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 FLORES
NAME EXTENSION (JR., SR)
FIRST NAME CARLO

MIDDLE NAME MERCADO

3. DATE OF BIRTH
10/16/1995 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH CAGAYAN DE ORO CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Female
✘ Male
17. RESIDENTIAL ADDRESS
6 CIVIL STATUS ✘ Single Married
House/Block/Lot No. Street
Widowed Separate
Other/s: d Subdivision/Village Barangay
7. HEIGHT (m) 1.70
City/Municipality Province
8. WEIGHT (kg) 95 ZIP CODE

18. PERMANENT ADDRESS BLOCK 8 LOT 6

9. BLOOD TYPE TYPE "O"
House/Block/Lot No. Street

10. GSIS ID NO.

ECOVERDE HOMES INDAHAG
Subdivision/Village Barangay
CAGAYAN DE ORO MISAMIS ORIENTAL
11. PAG-IBIG ID NO.
1211-7804-8258 City/Municipality Province

12. PHILHEALTH NO. ZIP CODE 9000

150504408525
13. SSS NO. 19. TELEPHONE NO.
826770530
14. TIN NO. 20. MOBILE NO.
770-277-643-000
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) f.carlo1818@gmail.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME
NAME EXTENSION (JR., SR)
LILAC C. FLORES 2/24/2021

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME FLORES

NAME EXTENSION (JR., SR)
FIRST NAME CARLOS

MIDDLE NAME PUGOY

25. MOTHER'S MAIDEN NAME

SURNAME MERCADO

FIRST NAME JACQUELENE

MIDDLE NAME RAGASA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

CLASS
ELEMENTARY SOUTHERN PHILIPPINES COLLEGE VALEDICTORIAN
2000 2006 2006
1ST HONORS
SECONDARY /
VOCATIONAL MIS. OR. GENERAL COMPREHENSIVE H.S. (SCIENCE CLASS)
2006 2010 2010

TRADE CITY COLLEGE

COURSE
COLLEGE XAVIER UNIVERSITY ATENEO DE CAGAYAN BACHELOR OF SCIENCE IN CIVIL ENGINEERING SCHOLARSHIP
2010 2015 2015 PROGRAM

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 20, 2023

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

CIVIL ENGINEERING LICENSURE EXAMINATION NOV. 2015 CEBU CITY, PH 0146789 10/16/2025

(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)

1/2/2023 PRESENT ENGINEER - 1 (COS) PROVINCIAL GOVT MISAMIS ORIENTAL SG 11 COS Y

1/10/2022 1/2/2023 DESIGN ENGINEER LIBERTY LAND CORPORATION 25000.00 CONTRACTUAL N

1/12/2022 9/30/2022 CIVIL ENGINEERING INSTRUCTOR II CAGAYAN DE ORO COLLEGE PHINMA 22000.00 CONTRACTUAL N

1/15/2022 7/15/2022 ENGINEERING CONSULTANT C-ONE TRADING CORPORATION 13000.00 3RD PARTY N

02/30/2020 03/15/2021 PROJECT ENGINEER TGB CONSTRUCTION SERVICES 17000.00 PROJECT BASED N
XAVIER UNIVERSITY ATENEO DE
1/6/2017 3/30/2020 ASSISTANT INSTRUCTOR III 16000.00 CONTRACTUAL N
CAGAYAN
8/2/2016 06/15/2017 FIELD ENGINEER HNH BUILDERS AND ENTERPRISES 17000.00 REGULAR N

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 20, 2023

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

XAVIER UNIVERSITY - SERVICE LEARNING PROGRAM 1/6/2018 8/30/2018 1 SEMESTER TECHNICAL FACILITATOR

(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

MIDAS CIVIL STARTER PACK 2 10/6/2022 1/7/2022 8.0 TECHNICAL MIDAS IT PHILIPPINES CORPORATION

2021 PICE MIDYEAR NATIONAL CONVENTION AND TECHNICAL CONFERENCE 6/25/2021 6/26/2021 16.0 TECHNICAL PICE NATIONAL

WEBINAR ON CONSTRUCTION MANAGEMENT: RELEARN THE BASIC OF PROJECT DYAS CONSTRUCTION AND MANAGEMENT
6/18/2021 6/18/2021 8.0 TECHNICAL
IMPLEMENTATION CONSULTANT
UNITED NATIONS DEVELOPMENT PROGRAM
LOCAL ROAD ASSET MANAGEMENT TRAINING 9/10/2019 9/13/2019 32.0 TECHNICAL
(ROAD2SDGS)

LECTURE SERIES ON GEOTECHINCAL ENGINEERING 8/28/2019 8/29/2019 16.0 TECHNICAL PICE MIS.OR. CHAPTER

UNITED NATIONS DEVELOPMENT PROGRAM

ORIENTATION OF G-HUBS QA ENGINEERS 9/03/2018 9/05/2018 24.0 SUPERVISORY
(ROAD2SDGS)

AUTODESK BIM 100: DIGITIZING THE BUILT ENVIRONMENT 6/01/2018 6/02/2018 16.0 TECHNICAL ESCA KNOWLEDGE ACADEMY

NATIONAL ACADEMY OF SCIENCE AND

MINDANAO REGIONAL SCIENTIFI MEETING WITH THE THEME: SCIENCE AND
3/12/2018 3/13/2018 16.0 TECHNICAL TECHNOLOGY AND DEPARTMENT OF SCIENCE
TECHNOLOGY - ENHANCED TRANSFORMATION FOR SUSTAINABILITY AND RESILIENCY AND TECHNOLOGY

QUANTUM GIS TRAINING 11/15/2017 11/17/2017 24.0 TECHNICAL NEDA REGION X

XAVIER UNIVERSITY - ENGINEERING

PROJECT PATUBIG: INNOVATIVE WATER SUPPLY SYSTEM FOR XAVIER ECOVILLE 2/12/2015 2/12/2015 8.0 TECHNICAL
RESOURCECENTER

(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)
CONSTRUCTION DESIGN AND
PLANNING
PICE MIS. OR. CHAPTER
CONSTRUCTION COSTS AND
ESTIMATES
TECHNICAL SPECIFICATIONS
DETAILING

LEARNING BASIC MAPPING

LEARNING STRUCTURAL DESIGN

NETFLIX AND INTERNET SURFING

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 20, 2023

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
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,
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? ________________________________
________________________________
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? 2/24/2021
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
XAVIER UNIVERSITY - ATENEO DE the last 6 months
DR. ANABEL ABUZO CAGAYAN 4.5 cm. X 3.5 cm
(passport size)

KRYSTYANALYN CALANGI ARCANA DEVLOPMENT CORPORATION

Computer generated
or photocopied picture
JUILLET BARTON C-ONE TRADING CORP. 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.

2010

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 ID

ID/License/Passport No.: 0146789

Signature (Sign inside the box)
MARCH 20, 2023
Date/Place of Issuance: PRC CDO REGION X
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