PERSONAL DATA SHEET

Print legibly, Mark appropriate □ with ” / ” and use separate sheet if necessary. 1. CS ID No. (to be filled up by CSC)
I.PERSONAL INFORMATION
2. SURNAME CABUCOS
FIRST NAME JEREMIAS
MIDDLE NAME SABERON 3. NAME EXTENSION (e.g. Jr., Sr.)
4. DATE OF BIRTH (mm/dd/yyyy) 6/7/1966 16. RESIDENTIAL ADDRESS
5. PLACE OF BIRTH LAHUG CEBU CITY 934-E SALINAS DRIVE EXT. LAHUG CEBU CITY
6. SEX / x / Male / / Female
7. CIVIL STATUS
/ / Single / / Widowed ZIP CODE 6000
/ X / Married / / Separated 17. TELEPHONE NO. 0928-5921318
/ / Annuled / / Others, specify______ 18. PERMANENT ADDRESS
8. CITIZENSHIP FILIPINO 934-E SALINAS DRIVE EXT. LAHUG CEBU CITY
9. HEIGHT (m) 5′ 6″
10. WEIGHT (kg.) 118 lbs. ZIP CODE 6000
11. BLOOD TYPE TYPE AB+ 19. TELEPHONE NO. None
12. GSIS ID NO. BP # 2001415691 20. E-MAIL ADDRESS (if any) [email protected]
13. PAG-IBIG ID NO. 1670 0105 4189 21. CELLPHONE NO. (if any) 0928-5921318
14. PHILHEALTH NO. 22. AGENCY EMPLOYEE NO. 2002-01-25-0369
15. SSS NO. 23. TIN 143-234-625
II. FAMILY BACKGROUND
24. SPOUSES SURNAME: Romano 25.NAME OF CHILD (Write full name) DATE OF BIRTH (mm/dd/yyyy)
FIRST NAME Lourdes Lou Jeremy R. Cabucos 13-Apr-89
MIDDLE NAME Ferenal Jan Loue R. Cabucos 27-Apr-91
OCCUPATION Housewife Jeremiah R. Cabucos 12-Jul-99
EMPLOYER/BUS. NAME: N/A Jericho R. Cabucos 10-Jul-07
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
(continue on separate sheet if necessary)
26. FATHER’S SURNAME Cabucos
FIRST NAME Beinvinido
MIDDLE NAME Gabini
27. MOTHER’S MAIDEN NAME
SURNAME Saberon
FIRST NAME Jesusa
MIDDLE NAME Makipig
III. EDUCATIONAL BACKGROUND
28 NAME OF SCHOOL DEGREE COURSE YEAR GRADUATED HIGHEST GRADE/LEVEL/ INCLUSIVE DATES OF ATTENDANCE SCHOLARSHIP/ACADEMIC HONORS
LEVEL (Write in full) (Write in full) (if graduated) UINTS EARNED (if not graduated) From To RECEIVED
ELEMENTARY University of Southern Philippines Lahug Elementary School 1978 1972 1976 1976 1978 None

SECONDARY Sudlon Agricultural School 1982 1978 1980 None
Abellana National High School 1980 1982
VOCATIONAL/ Concord Technical School Applied 1990 1989 1990 None
TRADE COURSE Electricity
University of San Carlos BSECE 2000 100 1982 1987 None

COLLEGE University Of The Vissayas BSECE 1998 2000

N/A N/A N/A N/A N/A
GRADUATES STUDIES N/A N/A

IV.CIVIL SERVICE ELIGIBILITY
29. CARREER SERVICE / RA 1080 (BOARD /BAR) RATING DATE OF PLACE OF EXAMINATION/ LICENSE (if applicable)
UNDER SPECIAL LAWS/ CES/ CSEE EXAMINATION/ CONFERMENT
CONFERMENT NUMBER DATE OF RELEASE
CSC SUBPROFESSIONAL EXAM 80% 5-Aug-90 Cebu City

