CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation made in the Personal Data Sheet and the Work Experience Sheet shall cause the filing of administrative/criminal case/s agai
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

I. PERSONAL INFORMATION
2. SURNAME CORTUNA
NAME EXTENSION (JR., SR
FIRST NAME ANGELITO

MIDDLE NAME RIVERA

3. DATE OF BIRTH
(mm/dd/yyyy) 05/29/1982 16. CITIZENSHIP
✘ Filipino Dual Citizenship
✘ by birth by
4. PLACE OF BIRTH Mamburao, Occidental Mindoro If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX ✘ Male Female

Single ✘ Married 17. RESIDENTIAL ADDRESS Lot 8 Block 21 Phase 5 Se

6 CIVIL STATUS
House/Block/Lot No. S
Widowed Separated
Sta. Rosa Heights Putin
Other/s:
Subdivision/Village Ba
Silang C
7. HEIGHT (m) 1.60
City/Municipality Pr
8. WEIGHT (kg) 70 ZIP CODE

18. PERMANENT ADDRESS Lot 8 Block 21 Phase 5 Se

9. BLOOD TYPE O
House/Block/Lot No. S
Sta. Rosa Heights Putin
10. GSIS ID NO. NOT APPLICABLE
Subdivision/Village Ba
Silang C
11. PAG-IBIG ID NO. 915089699671
City/Municipality Pr

12. PHILHEALTH NO. 010501817371 ZIP CODE 4118

13. SSS NO. 3384671288 19. TELEPHONE NO. NOT APPLICABLE

14. TIN NO. 223923307 20. MOBILE NO. 09179622142

15. AGENCY EMPLOYEE NO. NOT APPLICABLE 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME Cortuna 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) Angelito Jr. Cortuna
FIRST NAME Sheila

MIDDLE NAME Muniz

OCCUPATION Government employee

EMPLOYER/BUSINESS NAME Public Attorney's Office

BUSINESS ADDRESS Binan, Laguna

TELEPHONE NO. NOT APPLICABLE

24. FATHER'S SURNAME Cortuna

NAME EXTENSION (JR., SR)
FIRST NAME Reynaldo

MIDDLE NAME Pedines

25. MOTHER'S MAIDEN NAME

SURNAME Rivera

FIRST NAME Rosalina

MIDDLE NAME Luartes (Continue on separate sheet if necessary

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY Payompon Elementary School Primary June 1988 March 1994

Occidental Mindoro National High

SECONDARY Secondary June 1994 March 1998
School
VOCATIONAL /

TRADE
COURSE
COLLEGE University of the East BS in Civil Engineering June 1999 March 2003

GRADUATE STUDIES University of the East Master in Construction Management June 2003 March 2004 12 Units

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Re

 DATA SHEET
ience Sheet shall cause the filing of administrative/criminal case/s against the person

EFORE ACCOMPLISHING THE PDS FORM.

(Do not fill up. For CSC use only)

NAME EXTENSION (JR., SR)

Dual Citizenship

by naturalization
Pls. indicate country:

Serranos
Street
Puting Kahoy
Barangay
Cavite
Province

Serranos
Street
Puting Kahoy
Barangay
Cavite
Province

NOT APPLICABLE

09179622142

[email protected]

DATE OF BIRTH (mm/dd/yyyy)

9/12/2006

(Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

1994 5th Honor

1998 13th Honor

 2003

arate sheet if necessary)

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
May 29,
CIVIL ENGINEER LICENSURE EXAM 94.1 May 2005 Manila, Philippines 0102288 2018
May 29,
REAL ESTATE APPRAISER EXAM 80.0 February 2016 Manila, Philippines 0009430 2019
May 29,
REAL ESTATE BROKER EXAM 80.0 April 2016 Manila, Philippines 0026793 2019

(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
(Format "00-0")/
abbreviate) full/Do not abbreviate) INCREMENT
From To (Y/
N)
12/01/2017 PRESENT Project Monitoring Supervisor DL CERVANTES CONSTRUCTION CORP 40000.00 PROBATIONARY N

