CS Form No.

212

Revised 2017
PERSONAL DATA SHEET
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.

I. PERSONAL INFORMATION
2 SURNAME
MACLANG
FIRST NAME
ELLA CHARIZE
MIDDLE NAME
BERMUDO
3 DATE OF BIRTH
(mm/dd/yyyy) 9/19/1997 16. CITIZENSHIP
ü Filipino Dual Citizenship
birth
by naturalization
4 PLACE OF BIRTH If holder of dual citizenship, Pls. indicate country:
MARIKINA CITY
5 SEX Male ü Female please indicate the details.

6 CIVIL STATUS üSingle Married 17. RESIDENTIAL ADDRESS 9457 RETIRO ST.
Widowed Separated House/Block/Lot No.
N/A BRGY. GUADALUPE NUEV
Subdivision
/Village
7 HEIGHT (m) MAKATI CITY N/A
1.47m City/Munici
8 WEIGHT (kg) ZIP CODE pality
47kg 1212
9 BLOOD TYPE 18. PERMANENT ADDRESS B12 L4 ST. MARY ST.
O House/Block/Lot No.
10 GSIS ID NO. OLOPS VILLE SUBD. BRGY. GULOD MALAY
N/A Subdivision
/Village
11 PAG-IBIG ID NO. SAN MATEO RIZAL
1212-4247-7168 City/Munici
12 PHILHEALTH NO. ZIP CODE pality
N/A 1850
13 SSS NO. 19. TELEPHONE NO.
34-8154724-4 N/A
14. TIN NO. 20. MOBILE NO.
N/A 9156520452
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)
N/A ellabmaclang@gmail.com
II. FAMILY BACKGROUND
22 SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
N/A
FIRST NAME NAME EXTENSION (JR., SR)
N/A N/A
MIDDLE NAME
N/A N/A
OCCUPATION
N/A N/A
EMPLOYER/BUSINESS NAME
N/A N/A
BUSINESS ADDRESS
N/A N/A
TELEPHONE NO.
N/A N/A
24 FATHER'S SURNAME
MACLANG N/A
FIRST NAME NAME EXTENSION (JR., SR)
MIGUEL N/A
MIDDLE NAME
VEGA N/A
25 MOTHER'S MAIDEN NAME
JUDITH F. BERMUDO N/A
SURNAME
BERMUDO N/A
FIRST NAME
JUDITH N/A
MIDDLE NAME (Continue on separate sheet if nece
FRIVALDO
III. EDUCATIONAL BACKGROUND
NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE
26 (Write in full) (Write in full) PERIOD OF ATTENDANCE
LEVEL
From To

ELEMENTARY GUARDIAN ANGEL ACADEMY PRIMARY 2004 2010

SECONDARY GUARDIAN ANGEL ACADEMY HIGHSCHOOL 2010 2014
VOCATIONAL / TRADE COURSE
N/A N/A N/A N/A

COLLEGE TRINITY UNIVERSITY OF ASIA BS PSYCHOLOGY 2014 2018

GRADUATE STUDIES N/A N/A N/A N/A

(Continue on separate sheet if necessary)
SIGNATURE DATE
person concerned.

(Do not fill up. For CSC use

only)

NAME EXTENSION (JR., SR)

ü Filipino Dual Citizenship by

by naturalization
indicate country:

RETIRO ST.
Street
BRGY. GUADALUPE NUEVO
Barangay
N/A
Province

ST. MARY ST.

Street
UBD. BRGY. GULOD MALAYA
Barangay
RIZAL
Province

mail.com

rite full name and list all) DATE OF BIRTH (mm/dd/yyyy)

N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
(Continue on separate sheet if necessary)

HIGHEST LEVEL/ YEAR SCHOLARSHIP/

UNITS EARNED GRADUATED ACADEMIC
(if not graduated) HONORS
RECEIVED

N/A 2010 N/A

N/A 2014 N/A

N/A N/A N/A

N/A 2018 N/A

N/A N/A N/A