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 case/s ag

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 INFORMATION
2. SURNAME PINARA
NAME EXTENSION (JR., SR)
FIRST NAME ERIC JAMES

MIDDLE NAME LUMICAY

3. DATE OF BIRTH
(mm/dd/yyyy) 1/2/1993 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH NMMC, CAGAYAN DE ORO CITY If holder of dual citizenship, Pls. indicate countr
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS PINARA RES. HON

6 CIVIL STATUS
Widowed Separated House/Block/Lot No.
ZONE 4B S
Other/s:
Subdivision/Village
MANOLO FORTICH B
7. HEIGHT (m) 1.65
City/Municipality
8. WEIGHT (kg) 50 ZIP CODE 8703

18. PERMANENT ADDRESS PINARA RES. HON

9. BLOOD TYPE "A"
House/Block/Lot No.
ZONE 4B S
10. GSIS ID NO. N/A
Subdivision/Village
MANOLO FORTICH B
11. PAG-IBIG ID NO. 1211-6591-1616
City/Municipality

12. PHILHEALTH NO. 1505-0423-2613 ZIP CODE 8703

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

14. TIN NO. 482-758-917 20. MOBILE NO. 09177054091

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

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PINARA

NAME EXTENSION (JR., SR)
FIRST NAME ERIC

MIDDLE NAME ENDIERA

25. MOTHER'S MAIDEN NAME NIOCEÑA

SURNAME PINARA

FIRST NAME LEONORA

MIDDLE NAME LUMICAY (Continue on separate sheet if necess

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY SANKANAN ELEMENTARY SCHOOL ELEMENTARY 1999 2005 GRADUATED

SECONDARY SANKANAN NATIONAL HIGH SCHOOL HIGH SCOOL 2005 2009 GRADUATED

VOCATIONAL / TRADE COURSE N/A N/A N/A N/A N/A

N/A N/A N/A N/A N/A

MINDANAO UNIVERSITY OF SCIENCE &

TECHNOLOGY
INFORMATION TECHNOLOGY 2009 2010 43
COLLEGE
PHINMA-COC CIVIL ENGINEERING 2010 2015 GRADUATED

GRADUATE STUDIES N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE Thursday,

L DATA SHEET
ience Sheet shall cause the filing of administrative/criminal case/s against the person concerned.

FORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization
Pls. indicate country:

HONGORAN ST.
Street
SANKANAN
Barangay
BUKIDNON
Province

HONGORAN ST.
Street
SANKANAN
Barangay
BUKIDNON
Province

N/A

09177054091

pinaraericjames@yahoo.com

DATE OF BIRTH (mm/dd/yyyy)

 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC HONORS
GRADUATED
RECEIVED

2005 DIPLOMA

2009 DIPLOMA

N/A N/A

N/A N/A

N/A N/A

2015 DIPLOMA

eparate sheet if necessary)

Thursday, December 14, 2017

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

IV. CIVIL SERVICE ELIGIBILITY
27. CAREER SERVICE/ RA 1080 (BOARD/ BAR) UNDER DATE OF LICENSE (if applicable)
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER Date of
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT
Validity

BOARD OF CIVIL ENGINEERING 80.55 NOV. 18-19 2015 CDO CITY 0141018 1/2/2018

N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)
V. WORK EXPERIENCE
(Include private employment. Start from your recent work) Description of duties should be indicated in the attached Work Experience sheet. GOV'T
SERVICE
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) STATUS OF
(Write in full/Do not (Write in MONTHLY SALARY applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
N)
DEPARTMENT OF PUBLIC WORKS AND PHP 10,580.00
8/1/2017 PRESENT ADMIN AIDE-IV N/A JOB ORDER N
HIGHWAYS
4/17/2017 7/21/2017 ADMIN AIDE-IV PROVINCIAL ENGINEER'S OFFICE PHP 14,000.00 N/A JOB ORDER N

10/3/2016 2/18/2017 PROJECT ENGINEER KHAPIDS CONSTRUCTION INC. PHP 15,000.00 N/A CONTRACTUAL N

2/16/2016 7/31/2016 JUNIOR CIVIL ENGINEER J3 TRAINERS & CONSULTANT INC. PHP 15,000.00 N/A CONTRACTUAL N

12/5/2015 2/15/2016 JUNIOR CIVIL ENGINEER GRAND CITY HOTEL INC. PHP 15,000.00 N/A CONTRACTUAL N

(Continue on separate sheet if necessary)

SIGNATURE DATE Thursday, December 14, 2017

CS FORM 212 (Revised 2017), Page 2 of 4

VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
INCLUSIVE DATES
29. NAME & ADDRESS OF ORGANIZATION
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSIT
From To

