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 LAGUE
NAME EXTENSION (JR., SR) III
FIRST NAME JOHANNES GREGORII

MIDDLE NAME BANQUIRIGO

3. DATE OF BIRTH
(mm/dd/yyyy) 09-27-1992 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH PAGADIAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

✘ Single Married 17. RESIDENTIAL ADDRESS

6 CIVIL STATUS
Widowe Separated House/Block/Lot No. Street
d PUROK MAKIANGAYON BALANGASAN
Other/s: Subdivision/Village Barangay
PAGADIAN CITY ZAMBOANGA DEL SUR
7. HEIGHT (m) 1.5
City/Municipality Province
8. WEIGHT (kg) 70 ZIP CODE 7016

18. PERMANENT ADDRESS

9. BLOOD TYPE B+
House/Block/Lot No. Street
PUROK MAKIANGAYON BALANGASAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
PAGADIAN CITY ZAMBOANGA DEL SUR
11. PAG-IBIG ID NO. 1212-3986-7461
City/Municipality Province

12. PHILHEALTH NO. 1425-0804-1305 ZIP CODE 7016

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

14. TIN NO. 710244253000 20. MOBILE NO. 09453545161

15. AGENCY EMPLOYEE NO. EMP0355 21. E-MAIL ADDRESS (if any) johannestiog@gmail.com & gregorii2202@gmail.com
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)
NAME EXTENSION (JR., SR)
FIRST NAME N/A N/A N/A
MIDDLE NAME N/A N/A N/A
OCCUPATION N/A N/A N/A
EMPLOYER/BUSINESS NAME N/A N/A N/A
BUSINESS ADDRESS N/A N/A N/A
TELEPHONE NO. N/A N/A N/A
24. FATHER'S SURNAME LAGUE N/A 12-15-1960
NAME EXTENSION (JR., SR)
FIRST NAME GENARO JR
N/A N/A

MIDDLE NAME ALARIN N/A N/A

25. MOTHER'S MAIDEN NAME N/A N/A

SURNAME BANQUIRIGO N/A 06-15-1955

FIRST NAME EVELYN N/A N/A

MIDDLE NAME LOPEZ (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 TETUAN CENTRAL SCHOOL ELEMENTARY 2000 2004 GRADUATED 2004 DIPLOMA

SECONDARY /
VOCATIONAL REGIONAL SCIENCE HIGH SCGHOOL SECONDARY 2005 2009 GRADUATED 2009 DIPLOMA

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

TRADE
BACHELOR OF SCIENCE IN CIVIL
COURSE
COLLEGE SOUTHERN MINDANAO COLLEGES
ENGINEERING
2011 2015 GRADUATED 2015 DIPLOMA

MASTER OF BUSINESS
GRADUATE STUDIES SAINT COLUMBAN COLLEGES 2019 2020 27 Units N/A N/A
ADMINISTRATION
(Continue on separate sheet if necessary)

SIGNATURE DATE February 4, 2021

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
November 10-11,
CIVIL ENGINEERING BOARD EXAM 81.0 2018
Zamboanga City 0168352 9/27/2022

COMPUTER PROFICIENCY EXAMINATION FOR

January 3-5, 2018 Zamboanga City
TECHNICAL POSITION

(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 full/Do not SALARY
applicable)& STEP
APPOINTMENT
(Format "00-0")/
abbreviate) abbreviate) INCREMENT
From To (Y/ N)

DEPARTMENT OF PUBLIC WORKS AND

2/1/2019 Present Engineering Assistant 740/day n/a Job Order no
HIGHWAYS 1ST ENGINEERING DISTRICT
DEPARTMENT OF PUBLIC WORKS AND
1/3/2019 2/1/2019 UtilityWorker I 477/day n/a Job Order no
HIGHWAYS 1ST ENGINEERING DISTRICT
DEPARTMENT OF PUBLIC WORKS AND
2/7/2018 12-31-2018 UtilityWorker I 477/day n/a Job Order no
HIGHWAYS 1ST ENGINEERING DISTRICT
DEPARTMENT OF PUBLIC WORKS AND
1/10/2017 06-29-2018 UtilityWorker I 450/day n/a Job Order no
HIGHWAYS 1ST ENGINEERING DISTRICT
DEPARTMENT OF PUBLIC WORKS AND
09/15/2017 09/30/2017 UtilityWorker I 430/day n/a Job Order no
HIGHWAYS 1ST ENGINEERING DISTRICT