05/22/2017 11/21/2017 Tchnical Audit Head HOMEMARK INC 60000.00 CONTRACTUAL N

08/03/2015 02/01/2017 Assistant Manager (Civil) GS EAST ASIA MANILA INC 70000.00 REGULAR N
2000
08/01/2011 08/02/2015 Assistant Manager (Structural) SK ENGINEERING & CONSTRUCTION CONTRACTUAL N
(USD)
1800
07/19/2007 07/18/2011 Assistant Civil Engineer DAELIM INDUSTRIAL COMPANY CONTRACTUAL N
(USD)
07/04/2005 07/16/2007 Civil Engineer I JGC PHILIPPINES INC 25000.00 REGULAR N

(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 /
From To

Korean Volunteer Association 09/01/2011 09/01/2015 120.0 Cleaning parks and mounta

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

Hydraulics and Drainage Design 09/01/2015 09/01/2015 2.0 Supervisory GS EAST AS

Oily Sewer and Waste Water Treatment 09/08/2015 09/08/2015 2.0 Supervisory GS EAST AS

Understanding Hydraulic Calculation 09/15/2015 09/15/2015 2.0 Supervisory GS EAST AS

Project Execution Plan Based on Construction Priority 09/22/2015 09/22/2015 2.0 Managerial GS EAST AS

UG Facilities for Electrical & Instrument 09/29/2015 09/29/2015 2.0 Technical GS EAST AS

ITB Requirement Review, Road and Paving Design 10/02/2015 10/02/2015 2.0 Technical GS EAST AS

Understanding Underground Facilities in Plant Engineering 10/09/2015 10/09/2015 2.0 Technical GS EAST AS

Soil Investigation & Topographical Survey Procedure 10/16/2015 10/16/2015 2.0 Technical GS EAST AS

Design Guide for Hydraulics and Drainage Design 10/23/2015 10/23/2015 2.0 Technical GS EAST AS

LRFD14_Seismic Design of Steel Structures 10/30/2015 10/30/2015 2.0 Technical GS EAST AS

Seismic Design of Concrete Structures 11/3/2015 11/3/2015 2.0 Technical GS EAST AS

Development, Anchorage and Splicing of Reinforcement 11/10/2015 11/10/2015 2.0 Technical GS EAST AS

Concrete Capacity Design Method and Corrosion 11/17/2015 11/17/2015 2.0 Technical GS EAST AS

Qualification of Anchors For Cracked Concrete and Seismic Application 11/24/2015 11/24/2015 2.0 Technical GS EAST AS

Earthquake Engineering 12/01/2015 12/01/2015 2.0 Technical GS EAST AS

14001: 2004 Environmental Management 12/08/2015 12/08/2015 2.0 Managerial GS EAST AS

 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

MEMBER
NON-ACADEMIC DISTINCTIONS / RECOGNITION
31. SPECIAL SKILLS and HOBBIES 32. 33.
(Write in full)

Fluent in Korean Hangeul Special Citation - UST Investigative Journalism Philippi

(Continue on separate sheet if necessary)

SIGNATURE DATE
PLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

Cleaning parks and mountains

sheet if necessary)

AMS ATTENDED
years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

GS EAST ASIA MANILA

sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION

(Write in full)

Philippine Institute of Civil Engneers

sheet if necessary)

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 NO
YES ✘
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? ________________________________
I'm a former OFW
________________________________
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
Professional Regulation Commission the last 6 mon
Jaime Adolor Legal Division
735-1248 3.5 cm. X 4.5
(passport siz

With full and hand

name tag and signa
printed nam

Computer gener
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied p
is not accepta
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.:
ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
Date Accomplished Right Thumbm

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

Person Administering Oath

CS FORM 212 (Revised

 If YES, give details:
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
________________________________

If YES, give details:

________________________________
I'm a former OFW
________________________________
✘ NO

✘ NO

✘ NO
If YES, give details (country):

✘ NO

✘ NO

✘ NO

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