N/A

N/A

N/A

N/A

N/A

N/A

N/A
(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
(Start from the most recent L&D/training program and include only the relevant L&D/training taken for the last five (5) years for Division Chief/Executive/Managerial positions)

INCLUSIVE DATES OF ATTENDANCE Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ( Managerial/ CONDUC
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/
Technical/etc)
From To

STAAD ADVANCED CONCRETE DESIGN WORKSHOP 10/25/2017 10/25/2017 8 TECHNICAL LIMK

CONSTRUCTION PROJECT WORK PLANNING, SCHEDULE & CONTROL 7/9/2016 7/10/2016 16 TECHNICAL CO

G
OCCUPATIONAL FIRST AIDER TRAINING 5/30/2016 5/31/2016 16 TECHNICAL

BASIC OCCUPPATIONAL SAFETY HEALTH 5/20-21/2016 5/27-28/2016 32 TECHNICAL

CONSTRUCTION PROJECT COST ESTIMATING. BUDGETING & CONTROL 2/26/2016 2/27/2016 16 TECHNICAL Z

ON THE JOB TRAINING 4/8/2014 6/13/2014 320 TECHNICAL

ECO-FRIENDLY BUILDING DESIGNS IN REAL ESTATE DEVELOPMENT 9/21/2013 9/21/2013 8 TECHNICAL PRI

PROJECT MANAGEMENT SEMINAR 3/2/2013 3/2/2013 TECHNICAL

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
 DRAFTING (AUTOCAD)
P
3D MODELING (SKETCH UP)

ESTIMATING (EXCEL-MACRO)

MICROSOFT (WORD & POWERPOINT)

PHOTO EDITING (PHOTOSHOP)

VIDEO EDITING (MOVIE MAKER)

MUSIC EDITING (COOL EDIT PRO)

DANCING (HIPHOP & LYRICAL)

(Continue on separate sheet if necessary)

SIGNATURE DATE
OPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

arate sheet if necessary)

RAMS ATTENDED
5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

LIMKETKAI LUXE HOTEL / INFRASYS

COUNTRY VILLAGE HOTEL / CMDF

GOLDEN STALLLION SUITES /

PHILIPPINE RED CROSS

ZOE'S AVENUE SUITES / J3CI

ZOE'S AVENUE SUITES / CMDF

BUK. 3RD DEO DPWH / PDS

PRIMAVERA RESIDENCES / USPICE

arate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
 PHILIPPINE INSTITUTE OF CIVIL
ENGINEERS

arate sheet if necessary)

Thursday, December 14, 2017

CS FORM 212 (Revised 2017), Page 3 of 4

 34. Are you related by consanguinity or affinity to the appointing or recommending authority, or to the
chief of bureau or office or to the person who has immediate supervision over you in the Office,
Bureau or Department where you will be apppointed,
a. within the third degree? YES ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES NO
✘
If YES, give details:
________________________________

35. a. Have you ever been found guilty of any administrative offense? YES ✘ NO
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court? YES ✘ NO
If YES, give details:
________________________________
Date Filed:
________________________________
Status of Case/s:

36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation
YES ✘ NO
by any court or tribunal?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation, ✘ YES NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased If YES, give details:
out (abolition) in the public or private sector? RESIGNATTION
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
YES ✘ NO
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last YES ✘ NO
election to promote/actively campaign for a national or local candidate? If YES, give details:
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):

40. Pursuant to: (a) Indigenous People's Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
7277); and (c) Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items:
a. Are you a member of any indigenous group?
YES ✘ NO
If YES, please specify:
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No:
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No:

41. REFERENCES (Person not related by consanguinity or affinity to applicant /appointee)

NAME ADDRESS TEL. NO.

ID picture taken within
CHAIRMAN, CE DEPARTMENT, the last 6 months
ENGR. RONALDO MADRIAGA PHINMA-COC
09167292846 3.5 cm. X 4.5 cm
(passport size)
ASSISTANT PROVIAL ENGINEER,
ENGR. LESTER BOLO PEO, MIS-OR
09051273536 With full and handwritten
name tag and signature over
TANKULAN, MANOLO FORTICH, printed name
ATTY. EVELIO CORDOVEZ BUKIDNON
09177241953
Computer generated
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied picture
is not acceptable
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines. I authorize the agency head/authorized representative to verify/validate the contents stated herein.
I agree that any misrepresentation made in this document and its attachments shall cause the filing of PHOTO
administrative/criminal case/s against me.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID:

ID/License/Passport No.:
Signature (Sign inside the box)
Thursday, December 14, 2017
Date/Place of Issuance:
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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