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 ag
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 BALINDONG
NAME EXTENSION (JR., SR
FIRST NAME AMERHUSSEIN

MIDDLE NAME BALINDONG

3. DATE OF BIRTH
(mm/dd/yyyy) 01/14/1985 16. CITIZENSHIP
Filipino Dual Citizenship

by birth
4. PLACE OF BIRTH MARAWI CITY If holder of dual citizenship, Pls. indicate cou
please indicate the details.
5. SEX
✘ Male Female
17. RESIDENTIAL ADDRESS PUROK 3 GUM
6 CIVIL STATUS
✘ Single Married House/Block/Lot No. S
Widowed Separated MAH
Other/s: Subdivision/Village Ba
ILIGAN CITY LANAO
7. HEIGHT (m) 5'6''
City/Municipality Pr
8. WEIGHT (kg) 110 KG ZIP CODE

18. PERMANENT ADDRESS 037 4TH

9. BLOOD TYPE O
House/Block/Lot No. S
BARR
10. GSIS ID NO.
Subdivision/Village Ba
MARAWI CITY
11. PAG-IBIG ID NO.
City/Municipality Pr

12. PHILHEALTH NO. ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 298-707-050 20. MOBILE NO. 0915 - 042 - 5176

15. AGENCY EMPLOYEE NO.
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME
FIRST NAME
21. E-MAIL ADDRESS (if any) amerhusseinb@gmail.com
N/A 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR)
N/A

MIDDLE NAME N/A

OCCUPATION PROJECT DEVELOPMENT OFFICER

EMPLOYER/BUSINESS NAME PASIG RIVER REHABILITATION COMMISSION

BUSINESS ADDRESS 1608 QUEZON AVE. QUEZON CITY, METRO MANILA

TELEPHONE NO. 926-5232

24. FATHER'S SURNAME BALINDONG

NAME EXTENSION (JR., SR)
FIRST NAME ALAI
 MIDDLE NAME SARIP

25. MOTHER'S MAIDEN NAME

SURNAME BALINDONG

FIRST NAME PHARIDA

MIDDLE NAME BALINDONG (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 MSU - INTEGRATED LABORATORY SCHOOL GRADE SCHOOL 1993 1998

SECONDARY /
VOCATIONAL PUALAS NATIONAL HIGH SCHOOL HIGH SCHOOL 1998 2008

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

TRADE
COURSE
COLLEGE SPA COLLEGE INC. BSC - MAJOR IN MAAGEMENT 2007 2012

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE NOVEMB

CS FORM
L DATA SHEET
erience 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 birth by naturalization
Pls. indicate country:

GUMAMELA 3
Street
MAHAYAHAY
Barangay
LANAO DEL NORTE
Province

4TH STREET
Street
BARRIO SALAM
Barangay
LANAO DEL SUR
Province

0915 - 042 - 5176

amerhusseinb@gmail.com

DATE OF BIRTH (mm/dd/yyyy)

 (Continue on separate sheet if necessary)

SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED

2ND
1998
HONOR
1ST
2002
HONOR

N/A N/A

2012 N/A

parate sheet if necessary)

NOVEMBER 12, 2019

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 ap
RATING
SPECIAL LAWS/ CES/ CSEE EXAMINATION / PLACE OF EXAMINATION / CONFERMENT
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT

N/A N/A N/A 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.
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

OIC – Easement Recovery, Housing and

PASIG RIVER REHABILITATION
10/12/2018 12/28/2018 Resettlement Division Head/Project 39000.00 COS
COMMISSION
Development Officer IV

OIC – Easement Recovery, Housing and

PASIG RIVER REHABILITATION
11/28/2018 7/12/2018 Resettlement Division Head/Project 360000.00 COS
COMMISSION
Development Officer IV
PASIG RIVER REHABILITATION
2018 2019 Project Development Officer III 42000.00 COS
COMMISSION
PASIG RIVER REHABILITATION
2017 2018 Project Development Officer II COS
COMMISSION
2014 2015 Office Staff Esmero Law Office COS

2007 2013 Office Staff Provincial Engineer Office 8360.00 Casual

 (Continue on separate sheet if necessary)

SIGNATURE DATE
NOVEMBER 12, 2019
CS FORM 212 (Revised 20
 LICENSE (if applicable)

Date of
Validity

N/A

arate sheet if necessary)

