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)

I. PERSONAL INFORMATION
2. SURNAME CARIṄO
NAME EXTENSION (JR., SR) N/A
FIRST NAME ADONIS

MIDDLE NAME CEREZO

3. DATE OF BIRTH
(mm/dd/yyyy)
5/6/1978 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH SANTA CRuZ OCCIDENTAL MINDORO If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS 073 F.GALSIM

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
POBLACION II
Other/s:
Subdivision/Village Barangay
SANTA CRUZ OCCIDENTAL MINDORO
7. HEIGHT (m) 1.61
City/Municipality Province
8. WEIGHT (kg) 52 ZIP CODE 5105

18. PERMANENT ADDRESS

9. BLOOD TYPE "A"
House/Block/Lot No. Street
POBLACION II
10. GSIS ID NO. 2004132897
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A SANTA CRUZ OCCIDENTAL MINDORO

City/Municipality Province

12. PHILHEALTH NO. 090000820112 ZIP CODE 5105

13. SSS NO. 02-1699076-8 19. TELEPHONE NO. N/A

14. TIN NO. 938-881-920 20. MOBILE NO. 09057173573

15. AGENCY EMPLOYEE NO. 04555401 21. E-MAIL ADDRESS (if any) jeli_cerezo@yahoo.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME
NAME EXTENSION (JR., SR) N/A
N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME CARIṄO

NAME EXTENSION (JR., SR)
FIRST NAME JESUS N/A

MIDDLE NAME DARAGAY

25. MOTHER'S MAIDEN NAME

SURNAME CEREZO

FIRST NAME LOLITA

MIDDLE NAME GUTIERREZ (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

SCHOLARSHIP/
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE PERIOD OF ATTENDANCE HIGHEST LEVEL/
YEAR ACADEMIC
LEVEL UNITS EARNED
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
RECEIVED
From To

ELEMENTARY SAN JACINTO WEST CENTRAL SCHOOL ELEMENTARY 1986 1992 N/A 1994 N/A

SECONDARY OOCCIDENTAL MINDORO NATIONAL HIGH SCHOOL HIGH SCHOOL 1992 1996 N/A 1998 N/A

VOCATIONAL /
TRADE COURSE
ST. THOMAS DE AQUINAS INSTITUTE CARE GIVING 2008 2009 N/A 2009 N/A

COLLEGE OCCIDENTAL MINDORO STATE COLLGE BACHELOR OF ELEMENTARY EDUCATION 1997 2005 N/A 2005 N/A

GRADUATE STUDIES PHILIPPINE COLLEGE OF HEALTH SCIENCES,INC. MASTER OF ARTS IN EDUCATION 2014 2016 N/A N/A N/A
(Continue on separate sheet if necessary)

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