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
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

I. PERSONAL INFORMATION
2. SURNAME PIÑON 

FIRST NAME CRISENCIO NAME EXTENSION (JR., SR

MIDDLE NAME
 SAURO
3. DATE OF BIRTH 
(mm/dd/yyyy) February 21, 1988 16. CITIZENSHIP
Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH BILIRAN, BILIRAN If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. S
Sitio Lumbia San
Other/s:
Subdivision/Village Ba
Biliran B
7. HEIGHT (m) 1.71 M
City/Municipality Pr
8. WEIGHT (kg) 78 Kg ZIP CODE 6549

18. PERMANENT ADDRESS

9. BLOOD TYPE O+
House/Block/Lot No. S
Sitio Lumbia San
10. GSIS ID NO.
Subdivision/Village Ba
Biliran B
11. PAG-IBIG ID NO. 076763721109
City/Municipality Pr

12. PHILHEALTH NO. 1205101190590 ZIP CODE 6549

13. SSS NO. 06-3137083-7 19. TELEPHONE NO.

14. TIN NO. 309438577 20. MOBILE NO. 09163310973 / 09488483883

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) bolobolto12@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME PIÑON

NAME EXTENSION (JR., SR)
FIRST NAME INOCENCIO JR.
 MIDDLE NAME CORPIN

25. MOTHER'S MAIDEN NAME

SURNAME SAURO

FIRST NAME LUZVIMINDA

MIDDLE NAME JORQUIA (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BILIRAN CENTRAL SCHOOL 1995 2001

BILIRAN NATIONAL AGRICULTURAL HIGH

SECONDARY /
VOCATIONAL SCHOOL
2001 2005

TRADE
COURSE
COLLEGE NAVAL STATE UNIVERSITY 2005 2010

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE Augus

CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR) III

Dual Citizenship

by naturalization

Pls. indicate country:

Street
San Roque
Barangay
Biliran
Province

Street
San Roque
Barangay
Biliran
Province

09163310973 / 09488483883

bolobolto12@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

January 01, 1947

 April 16, 1953

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2001 First Honorable

Mention

2005

2010

parate sheet if necessary)

August 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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

CIVIL ENGINEERING BOARD EXAM 73.5 11/20/2010 CEBU CITY, PHILIPPINES 0119006

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY GRADE (if
(mm/dd/yyyy) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

DEPARTMENT OF PUBLIC WORKS and CURRENTLY

05/16/2015 PRESENT ENGINEERING ASSISTANT 15, 356 8 EMPLOYED
HIGHWAYS
DEPARTMENT OF SOCIAL WELFARE
10/14/2014 12/31/2014 TECHNICAL FACILITATOR 29,002 17
DEVELOPMENT
05/18/2014 10/31/2014 PROJECT ENGINEER FIERDSTAR BUILDER CONTRACTORS 15, 000
DEPARTMENT OF HEALTH EASTERN
04/23/2012 05/16/2014 ENGINEER 1 19, 940 12
VISAYAS
06/01/2011 04/23/2012 ENGINEER 1 METAPHIL (Aboitiz Construction Inc.) 8, 500
 (Continue on separate sheet if necessary)

SIGNATURE DATE August 14, 2017

CS FORM 212 (Revised 20

 LICENSE (if applicable)

Date of
Validity

2/21/2019

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)
YES

YES

NO

YES

NO
arate sheet if necessary)

August 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 POSITION /
From To

(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/ CONDUCTED/
NUMBER OF HOURS
(Write in full) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To

GENDER SENSITIVITY and MAINSTREAMING 10/23/2016 10/25/2016 24 COREXCEL

COMPREHENSIVE TRAINING for PROVISIONAL ACCREDITATION OF DPWH DEPARTMEN
06/20/2016 07/15/2016 168
FIELD ENGINEERS HIGHWAYS
DPWH, RO-8
INVIRONMENTAL IMPACT ASSESMENT and SOCIAL SAFEGUARDS TRAINING 08/25/2015 08/28/2015 32 SAFEGUARD
AP RENEWA
SOLID WASTE MANAGEMENT AWARENESS PROGRAM 07/25/2011 07/25/2011 8 Section)
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERS
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

SPORTS PHILIPPP

CARPENTRY

AUTOCAD LITERATE

MICROSOFT OFFICE LITERATE

(Continue on separate sheet if necessary)

SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

COREXCEL TRAINING and DEVELOPMENT

DEPARTMENT OF PUBLIC WORKS and
HIGHWAYS RO-8
DPWH, RO-8 (ENVIRONMENTAL and SOCIAL
SAFEGUARD DIVISION)
AP RENEWABLES INC. (Environmental
Section)
eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
PHILIPPPINE INSTITUTE OF CIVIL ENGINEER

SINGLES FOR CHRIST (FFL)

eparate sheet if necessary)

August 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 
b. within the fourth degree (for Local Government Unit - Career Employees)? YES 
If YES, give details:
________________________________

a. Have you ever been found guilty of any administrative offense?

35. 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
by any court or tribunal?
YES NO
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? Resignation
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
YES NO
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
the last 6 months
Engr. Conrado M. Fuentes DOH-EV Candahug, Palo, Leyte 0929-728-2600 3.5 cm. X 4.5 cm
(passport size)

Engr. Luciano O. Gumba DPWH-RO-8 Baras, Palo, Leyte (053) 65050 With full and handwritten
name tag and signature over
printed name
Engr. Enrico W. Gomez DPWH-RO-8 Baras, Palo, Leyte
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: PRC ID ( Civil Engineer)

ID/License/Passport No.: 0119006

Signature (Sign inside the box)
August 14, 2017
Date/Place of Issuance: December 20, 2010
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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

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