Copy of CS Form No_212

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    PERSONAL DATA SHEET READ THE ATTACHED GUIDE TO FILLING OUT THE PERSONAL DATA SHEET (PDS) BEFORE ACCOMPLISHING THE PDS FORM. 1. CS ID No. I. PERSONAL INFORMATION .S!RNAME CORT!NA FIRST NAME AN ELITO NAME E#TENSION ($R. MIDDLE NAME RI&ERA '. *+* +, 1-. CITIENS/IP0.PLACE OF IRT/ M234ur2o% O55i6ent2l Min6oro If 7ol6er of 6u2l 5iti8ens7ip% Pls. in6i52te .SE#ple2se in6i52te t7e 6et2ils.-CI&IL STAT!S1:. RESIDENTIAL ADDRESS Lot , 1lo5;  P72se S /ouse*1lo5;*Lot No. St2. Ros2 /ei<7tsPuti Su46i>ision*&ill2<e  :./EI /T (3)  .- Sil2n< City*Muni5ip2lity  ,.?EI /T (;<) : IP CODE +.LOOD T@PE O 1,. PERMANENT ADDRESS Lot , 1lo5;  P72se S /ouse*1lo5;*Lot No. 1. SIS ID NO. NOT APPLICA1LE St2. Ros2 /ei<7tsPuti Su46i>ision*&ill2<e  11.PA II ID NO. + ,+-++-: Sil2n< City*Muni5ip2lity  1.P/IL/EALT/ NO.   , :': IP CODE 0 , 1'.SSS NO. '',0-: ,, 1+. TELEP/ONE NO. NOT APPLICA1LE 10. TIN NO. '+'': . MOILE NO. + :+- 0 1. A ENC@ EMPLO@EE NO. NOT APPLICA1LE 1. EMAIL ADDRESS (if 2ny) II. FAMIL@ 1AC= RO!ND .SPO!SEBS S!RNAME Cortun2 '. NAME of C/ILDREN (?rite full n23e 2n6 list 2ll) FIRST NAME S7eil2An<elito $r. Cortun2  MIDDLE NAME Muni8 OCC!PATION o>ern3ent e3ployee EMPLO@ER*!SINESS NAME Pu4li5 AttorneyBs Offi5e !SINESS ADDRESS 1in2n% L2<un2 TELEP/ONE NO. NOT APPLICA1LE 0.FAT/ERBS S!RNAME Cortun2 FIRST NAME Reyn2l6o MIDDLE NAME Pe6ines .MOT/ERBS MAIDEN NAMES!RNAME Ri>er2 FIRST NAME Ros2lin2 MIDDLE NAME Lu2rtes (Continue on sep2r2te s7eet if ne5ess2r III. ED!CATIONAL 1AC= RO!ND  -.LE&EL PERIOD OF ATTENDANCE Fro3ToELEMENTAR@ P2yo3pon Ele3ent2ry S57oolPri32ry $une +,,M2r57 ++0 SECONDAR@ Se5on62ry $une ++0M2r57 ++, WARNING: Any misinte!et ti#n m $e in t%e Pes#n & D t S%eet n$ t%e W#' E!eiene S%eet s% &&  *se t%e +i&in, #+ $minist ti-eimin &  ses #nene$. Print le<i4ly. Ti5; 2ppropri2te 4oes ( ) 2n6 use sep2r2te s7eet if ne5ess2ry. In6i52te N*A if not 2ppli524le. DO NOT A11RE&IATE. DATE OF IRT/ (33*66*yyyy) NAME E#TENSION ($R.% SR) NAME E#TENSION ($R.% SR) NAME OF SC/OOL (?rite in full)ASIC ED!CATION*DE REE*CO!RSE (?rite in full) HIGHEST LEVEL/ UNITS EARNED i! not gra uate # O55i6ent2l Min6oro N2tion2l /i<7 S57ool CS Form No. 212 Revised 2017     Filipino Dual Citizenship Male Female Single Married    Widowed Other/s: Separatedby birth  COLLE E !ni>ersity of t7e E2st1S in Ci>il En<ineerin< $une +++M2r57 ' RAD!ATE ST!DIES !ni>ersity of t7e E2stM2ster in Constru5tion M2n2<e3ent $une 'M2r57 0   !nits (Continue on sep2r2te s7eet if ne5ess2ry) SI NAT!REDATE  CS FORM 1    (Do not fill up. For CSC use only)  .% SR) 5ountry9 Serr2nos Street  Putin< =27oy 12r2n<2y  C2>ite Pro>in5e  Serr2nos Street  Putin< =27oy 12r2n<2y  C2>ite Pro>in5e  NOT APPLICA1LE + :+- 0 DATE OF IRT/ (33*66*yyyy) +* *- (Continue on sep2r2te s7eet if ne5ess2ry)   ++0t7 /onor ++, 't7 /onor  , inst t%e !es#n $EAR GRADUATED SC/OLARS/IP*  ACADEMIC /ONORS RECEI&ED     by naturalization  ' r2te s7eet if ne5ess2ry)  (Re>ise6 1:)% P2<e 1 of 0
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