1/5/2017 09/15/2017 Engineering Aide CITY ENGINEERS OFFICE 260/day n/a Job Order no

(Continue on separate sheet if necessary)

SIGNATURE DATE February 4, 2021

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

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

AUTOCAD N/A N/A

MICROSOFT OFFICE N/A N/A

CIVIL 3D N/A N/A

DOCUMENTATION N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE February 4, 2021

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? ________________________________
________________________________
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: 009-0973-002-000362
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
SOUTHERN MINDANAO COLLEGES DEAN the last 6 months
Engr. ELENO ESOLANA, JR. ENGINEERING DEPARTMENT 3.5 cm. X 4.5 cm
(passport size)

Engr. CARLITO TAGUD STA. LUCIA, PAGADIAN CITY 9122868363 With full and handwritten
name tag and signature over
printed name
Engr. GENRIC LAGARAS BALANGASAN DISTRICT, PAGADIAN CITY 9665029833
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: PRC I.D.

ID/License/Passport No.: 0168352

Signature (Sign inside the box)
December 17, 2020
Date/Place of Issuance: 01-18-2019, 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

 PROFESSIONAL EXPERIENCE SHEET
Attachment to CS Form No. 212

Instructions: The duration should include start and finish dates, if known, month in abbreviated form known and
year in full. For the current position, use the word Present, e.g. 1998 - Present. Professional experience should be
listed from most recent first.

• Duration (Inclusive Dates)

• Position, Name of Office/Unit and Immediate Supervisor, Name of Agency/Organization and Location

> List of Accomplishments and Contributions (if any)

> Description of Duties

Date JANUARY 2, 2019 TO PRESENT

Position ENGINEERING ASSISTANT
Immediate Supervisor Engr. Florencia B. Sanchez
Name Of Office DPWH - 1st District Engineering Office, Balangasan District, Pagadian City

Description Of Duties To prepare program of works and estimates of Covered Court

To assist in preparation of program of works of various projects
To Assist inspection of Various Vertical Projects
To perform duties related to Civil Works and others pertains to office works assigned.

Date JULY 2, 2018 TO December 31, 2018

Position Utility Worker I
Immediate Supervisor Engr. Florencia B. Sanchez
Name Of Office DPWH - 1st District Engineering Office, Balangasan District, Pagadian City

Description Of Duties To prepare program of works and estimates of Covered Court

To assist in preparation of program of works of various projects
To perform duties related to Civil Works and others pertains to office works assigned.

Date OCTOBER 1, 2017 TO JUNE 29, 2018

Position Utility Worker I
Immediate Supervisor Engr. Florencia B. Sanchez
Name Of Office DPWH - 1st District Engineering Office, Balangasan District, Pagadian City

Description Of Duties To prepare program of works and estimates of Rainwater Collector

To assist in preparation of program of works of various projects
To perform duties related to Civil Works and others pertains to office works assigned.

Date SEPTEMBER 15, 2017 TO SEPTEMBER 30, 2017

Position Utility Worker I
Immediate Supervisor Engr. Florencia B. Sanchez
Name Of Office DPWH - 1st District Engineering Office, Balangasan District, Pagadian City

Description Of Duties To prepare program of works and estimates of various projects

To assist in preparation of program of works of various projects
To perform duties related to Civil Works and others pertains to office works assigned.

Date MAY 1, 2017 TO SEPTEMBER 15, 2017

Position Engineering Aide
Immediate Supervisor Engr. Dorie B. Lumasag
Name Of Office City Engineers Office, San Jose District, Pagadian City

Description Of Duties To assist in preparation of program of works of various projects

Johannes Gregorii B. Lague

( Signature over Printed Name of Employee/Applicant)

Date: February 4, 2021