GOV'T
SERVICE

(Y/
N)

Y
arate sheet if necessary)

NOVEMBER 12, 2019

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

PDP LABAN SAN JUAN CHAPTER 4/15/2017 PRESENT M

YOUTH ALLIANCE FOR BETTER LANAO 2/10/2006 2/10/2015 FINAN

(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) Supervisory/
(mm/dd/yyyy)
Technical/etc)
From To
Seminar/workshop for the Revision and Upgrading of the Local Shelter Plan of Pasig
06/18/2019 06/22/2019 32.0 Pasig R
City

Stakeholder Validation of Proposed Masterplan for Pasig River Restoration 01/24/2019 01/24/2019 8.0 Pasig R

Orientation on Budget Cycle 01/15/2019 01/15/2019 8.0 Pasig R

Pasig River Rehabilitation Commission Community Organizing workshop 12/21/2017 12/21/2017 8.0 Pasig R

Stress Management Seminar 11/27/2017 11/29/2017 24.0 Pasig R

Year-end Assessment / Multi-Year Planning Seminar 8/11/2017 10/11/2017 24.0 Pasig R

Asian Produ
International Conference on Public Sector 10/10/2017 11/10/2017 16.0 MANAGERIAL
A
Consultation – Workshop on the Proposed Framework for Pasig River Restoration Pasig Rive
4/10/2017 6/10/2017 24.0 MANAGERIAL
Towards a Sustainable and Healthy River System

Final Gap Assessment (ISO 9001: Quality Management System) 09/27/2017 09/29/2017 24.0 MANAGERIAL Pasig R

Management Review (ISO 9001: Quality Management System) 09/26/2017 09/26/2017 8.0 Pasig R

Management Review (ISO 9001: Quality Management System) 11/9/2017 11/9/2017 8.0 Pasig R

Training Course on Auditing Quality Management System (ISO 9001: Quality

07/17/2017 07/20/2017 32.0 MANAGERIAL Develop
Management System)

Workshop on ISO 9001: 2015 Documented Information 04/17/2017 04/18/2017 16.0 MANAGERIAL Develop

Workshop on ISO 9001: 2015 Documented Information 10/4/2017 11/4/2017 16.0 MANAGERIAL Develop

Workshop on ISO 9001: 2015 Process Mapping 03/27/2017 03/27/2017 8.0 MANAGERIAL Develop

Workshop on ISO 9001: 2015 Quality Policy and Planning 03/13/2017 03/15/2017 24.0 MANAGERIAL Develop
 (Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

BASKETBALL N/A PDP L

GAMING

VOLLEYBALL

TABLE TENNIS

(Continue on separate sheet if necessary)

SIGNATURE DATE N
/ PEOPLE / VOLUNTARY ORGANIZATION/S

POSITION / NATURE OF WORK

MEMBER

FINANCE OFFICER

eparate sheet if necessary)

ROGRAMS ATTENDED
five (5) years for Division Chief/Executive/Managerial positions)

CONDUCTED/ SPONSORED BY
(Write in full)

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Asian Productivity Organization & Development

Academy of the Philippines
Pasig River Rehabilitation Commission & UP
Planades

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Pasig River Rehabilitation Commission

Development Academy of the Philippines

Development Academy of the Philippines

Development Academy of the Philippines

Development Academy of the Philippines

Development Academy of the Philippines

eparate sheet if necessary)

MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)

PDP LABAN SAN JUAN COUNCIL

eparate sheet if necessary)

NOVEMBER 12, 2019

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: MERANAO
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
PRRC, QUEZON AVE. QUEZON CITY, the last 6 months
JOSE ANTONIO GOITIA METRO MANILA
926-5232 3.5 cm. X 4.5 cm
(passport size)
PRRC, QUEZON AVE. QUEZON CITY,
ANSHARI C. LOMODAG METRO MANILA
926-5233 With full and handwritten
name tag and signature over
PRRC, QUEZON AVE. QUEZON CITY, printed name
JIMBO M. MALLARI METRO MANILA
926-5234
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:

ID/License/Passport No.:
Signature (Sign inside the box)
NOVEMBER 12, 2019
Date/Place of Issuance:
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 o

If YES, give details (country):
, affiant exhibiting his/her validly issued government ID as indicated above.

CS FORM 212 (Revised 2017), Page 4 of 4