V. WORK EXPERIENCE (INCLUDE PRIVATE EMPLOYMENT. Start from your current work)
30. INCLUSIVE DATES (mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE/ COMPANY MONTHLY SALARY GRADE & STEP INCREMENT STATUS OF GOV’T SERVICE
From To (Write in full) (Write in full) SALARY (Format 00-0) APPOINMENT (Yes / No)
6/5/1988 6/30/1989 Janitor Air Transportation Office 34.04/Day Casual Yes

7/1/1989 12/17/1990 Janitor Air Transportation Office 24,000.00/ Temporary Yes
Annual
12/18/1990 8/15/1991 Electrician A Mactan-Cebu International 28,000.00/ Temporary Yes
Airport Authority Annual
8/16/1991 12/31/1993 Transmission Lineman C Mactan-Cebu International 38,024.00/ Permanent Yes
Airport Authority Annual
1/1/1994 12/31/1994 Transmission Lineman C Mactan-Cebu International Airport Authority 42, 948.00/ Annual per NCC 72 Permanent Yes
1/1/1995 12/31/1995 Transmission Lineman C Mactan-Cebu International Airport Authority 54,948.00/Annual per NCC 73 Permanent Yes

1/1/1996 12/5/1996 Transmission Lineman C Mactan-Cebu International Airport Authority 66,048.00/ per NCC 76

Permanent Yes
Annual
12/6/1996 Present Sr. Electronics & Communications System Technician Mactan-Cebu International Airport Authority 109,458.00/ Permanent Yes
Annual

VI. VOLUNTARY OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIAZATION
31. NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER OF CONDUCTED/ SPONSOREDD BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To

VII. TRAINING PROGRAMS (Start from the most recent training.)
32. NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES NUMBER OF CONDUCTED/ SPONSOREDD BY
(Write in full) (mm/dd/yyyy) HOURS (Write in full)
From To
Multi-Purpose Cooperative Membership Education Program/Seminar 5/10/1990 5/11/1990 DEPARTMENT OF AGRICULTURE

Orientation/Re-Orientation Seminar 5/27/1991 8 Hrs/Day PERSONNEL DIVISION / MCIAA

Controlix 2D X-ray Maintenance Training 3/1/1993 3/13/1993 8 Hrs/Day SCHLUMBERGER INDUSTRIES

Maintenance Training for Passenger Boarding Bridge 10/22/1994 STEARNS AIRPORT EQUIPMENT COMPANY, INC
Windows 3.1, Word for Wndows 2.0, Excel 4.0 10/7/1995 12 Hrs DATALOGIC MICROSYSTEMS
Public Address System 1/24/1996 1/26/1996 8 Hrs/Day TOA Corporation

Intercom System 1/18/1996 1/22/1996 8 Hrs/Day TOA Corporation

Fire Detection & Alarm System 3/1/1996 3/1/1996 8 Hrs/Day MEDIA CREATION

Operation & Maintenance of the F.I.D.S 2/2/1996 2/2/1996 8 Hrs/Day SOLARI Di UDINE

Operation and Maintenance Techniques of the FETEX-9600 PABX System 2/7/1996 2/9/1996 8 Hrs/Day FUJITSU PHILIPPINES, INC.

Operator & Maintenance Training for Power Distribution System and Lighting System 4/22/1996 SYSTEM FACTORS CORP.

Electrical Switchgear Operation & Maintenance 4/27/1996 4/28/1996 JERVIS ELECTRIC CORPORATION

Operator & Maintenance Training for HITACHI Hydraulic Passenger Elevator & Escalator 4/29/1996 HI ELES INDUSTRIAL CORPORATION

Operation & Maintenance Training for the Docking Guidance System R-L-G & Co.

