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 cas
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+A9:N23+A9:N23 INFORMATION

2. SURNAME ODRONIA

FIRST NAME ROMEL

MIDDLE NAME SICCUAN

3. DATE OF BIRTH
JULY 29, 1967 16. CITIZENSHIP
(mm/dd/yyyy) Filipino

4. PLACE OF BIRTH CAMALANIUGAN CAGAYAN If holder of dual citizenship,

please indicate the details.

5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS B47,L8A

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
GTEH
Other/s:
Subdivision/Village
7. HEIGHT (m) 1.59 BACOOR
City/Municipality
8. WEIGHT (kg) 79.5 ZIP CODE

18. PERMANENT ADDRESS B47,L8A

9. BLOOD TYPE O
House/Block/Lot No.
GTEH
10. GSIS ID NO. 006-0115-7222-0
Subdivision/Village
BACOOR
11. PAG-IBIG ID NO. 121045799670
City/Municipality

12. PHILHEALTH NO. 19-000282006-8 ZIP CODE

13. SSS NO. NONE 19. TELEPHONE NO. (046) 519-39-71

14. TIN NO. 116-420-106 20. MOBILE NO. 09158123490

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) jrso29@yahoo.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME ODRONIA 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) KARL MICHEAL T. ODRONIA
FIRST NAME LORRAINE
MICOLAI KATE T. ODRONIA
MIDDLE NAME TADEO

OCCUPATION DENTIST

EMPLOYER/BUSINESS NAME ODRONIA DENTAL'S CLINIC

BUSINESS ADDRESS B47,L8A HOUSTON ST. GTEH, MOLINO4, BACOOR CITY

TELEPHONE NO. (046)519-39-71

24. FATHER'S SURNAME ODRONIA

NAME EXTENSION (JR., SR)
FIRST NAME ESTEBAN

MIDDLE NAME AGUIRRE

25. MOTHER'S MAIDEN NAME

SURNAME SICCUAN

FIRST NAME MAGDALENA

MIDDLE NAME DIAZ (Continue on separate sheet if n

III. EDUCATIONAL BACKGROUND

PERIOD OF
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE
LEVEL ATTENDANCE
(Write in full) (Write in full)
From To

ELEMENTARY CAMALANIUGAN CENTRAL SCHOOL PRIMARY EDUC. 6/1/1974 3/1/1980

SECONDARY LYCEUM OF CAMALANIUGAN SECONDARY EDUCATION 6/1/1980 3/1/1984

VOCATIONAL /
TRADE COURSE

COLLEGE LYCEUM OF APARRI AB-HISTORY 6/1/1984 3/1/1988

UNIVERSTITY OF MANILA(UM)/MANUEL L.QUEZON

GRADUATE STUDIES BACHELOR OF LAWS 6/1/1989 3/1/1994
)MLQU)
(Continue on separate sheet if necessary)

SIGNATURE DATE

CS
ERSONAL DATA SHEET

ork Experience Sheet shall cause the filing of administrative/criminal case/s against the person

(PDS) BEFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship
by birth by naturalization
Pls. indicate country:

HOUSTON
Street
MOLINO 4
Barangay
CAVITE
Province

HOUSTON
Street
MOLINO 4
Barangay
CAVITE
Province

(046) 519-39-71

09158123490

jrso29@yahoo.com

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
KARL MICHEAL T. ODRONIA
JUNE 29, 1998
MICOLAI KATE T. ODRONIA
SEPT. 27, 1999
 (Continue on separate sheet if necessary)

HIGHEST
SCHOLARSHIP/
LEVEL/ YEAR
ACADEMIC
UNITS EARNED GRADUATE
HONORS
(if not D
RECEIVED
graduated)

1980 NONE

1984 NONE

1988 NONE

1994 NONE

tinue on separate sheet if necessary)

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