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 (Do not fill up. For CSC use only)
No.
I. PERSONAL INFORMATION
2. SURNAME Almojuela
NAME EXTENSION(JR, SR)
FIRST NAME Cedric N/A
MIDDLE NAME Capila
3. DATE OF BIRTH
16. CITIZENSHIP [ X ] Filipino [ ] Dual Citizenship
(mm/dd/yyy) 03/08/2000
[ ] by birth [ ] by naturalization

4. PLACE OF BIRTH BORONGAN CITY, EASTERN SAMAR if holder of dual citizenship Pls. indicate country:

5. SEX [ X ] Male [ ] Female Pls. indicate the details N/A

0454 CIRCUMFERENTIAL ROAD

6. CIVIL STATUS [X] Single [ ] Married 17. RESIDENTIAL ADDRESS House/Block/Lot No. Street
[ ] Widowed N/A Songco
[ ]
[ ] Other/s: N/A Subdivision/Village Barangay
Separated
CITY OF BORONGAN (Capital) EASTERN SAMAR
7. HEIGHT (m) 1.63 City/Municipality Province
Zip Code
8. WEIGHT (kg) 65 6800
0454 CIRCUMFERENTIAL ROAD
9. BLOOD TYPE O+ 18. PERMANENT ADDRESS
House/Block/Lot No. Street
N/A Songco
10. GSIS ID NO. N/A
Subdivision/Village Barangay
CITY OF BORONGAN (Capital) EASTERN SAMAR
11. PAGIBIG ID NO. N/A
City/Municipality Province
12. PHILHEALTH NO. 130255936779 ZIP CODE 6800

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

14. TIN NO. 765 081 375 000 20. MOBILE NO. 09264851440

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) calmojuela66@gmail.com

II. FAMILY BACKGROUND

23. NAME of CHILDREN (Write full name and list DATE OF BIRTH
22. SPOUSE'S SURNAME. N/A
all) (mm/dd/yyyy)
NAME EXTENSION (JR.,SR)
FIRST NAME N/A N/A N/A
N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYERS/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER 'S SURNAME. ALMOJUELA

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

MIDDLE NAME LUNA

24. MOTHER'S MAIDEN NAME. MARIA SONIA QUIAL CAPILA

SURNAME ALMOJUELA

FIRST NAME MARIA SONIA

MIDDLE NAME CAPILA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

From To

SPECIAL
ELEMENTARY EUGENIO S. DAZA PILOT ELEMENTARY SCHOOL ELEMENTARY EDUCATION 2006 2012 GRADUATED 2012 ACADEMIC
AWARD
WITH
EASTERN SAMAR NATIONAL COMPREHENSIVE HIGH
SECONDARY HIGH SCHOOL 2012 2018 GRADUATED 2018 HONORS
SCHOOL

VOCATIONAL / TRADE COURSE N/A N/A N/A N/A N/A N/A N/A

COLLEGE EASTERN SAMAR STATE UNIVERSITY BS IN CIVIL ENGINEERING 2018 2022 GRADUATED 2022 DOST - SEI
UNDERGRAD
SCHOLARSHIP
(RA-7687)
/
CUM LAUDE

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

(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 BARANGAY ELGIBILITY / EXAMININATION PLACE OF EXAMINATION / CONFERMENT
(If Applicable)
DRIVER'S LICENSE / CONFERNMENT
NUMBER Date of Validity

Bar/Board Eligibility (RA1080) 82.5 04/23/2023 CITY OF CEBU 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.
SALARY /
JOB
/ PAY
INCLUSIVE DATES GRADE GOV'T
28. POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY
(if STATUS OF APPOINTNMENT SERVICE
(mm/dd/yyyy) (Write in full / Do not abbreviate) (Write in full/Do not abbreviate) SALARY
(Y/N)
applicable
) & STEP
(Format
"00-0") /
From To
INCREMENT

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

(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
NAME AND ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER OF
29. (Write in full) POSITION / NATURE OF WORK
(mm/dd/yyyy) HOURS
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)
Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING INCLUSIVE DATES NUMBER OF (Managerial / CONDUCTED / SPONSORED BY
PROGRAMS (mm/dd/yyyy) HOURS Supervisory / (Write in full)
(Write in full) Technical /
From To etc.)

05/06/2022 05/06/2022 4 Technical EASTERN SAMAR STATE

SUSTAINABLE WATER DISTRUBUTION SYSTEM USING EPANET SOFTWARE
UNIVERSITY - MAIN CAMPUS

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBERSHIP IN ASSOCIATION /
31. SPECIAL SKILLS and HOBBIES NON-ACADEMIC DISTINCTIONS / RECOGNITION 33.ORGANIZATION
32. (Write in full)
(Write in full)
ELECTRICAL INSTALLATION AND MAINTENANCE (NC II) N/A N/A

BASIC AUTOCAD 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 a ffinity 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 [ ] YES [X] NO
Department where you will be apppointed,
a. within the third degree?
. [ ] YES [X] NO
If Yes, give details:
b. within the fourth degree (for Local Government Unit - Career Employees)?
[ ] YES [X] NO
35. a. Have you ever been found guilty of any administrative offense?
If Yes, give details:

. [ ] YES [X] NO
Date Filed :
b. Have you been criminally charged before any court?
. [ ] YES [X] NO
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 [ ] YES [X] NO
or tribunal? If Yes, give details:

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped [X] YES [ ] NO
from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) in the public or
private sector?
If Yes, give details:

RESIGNATION.
38. a. Have you ever been a candidate in a national or local election held within the last year (except Barangay [ ] YES [X] NO
election)? If Yes, give details:

. [ ] YES [X] NO
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?
[ ] YES [X] NO
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) [ ] YES [X] NO
Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: If Yes, please specify:
a. Are you a member of any indigenous group?
. [ ] YES [X] NO
If Yes, please specify ID No:
b. Are you a person with disability
. [ ] YES [X] NO
If Yes, please specify ID No:
c. Are you a solo parent?

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

ID picture taken within
NAME ADDRESS TEL. NO. the last 6 months
3.5 cm. X 4.5 cm
ATTY. CYRIL JESUS D. ALZATE BRGY. CAMPESAO BORONGAN CITY 09455176918 (passport size)
ENGR. JENITH L. BANALDIA BRGY. STA FE, BORONGAN CITY 09219770369
With full handwritten
ENGR. ERVIN LEAN B. ALURA BRGY. 04, MAYDOLONG, EASTERN 09983530098 name tag and signature
SAMAR over
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete statement printed name
pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I authorize the agency Computer generated
head/authorized representative to verify/validate the contents stated herein. I agree that any misrepresentation made in this or photocopied picture
document and its attachments shall cause the filing of administrative/criminal case/s against me. is not acceptable
PHOTO

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's

License, etc.) PLEASE INDICATE ID Number
Government Issued ID: PHILHEALTH
Signature (Sign inside the
ID/License/Passport No. 13-025593677-9
box)
Date/Place of Issuance: 09/14/2022/BORONGAN CITY
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