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
DIMAAMPAO
NAME EXTENSION (JR., SR)
FIRST NAME
ADHAM
MIDDLE NAME DAGALANGIT
3. DATE OF BIRTH
16. CITIZENSHIP Filipino Dual Citizenship
(mm/dd/yyyy)
05/02/1989 by birth by naturalization
4. PLACE OF BIRTH LUMBA-BAYABAO, LANAO DEL SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS N/A ABUTALIB

Widowed Separated House/Block/Lot No. Street

Other/s: N/A MARAWI POBLACION

Subdivision/Village Barangay
7. HEIGHT (m) 1.65 MARAWI LANAO DEL SUR
City/Municipality Province
8. WEIGHT (kg) 60 ZIP CODE 9700

9. BLOOD TYPE B 18. PERMANENT ADDRESS NIA ABUTALIB

House/Block/Lot No. Street
10. GSIS ID NO. N/A N/A MARAWI POBLACION
Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A MARAWI LANAO DELSUR

City/Municipality Province

12. PHILHEALTH NO. 150255199333 ZIP CODE 9700

13. SSS NO. 0828927187 19. TELEPHONE NO. N/A

14. TIN NO. 950-743-999-000 20. MOBILE NO. 9175600856

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) adko_d@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)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A
MIDDLE NAME N/A N/A N/A
OCCUPATION N/A N/A N/A
EMPLOYER/BUSINESS NAME N/A N/A N/A
BUSINESS ADDRESS N/A N/A N/A
TELEPHONE NO. N/A N/A N/A
24. FATHER'S SURNAME DIMAAMPAO N/A N/A
NAME EXTENSION (JR., SR)
FIRST NAME ABBAS N/A N/A
MIDDLE NAME DIMAPORO N/A N/A
25. MOTHER'S MAIDEN NAME MAHAR P. DAGALANGIT N/A N/A
SURNAME DIMAAMPAO N/A N/A
FIRST NAME MAHAR N/A N/A
MIDDLE NAME DAGALANGIT (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

DANSALAN COLLEGE FOUNDATION

ELEMENTARY PRIMARY EDUCATION 1998 2003 2003
INCORPORATED
DANSALAN COLLEGE FOUNDATION
SECONDARY HIGH SCHOOL 2003 2007 2007
INCORPORATED
VOCATIONAL /
TRADE COURSE
PHILIPPINE ENGINEERING AND AGRO- BACHELOR OF SCIENCE IN CIVIL
COLLEGE 2014 2016 2016
INDUSTRIAL COLLEGE INCORPORATED ENGINEERING
GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE 10/18/2019

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