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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 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 BASILIO
NAME EXTENSION (JR., SR)
FIRST NAME EDUARD JHOURELL

MIDDLE NAME MATEO


3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 11/5/1995

4. PLACE OF BIRTH CALOOCAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX

6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLK. 4 LOT 9 BURGOS STREET
House/Block/Lot No. Street
VILLA ROMA PH. 4 SAOG
Subdivision/Village Barangay

7. HEIGHT (m) 1.65 MARILAO BULACAN


City/Municipality Province
8. WEIGHT (kg) 63 ZIP CODE 3019

9. BLOOD TYPE
18. PERMANENT ADDRESS BLK. 4 LOT 9 BURGOS STREET
House/Block/Lot No. Street
VILLA ROMA PH. 4 SAOG
10. GSIS ID NO.
Subdivision/Village Barangay

11. PAG-IBIG ID NO.


MARILAO BULACAN
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 3019

13. SSS NO. 3472368416 19. TELEPHONE NO. (044)8120706

14. TIN NO. 20. MOBILE NO. (+63) 9478965357

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) eduardbasilio@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)
FIRST NAME N/A

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME BASILIO

FIRST NAME EDGARDO

MIDDLE NAME ENCARNADO

25. MOTHER'S MAIDEN NAME DETHERINA C. MATEO

SURNAME BASILIO

FIRST NAME DETHERINA

MIDDLE NAME MATEO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND


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

MARCH
ELEMENTARY ST. MICHAEL ACADEMY 2002 2008
2008
MARCH
SECONDARY
VOCATIONAL / ST. MICHAEL ACADEMY 2008 2012
2012

N/A
TRADE
UNIVERSITY OF THE EAST - APRIL
COURSE
COLLEGE BS ELECTRONICS ENGINEERING 2012 2017
CALOOCAN 2017

GRADUATE STUDIES N/A


(Continue on separate sheet if necessary)

SIGNATURE DATE 3/13/2019


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

ELECTRONICS ENGINEER BOARD EXAM OCT.21-22, 2017 UNIVERSITY OF THE EAST - MANILA 67313 02/25/2020

ELECTRONICS TECHNICIAN BOARD EXAM OCT.23, 2017 UNIVERSITY OF THE EAST - MANILA 13951.00 02/25/2020

(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) MONTHLY STATUS OF
(Write in full/Do not (Write in SALARY
applicable)& STEP
APPOINTMENT
abbreviate) full/Do not abbreviate) (Format "00-0")/
INCREMENT
From To (Y/
N)
01/16/2018 present BIOMEDICAL TECHNICIAN ST. LUKE'S MEDICAL CENTER-QC ₱16,676.00 n/a REGULAR N
CUSTOMER SERVICE
04/10/2018 5/20/2018 SPI GLOBAL ₱14,000.00 n/a CONTRACTUAL N
REPRESENTATIVE

(Continue on separate sheet if necessary)

SIGNATURE DATE 3/13/2019


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 / NATURE OF WORK
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/ SPONSORED BY
NUMBER OF HOURS
(Write in full) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To
ST. LUKE'S MEDICAL CENTER-QC/ BLUE SKY
SERVICE TRAINING FOR HAMILTON-C1 VENTILATOR 1/15/2018 1/15/2018 4.0 TECHNICAL
TRADING CORP.

STRYKER 1488HD VISUALIZATION SYSTEM TECHNICAL TRAINING 1/17/2018 1/17/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ STRYKER

BASIC OPERATION OF FLUKE BIOMEDICAL ESA 615 ELECTRICAL SAFETY ST. LUKE'S MEDICAL CENTER-QC/ AMI
6/19/2018 6/19/2018 4.0 TECHNICAL
ANALYZER EQUIPMENT SERVICES AND SOLUTIONS
BASIC OPERATION AND TROUBLESHOOTING OF DRAEGER TI500 TRANSPORT
1/30/2018 1/30/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ MEDILINES
INCUBATOR

BASIC OPERATION AND TRROUBLESHOOTING OF DRAEGER CALEO INCUBATOR 1/23/2018 1/23/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ MEDILINES

BASIC TROUBLESHOOTING FOR GE CASE PREMIUM WITH T2100-ST2 TREADMILL ST. LUKE'S MEDICAL CENTER-QC/ RG
1/9/2019 1/9/2019 4.0 TECHNICAL
AND SUZUKEN KENZ 1215 ECG MACHINE MEDITRON

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION


MEMBERSHIP IN ASSOCIATION/ORGANIZATION
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33. (Write
(Write in full)
in full)
INSTITUTE OF ELECTRONICS AND
PLAYING TABLE TENNIS OR CLUSTER BIOMEDICAL TECHNICIAN OF THE YEAR COMMUNICATIONS ENGINEERS OF THE PHILIPPINES

TRYING OUT NEW FOOD

PLAYING VIDEO GAMES

PLAYING BADMINTON

SKETCHING

(Continue on separate sheet if necessary)

SIGNATURE DATE 3/13/2019


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

35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased out If YES, give details:
(abolition) in the public or private sector? ________________________________
CONTRACTUAL JOB
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
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 w
the last 6 mont
PAUL JEREMY LUMPIAS QUEZON CITY 09992212267 3.5 cm. X 4.5 c
(passport size

ENGR. FRANCIS P. GUBANGCO CALOOCAN CITY 09324173283 With full and handw
name tag and signatu
printed name
KIMHAZEL R. NAVARRO BATANGAS 09991489804
Computer genera
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pic
is not acceptab
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/License/Passport No.: 0067313 Signature (Sign inside the box)

Date/Place of Issuance: 11/07/2017 - PRC MANILA Date Accomplished Right Thumbma

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

Person Administering Oath

CS FORM 212 (Revise


If YES, give details:
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
________________________________

If YES, give details:


________________________________
CONTRACTUAL JOB
________________________________

If YES, give details (country):

ID picture taken within


the last 6 months
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten


name tag and signature over
printed name

Computer generated
or photocopied picture
is not acceptable

PHOTO
Right Thumbmark

, affiant exhibiting his/her validly issued government ID as indicated above.

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