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 HAMBRE
NAME EXTENSION (JR., SR)
FIRST NAME ADJUREX

MIDDLE NAME PLARISAN

3. DATE OF BIRTH
(mm/dd/yyyy) 04/07/1973 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH PASAY CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS Single ✘ Married 17. RESIDENTIAL ADDRESS 137 F. BLUMENTRITT ST.
Widowed Separated House/Block/Lot No. Street
BRGY. TIBAGAN
Other/s:
Subdivision/Village Barangay
SAN JUAN CITY
7. HEIGHT (m) 1.63
City/Municipality Province
8. WEIGHT (kg) 64 ZIP CODE

9. BLOOD TYPE O
18. PERMANENT ADDRESS 137 F. BLUMENTRITT ST.
House/Block/Lot No. Street
BRGY. TIBAGAN
10. GSIS ID NO.
Subdivision/Village Barangay
SAN JUAN CITY
11. PAG-IBIG ID NO.
City/Municipality Province

12. PHILHEALTH NO. ZIP CODE

13. SSS NO. 08-1113252-3 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any)

II. FAMILY BACKGROUND

DATE OF BIRTH
22. SPOUSE'S SURNAME HAMBRE 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME LOURI JOSEPH ADRIAN HAMBRE 05/05/2007

MIDDLE NAME LUSARITO

OCCUPATION HOUSEWIFE

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME HAMBRE

NAME EXTENSION (JR., SR)
FIRST NAME RODOLFO

MIDDLE NAME PACTURANAN

25. MOTHER'S MAIDEN NAME CAÑONEO

SURNAME HAMBRE

FIRST NAME ERLINDA

MIDDLE NAME PLARISAN (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BONBON ELEM. SCHOOL PRIMARY 1981 1986 1986

SECONDARY /
VOCATIONAL CAGAYAN DE ORO COLLEGE SECONDARY 1986 1990 1990

CADVISION AUTOCAD June June 2002

TRADE
COURSE
COLLEGE CAGAYAN DE ORO COLLEGE B.S. ARCHITECTURE 1991 1995 1995

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

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)
Sept. 11, 2019 PRESENT TECHNICAL SUPPORT STAFF III DEPARTMENT OF AGRARIAN REFORM

Aug. 15, 2017 2017 ARCHITECT / PROJECT CONSULTANT HAWKSTOW CONST. & DEV. (PROJ. BASE)

May 23, 2015 May 16, 2017 ESTIMATOR / CAD DESIGNER JAR MANALOTO & ASSOCIATES

Nov. 22, 2013 Jan. 22, 2015 ESTIMATOR / CAD OPERATOR CIRCA 1926 PRE-CAST INC.

June 09,2011 Nov. 19, 2012 CAD DESIGNER / ESTIMATOR SAMSUNG C&T GROUP, (QATAR)
June 09,
May 17, 2010 FREELANCE CAD DESIGNER
2011
SAUDI LEBANESE MODERN CONST.
May 15, 2009 May 16, 2010 CAD OPERATOR
(RIYADH, SAUDI ARABIA)
Oct. 07, 2004 Ápril 15, 2009 CAD OPERATOR IRVINE CONST. CORPORATION

July 17, 2001 Oct. 01, 2003 CAD DESIGNER AL RASHID ABETONG (RIYADH K.S.A.)

July 19, 1999 July 05, 2000 PROJ. SUPERVISOR JOSE ANGELO CONST.

April 24, 1998 July 19, 1999 CAD OPERATOR / CONST. FOREMAN ALFREDY SY ARCHITECTS & ASSO.

June 26, 1996 Mar. 16, 1998 DRAFTSMAN / PROJ. SUPERVISOR DENNIS L. LAGUNILLA ARCHITECTS

Jan. 06, 1993 June 24, 1996 DRAFTSMAN REX C. ACDAL ARCHITECTS
March 08,
1991
Dec. 18, 1993 DRAFTSMAN (O.J.T.) M.E. DUMPA ARCHITECTS

(Continue on separate sheet if necessary)

SIGNATURE DATE
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

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

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

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN
NON-ACADEMIC DISTINCTIONS / RECOGNITION ASSOCIATION/ORGANIZATION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)
(Write in full)

N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE
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:

________________________________

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? FINISHED CONTRACT & RESIGNED
________________________________
________________________________
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
ALDOUS ARVIN ARELLANO CAINTA, RIZAL 348-1926 3.5 cm. X 4.5 cm
(passport size)

JOHN ARVIN MANALOTO MARIES VILL. ANTIPOLO 682-8423 With full and handwritten
name tag and signature over
printed name

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)

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