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 Lumauig
NAME EXTENSION (JR., SR) N/A
FIRST NAME Michael Angelo

MIDDLE NAME Agudelo

3. DATE OF BIRTH
05/26/1997 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH Cabanatuan City, Nueva Ecija If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS 039 Narra Street

Widowed House/Block/Lot No. Street

Separate
Maria Theresa Maria Theresa
Other/s: d
Subdivision/Village Barangay
Cabanatuan City Nueva Ecija
7. HEIGHT (m) 1.68
City/Municipality Province
8. WEIGHT (kg) 50 ZIP CODE 3100

18. PERMANENT ADDRESS 039 Narra Street

9. BLOOD TYPE AB+
House/Block/Lot No. Street
Maria Theresa Maria Theresa
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Cabanatuan City Nueva Ecija
11. PAG-IBIG ID NO. 121162616730
City/Municipality Province

12. PHILHEALTH NO. 210502220246 ZIP CODE 3100

13. SSS NO. 0239702658 19. TELEPHONE NO. N/A

14. TIN NO. N/A 20. MOBILE NO. 09264022116

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

MIDDLE NAME N/A N/A N/A

OCCUPATION N/A N/A N/A

EMPLOYER/BUSINESS NAME N/A N/A N/A

BUSINESS ADDRESS N/A N/A N/A

TELEPHONE NO. N/A N/A N/A

24. FATHER'S SURNAME Lumauig N/A N/A

NAME EXTENSION (JR., SR) JR
FIRST NAME Tomas N/A N/A

MIDDLE NAME Galindez N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME Agudelo N/A N/A

FIRST NAME Marissa N/A N/A

MIDDLE NAME Gutierez (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Fort Magsaysay Elementary School Primary Education N/A 2009 N/A
2003 2009
Nueva Ecija University of Science and 2009/ 2012/
SECONDARY /
VOCATIONAL High School N/A 2013 N/A
Technology/San Josef National High School 2012 2013

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

TRADE
COURSE
COLLEGE PHINMA-Araullo University BS Civil Engineering N/A 2019 N/A
2013 2019

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/22/2021

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

RA 1080 79.5 May-19 Metro Manila 0171109 05/26/2022

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

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

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

N/A N/A 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
28. INCLUSIVE DATES SALARY/ JOB/ PAY SERVICE
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
(Y/ N)
Engineering Equipment Incorporated
06/24/2019 09/29/2020 Junior Quality Control Engineer 15000.00 N/A Full Time N/A
Corporation
N/A N/A N/A N/A N/A N/A N/A N/A

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(Continue on separate sheet if necessary)

SIGNATURE DATE 01/22/2021

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

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

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(Continue on separate sheet if necessary)
VII. LEARNING AND DEVELOPMENT (L&D) INTERVENTIONS/TRAINING PROGRAMS ATTENDED
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

Quality Control Engineer Training Program 06/24/2019 02/17/2019 190.0 Technical Engineering Equipment Incorporated Corporation

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

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(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 in
(Write in full)
full)

Guitar player N/A Walang Imposible Sa Diyos Outreach Ministries

Biblical interpretation N/A N/A

2D & 3D Modeling N/A N/A

Computer Literate N/A N/A

N/A N/A N/A

N/A N/A N/A

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/22/2021

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:

________________________________
N/A

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

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:
________________________________
N/A
________________________________
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? Cessation of need
________________________________
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
YES ✘ NO
Barangay election)? N/A
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: N/A
39. Have you acquired the status of an immigrant or permanent resident of another country?
YES ✘ NO
If YES, give details (country):
N/A
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: N/A
b. Are you a person with disability? YES ✘ NO
If YES, please specify ID No: N/A
c. Are you a solo parent? YES ✘ NO
If YES, please specify ID No: N/A

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

NAME ADDRESS TEL. NO.

ID picture taken within
the last 6 months
Nathaniel L. Pangilinan Cabanatuan City, Nueva Ecija 9428220617 4.5 cm. X 3.5 cm
(passport size)

Jafferson T. Lesino Paranaque City 9155135377

Computer generated
or photocopied picture
Mayen Irrah D. Especial Bugias, Benguet 9153112936 is not acceptable

42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and
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: Professional Regulation Commission

ID/License/Passport No.: 0171109

Signature (Sign inside the box)
01/22/2021
Date/Place of Issuance: 05/30/2019/Metro Manila
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this January 22, 2021 , affiant exhibiting his/her validly issued government ID as indicated above.

Michael Angelo A. Lumauig

Person Administering Oath

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