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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 CORPUZ
NAME EXTENSION (JR., SR)
FIRST NAME ERWIN
MIDDLE NAME GALINGANA
3. DATE OF BIRTH 08/03/1997
(mm/dd/yyyy) 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH AURORA, ISABELA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female
6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS
Widowed Separated House/Block/Lot No. Street
Other/s: BANNAWAG
Subdivision/Village Barangay
7. HEIGHT (m) 1.65 AURORA ISABELA
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 3316
9. BLOOD TYPE 18. PERMANENT ADDRESS
House/Block/Lot No. Street
10. GSIS ID NO. N/A BANNAWAG
Subdivision/Village Barangay
11. PAG-IBIG ID NO. N/A AURORA ISABELA
City/Municipality Province
12. PHILHEALTH NO. N/A ZIP CODE 3316

13. SSS NO. 01275420104 19. TELEPHONE NO. N/A
14. TIN NO. 709650492000 20. MOBILE NO. 09059458263

15. AGENCY EMPLOYEE NO. EGC-03081997 21. E-MAIL ADDRESS (if any) erwingalinganacorpuz@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) N/A
FIRST NAME
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
24. FATHER'S SURNAME CORPUZ
FIRST NAME JUANITO NAME EXTENSION (JR., SR)
MIDDLE NAME SAET
25. MOTHER'S MAIDEN NAME

SURNAME GALINGANA
FIRST NAME EDELIZA
MIDDLE NAME BAJACAN (Continue on separate sheet if necessary)
III. EDUCATIONAL BACKGROUND
SCHOLARSHIP/
HIGHEST LEVEL/
PERIOD OF ATTENDANCE
26. NAME OF SCHOOL BASIC EDUCATION/DEGREE/COURSE YEAR ACADEMIC

LEVEL UNITS EARNED
(Write in full) (Write in full) GRADUATED HONORS
(if not graduated)
From To RECEIVED
VALEDICTORIA
ELEMENTARY BANNAWAG ELEMENTARY SCHOOL 2003 2009 2009 N
SECONDARY DOÑA AURORA NATIONAL HIGH SCHOOL SPECIAL SCIENCE CURRICULUM 2009 2013 2013
VOCATIONAL /
N/A
TRADE COURSE
ISABELA STATE UNIVERSITY-MAIN CAMPUS BACHELOR OF SECONDARY EDUCATION-
COLLEGE ECHAGUE MATHEMATICS 2013 2017 2017
ISABELA STATE UNIVERSITY-MAIN CAMPUS MASTER OF SCIENCE IN MATHEMATICS
GRADUATE STUDIES ECHAGUE EDUCATION 2018 ON-GOING ON-GOING
(Continue on separate sheet if necessary)
SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 1 of 4