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

MIDDLE NAME SAMORIN

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) JULY 26, 1997 ✘ Filipino Dual Citizenship
by
by birth
4. PLACE OF BIRTH BRGY. PIAO, PRES. M.A. ROXAS Z.N. If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
✘ Male Female
17. RESIDENTIAL ADDRESS N/A PUROK 7, PARPAGAYO
6 CIVIL STATUS ✘ Single Married House/Block/Lot No. Street
Widowed Separat N/A PIAO
Other/s: ed Subdivision/Village Barangay
PRES. M.A. ROXAS ZAMBOANGA DEL NORTE
7. HEIGHT (m) 1.62
City/Municipality Province
8. WEIGHT (kg) 56 ZIP CODE 7102
18. PERMANENT ADDRESS N/A PUROK 7, PARPAGAYO
9. BLOOD TYPE B+
House/Block/Lot No. Street
N/A PIAO
10. GSIS ID NO. 2005768255
Subdivision/Village Barangay
PRES. M.A. ROXAS ZAMBOANGA DEL NORTE
11. PAG-IBIG ID NO. 121267308255
City/Municipality Province

12. PHILHEALTH NO. 14-251989952-2 ZIP CODE 7102

13. SSS NO. 10-1371621-2 19. TELEPHONE NO. N/A

14. TIN NO. 767-775-881 20. MOBILE NO. 09650365131

15. AGENCY EMPLOYEE NO. 8752P9298 21. E-MAIL ADDRESS (if any) [email protected]
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)

FIRST NAME N/A N/A N/A N/A

MIDDLE NAME N/A

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME

EDAGA FEB. 14, 1960

FIRST NAME VALENTINO N/A

MIDDLE NAME APOLONIO

25. MOTHER'S MAIDEN NAME

SURNAME SAMORIN JAN. 03, 1963

FIRST NAME CONSTANCIA

MIDDLE NAME ONDO (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

ELEMENTARY NABILID ELEMENTARY SCHOOL ELEMENTARY 2004 2010 N/A 2010 6th Place

JOSE RIZAL MEMORIAL STATE

SECONDARY /
VOCATIONAL SECONDARY 2010 2014 N/A 2014 6th Place
UNIVERSITY -KATIPUNAN CAMPUS

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

TRADE
BACHELOR OF SCIENCE IN CIVIL
COURSE
COLLEGE ANDRES BONIFACIO COLLEGE 2014 2019 N/A 2019 SCHOLAR
ENGINEERING (BSCE)

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

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 2,2022

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

BOARD OF CIVIL ENGINEERS 80.40% 2019 SOUTHWESTERN UNIVERSITY CEBU CITY 0174261 07/26/2025

DRIVER'S LICENSE 2019 DIPOLOG CITY , ZAMBOANGA DEL NORTE J01-17-004090 07/26/2032

(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)
Municipal Engineering Office, Local
1/10/2021 PRESENT Administrative Aide II 11,309.00 SG 02-1 PERMANENT Y
Government Unit -Pres. M.A. Roxas
Municipal Engineering Office, Local CASUAL/
1/5/2020 09/30/2021 Administrative Aide I 5,280.00 N/A Y
Government Unit -Pres. M.A. Roxas PLANTILLA
Municipal Engineering Office, Local
02/17/2020 04/30/2020 Administrative Aide I 6,000.00 N/A JOB ORDER Y
Government Unit -Pres. M.A. Roxas

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 2,2022

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

(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) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To
TRAINING-WORKSHOP ON 3D DESIGN, MODELING, AND RENDERING, V-RAY AND DEPARTMENT OF INTERIOR AND LOCAL
JUL. 18, 2022 JUL. 20, 2022 24 TECHNICAL
ANIMATION USING SKETCH-UP AND ENSCAPE GOVERNMENT
TECHNICAL CONFERENCE ON THE AUDIT OF GOVERNMENT INFRASTRUCTURE
JUL. 15, 2022 JUL. 15, 2022 8 TECHNICAL COMMISSION ON AUDIT & ALGAZI
PROJECTS
REINFORCED-CONCRETE (RC) AND POST-TENSIONED (PT) FLAT SLAB DESIGN USING
APR. 27, 2022 APR. 27, 2022 2 TECHNICAL XSTRUCTURES ENGINEERING CONSULTANTS
STAAD.PRO AND RAM CONCEPT
DEPARTMENT OF INTERIOR AND LOCAL
SEMINAR-WORKSHOP ON GEOTAGGING AND OTHER GEOSPATIAL APPLICATIONS MAR. 21, 2022 MAR. 23, 2022 24 TECHNICAL
GOVERNMENT

47TH NATIONAL CONVENTION AND TECHNICAL CONFERENCE NOV. 26, 2021 NOV. 27, 2021 16 TECHNICAL PHILIPPINE INSTITUTE OF CIVIL ENGINEERS

ORIENTATION ON SHAPING LOCAL PROJECT MONITORING COMMITTEES ( LMPCs) DEPARTMENT OF INTERIOR AND LOCAL
JULY 15, 2021 JULY 16, 2021 16 TECHNICAL
TOWARDS GREATER RESPONSIBILITES GOVERNMENT

ONLINE TRAINING ON DETAILED ENGINEERING DESIGN (DED) PREPARARATION FOR DEPARTMENT OF INTERIOR AND LOCAL
JULY 12, 2021 JULY 14, 2021 24 TECHNICAL
LOCAL ROADS ( HORIZONTAL STRUCTURES ) GOVERNMENT

(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)

2D DRAFTING AND DESIGN USING AUTOCAD Outstanding Certificate of Recognition for astounding contribution as one Significant Engineer
PHILIPPINE INSTITUTE OF CIVIL ENGINEERS
responsible in the Drainage System and some Project for Pres. M.A. Roxas National High School
(PICE)
3D MODELING USING SKETCH UP (PMARNHS)

3D ANIMATION AND RENDERING USING VRAY

AND ENSCAPE
COMPUTER LITERATE

BADMINTON

CYCLING

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMBER 2,2022

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
by any court or tribunal? YES ✘ NO
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 YES ✘ NO
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
Barangay election)? YES ✘ NO
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. ESTERLITA T. ANDALAHAO DOHINOB, PRES. MANUEL A. ROXAS 9776138720 4.5 cm. X 3.5 cm
(passport size)

ENGR. ELENA S. BECHAYDA DOHINOB, PRES. MANUEL A. ROXAS 9292936949

Computer generated
or photocopied picture
ENGR. NILO C. AGUSTIN LANGATIAN, PRES. M.A. ROXAS 9469790391 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: PRC I.D.

ID/License/Passport No.: 0174261

Signature (Sign inside the box)

Date/Place of Issuance: NOV. 27, 2019 PAGADIAN 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