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

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 MAGADDON
FIRST NAME ENGEL
MIDDLE NAME ASUTEN
3. DATE OF BIRTH
(mm/dd/yyyy) 12/19/94 16. CITIZENSHIP Filipino Dual Citizensh

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

please indicate the details.

5. SEX Male Female

6 CIVIL STATUS
Single Married 17. RESIDENTIAL ADDRESS #94
Widowed Separated House/Block/Lot No.

Other/s:
Subdivision/Village
7. HEIGHT (m) 1.70 CAMALANIUGAN
City/Municipality
8. WEIGHT (kg) 58 ZIP CODE 3510
9. BLOOD TYPE B+ 18. PERMANENT ADDRESS #94
House/Block/Lot No.

10. GSIS ID NO.

11. PAG-IBIG ID NO. CAMALANIUGAN

City/Municipality

12. PHILHEALTH NO. ZIP CODE 3510

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 496-269-316 20. MOBILE NO. 09369451391

15. AGENCY EMPLOYEE NO. 17DJORC1-0003 21. E-MAIL ADDRESS (if any) engelmagaddon@gm
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)

FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME MAGADDON

FIRST NAME ROMEO
MIDDLE NAME ESTAL
25. MOTHER'S MAIDEN NAME

SURNAME ASUTEN
FIRST NAME FREDELITA
MIDDLE NAME BORDEY (Continue on separate sheet if n

III. EDUCATIONAL BACKGROUND

26. NAME OF SCHOOL PERIOD OF ATTENDANCE

BASIC EDUCATION/DEGREE/COURSE
LEVEL (Write in
(Write in full)
full)
From To

ELEMENTARY CAMALANIUGAN CENTRAL SCHOOL ELEMENTARY GRADUATE 6/1/2001 3/1/2007

CAMALANIUGAN NATIONAL
SECONDARY
HIGHSCHOOL
SECONDARY GRADUATE 6/1/2007 3/1/2011
VOCATION / TRADE
SCHOOL

UNIVERSITY OF SAINT LOUIS BACHELOR'S DEGREE IN CIVIL

COLLEGE
TUGUEGARAO ENGINEERING 6/1/2011 3/1/2017

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
L DATA SHEET
rience 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)

Dual Citizenship
by birth by naturalization
Pls. indicate country:

REAL DE HOOD ST.

Street
CENTRO NORTE
Barangay
CAGAYAN
Province

3510
REAL DE HOOD ST.
Street

CAGAYAN
Province

09369451391

[email protected]

23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

(Continue on separate sheet if necessary)

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

VALEDICTOR
GRADUATE 2007 IAN

GRADUATE 2011
 GRADUATE 2016

separate sheet if necessary)

July 5, 2017

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

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

RA 1080 ( CIVIL ENGINEERING BOARD UNIVERSITY OF THE EAST

0.742 11/16/2016
EXAM) CALOOCAN

(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
(Write in full/Do not (Write in SALARY
applicable)& STEP
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To

DEPARTMENT OF PUBLIC WORK AND

06/05/2017 PRESENT ENGINEERING ASSISTANT 698.54/day 8
HIGHWAYS
DEPARTMENT OF PUBLIC WORK AND
01/01/2017 06/30/2017 ENGINEERING ASSISTANT 698.54/day 8
HIGHWAYS
DEPARTMENT OF PUBLIC WORK AND
12/28/2016 12/31/2016 ENGINEERING ASSISTANT 678.68day 8
HIGHWAYS
 (Continue on separate sheet if necessary)

SIGNATURE DATE
 LICENSE (if applicable)

NUMBER Date of
Validity

0147834 12/19/2019

on separate sheet if necessary)

es should be indicated in the attached Work Experience sheet.

GOV'T SERVICE

STATUS OF APPOINTMENT

(Y/ N)

JOB ORDER YES

JOB ORDER YES

JOB ORDER YES

on separate sheet if necessary)

7/5/2017

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

CAGAYAN ST
REGIONAL CIVIL ENGINEERING STUDENT'S SUMMIT 01/23/2015 01/24/2015 24
CAMPUS

UNIVERSIT
REGIONAL CIVIL ENGINEERING CONVENTION 2014 01/23/2014 01/24/2014 24
TUGUEGA

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

COMPUTER LITERATE
KNOWLEDGEABLE IN AUTOCAD, STAAD,
AND DESIGN APPLICATION
KNOWLEDGABLE IN THE USE SURVEY
EQUIPMENTS

(Continue on separate sheet if necessary)

SIGNATURE DATE
EOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

arate sheet if necessary)

GRAMS ATTENDED
e (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

CAGAYAN STATE UNIVERSITY CARIG

CAMPUS

UNIVERSITY OF SAINT LOUIS

TUGUEGARAO

arate sheet if necessary)

 MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

arate sheet if necessary)

7/5/2017
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? ________________________________
________________________________
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
the last 6 months
ENGR. BENEDICT B. MENDOZA TUGUEGARAO , CAGAYAN 9778237908 3.5 cm. X 4.5 cm
(passport size)

ENGR. REYVIN CABISON LAL-LO, CAGAYAN 9752319536 With full and handwritten
name tag and signature over
printed name
ENGR. MARK KEVIN ULEP GATTARAN, CAGAYAN 9058335191
Computer generated
or photocopied picture
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and 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 LICENSE
ID/License/Passport No.: 0147834
Signature (Sign inside the box)

Date/Place of Issuance: 12/25/2016

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