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 LINGASA

FIRST NAME JARELYN

MIDDLE NAME GANLOT

3. DATE OF BIRTH
(mm/dd/yyyy)
01/05/1990 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH Matiao, Pantukan, Davao del Norte If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS N/A NANGKA

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
N/A MATIAO
Other/s:
Subdivision/Village Barangay
PANTUKAN COMPOSTELA VALLEY
7. HEIGHT (m) 1.67
City/Municipality Province

8. WEIGHT (kg) 65 ZIP CODE 8809

18. PERMANENT ADDRESS N/A MATIAO

9. BLOOD TYPE O
House/Block/Lot No. Street
N/A MATIAO
10. GSIS ID NO.
Subdivision/Village Barangay
PANTUKAN COMPOSTELA VALLEY
11. PAG-IBIG ID NO. 1212-3370-9697
City/Municipality Province

12. PHILHEALTH NO. 1602-5549-4330 ZIP CODE 8809

13. SSS NO. 09-3052090-6 19. TELEPHONE NO. N/A

14. TIN NO. 700-645-091 20. MOBILE NO. 09556681617

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) jarelynlingasa0105@gmail.com
N/A 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
N/A JR.

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME LINGASA

NAME EXTENSION (JR., SR)
FIRST NAME CADEL

MIDDLE NAME YUNOS

25. MOTHER'S MAIDEN NAME

SURNAME GANOT

FIRST NAME FATIMA

MIDDLE NAME MAPA (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 MATIAO ELEMENTARY SCHOOL ELEMENTARY 1996 2001 GRADUATED 2001 N/A

SECOND
SECONDARY TAMBONGON NATIONAL HIGH SCHOOL HIGH SCHOOL 2001 2006 GRADUATED 2006 HONORABL
E
VOCATIONAL /
NESTOR FAUSTA MEMORIAL COLLEGE HEALTH CARE SERVICES 2010 2011 GRADUATED 2011 NONE
TRADE COURSE

COLLEGE UNIVERSITY OF MINDANAO TAGUM COLLEGE BACHELOR OF SECONDARY EDUCATION 2013 2017 GRADUATED 2017 KATIBAYAN NG KAGALINGAN
AWARDS

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

(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4