Operation & Maintenance Training for Airport Apron Flood Lighting and Car Parking Lighting 9/10/1996 9/12/1996 TOSHIBA LIGHTING & TECHNOLOGY CORPORATION

Airport Operation Basic Course 8/14/2000 9/1/2000 MCIAA

Seminar on Leave Laws and Rules
9/18/2000
MCIAA

Establishment of Preventive Maintenance System 9/13/2001 9/14/2001 16 Hrs METALS INDUSTRY RESEARCH AND DEVELOPMENT CENTER (DOST)

Occupational Safety & Health Seminar 9/10/2003 9/12/2003 OCCUPATIONAL SAFETY OF THE PHILIPPINES, INC

Flir Thermacam EM Operator’s Training 7/9/2003 SPECTRUM SCIENTIFIC CORPORATION

Basic Welding and Safety Practices 9/6/2004 9/17/2004 PHILIPPINE BASIC WELDING RESEARCH & DEVELOPMENT SOCIETY (TESDA)

NetSecure Training Program 7/1/2005 7/15/2005 MOZCOM

Radiation Safety Officers of Industrial X-ray Facility Training Course 12/5/2005 12/9/2005 BHDT – DEPARTMENT OF HEALTH

Basic Operator Training Course for PX Series of L3 Communication Security & Detection System 8/9/2006 ASIA BORDERS PHILIPPINES, INC.

Answer 24/7 Unified Messaging Training 4/24/2006 4/29/2006 TELECOMMUNICATIONS & COMPUTER TECHNOLOGIES, INC.

Call Accounting System Training 4/24/2006 4/29/2006 TELECOMMUNICATIONS & COMPUTER TECHNOLOGIES, INC.

Ericson MD 110 PABX System Operation & Maintenance Training 4/3/2006 4/9/2006 TELECOMMUNICATIONS & COMPUTER TECHNOLOGIES, INC.

Ericson MD 110 PABX Operator Console Training 4/2/2006 4/3/2006 TELECOMMUNICATIONS & COMPUTER TECHNOLOGIES, INC.

Integration of EXES-6000 with N-8000EX Training 11/16/2007 TOA ELECTRONICS Pte Ltd

Executive Forum 5/6/2008 5/8/2008 CORONA MANAGEMENT CENTER OF THE PHILS.

Blue Media Experience 4/15/2009 BLUE MEDIA – TAGUIG CITY

Aviation Security Awareness Training 7/19/2009 PHILIPPINE-AUSTRALIA AVSEC / IOG

Laws & Rules on Government Expenditures 3/21/2011 3/25/2011 40 Hrs COMMISSION ON AUDIT

Security & Video Surveillance Systems for High Rise & Commercial Buildings 9/27/2011 ELECTRONIC SECURITY SYSTEMS CORPORATION

CCTV & Security Systems 9/27/2011 INSTITUTE OF ELECTRONICS ENGINEERS OF THE PHILIPPINES

Optimising Energy Effeciency Seminar 9/12/2012 ACCESS FRONTIER

Maintenance of Passenger Boarding Bridge
12/20/2013
SHENZEN CIMC-TIANDA AIRPORT SUPPORT LTD.

X-ray Machine Operation & Maintenance 7/21/2013 DPSPI

Values Orientation Workshop 3/15/2016 3/16/2016 16 Hrs CIVIL SERVICE COMMISSION

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION
33. SPECIAL SKILLS / HOBBIES: 34. NON-ACADEMIC DISTINCTIONS / RECOGNITION 35. MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write in full) (Write in full)
Playing Badminton

(Continue on separate sheet if necessary)
CS FORM 212 (Revised 2005), Page 3 of 4
36. Are you related by consanguinity or affinity to any of the following:

a. Within the third degree (for National Government Employees):
□ YES
□ NO
appointing authority, recommending authority, chief of office/bireau/department or person who
has immediate supervision over you in the office, Bureau or Department where yopu will be If YES, give details:
appointed?

b. Within the fourth degree (for Local Government Employees):
□ YES
□ NO
appointing authority or recommending authority where you will be appointed? If YES, give details:

37. a. Have you ever been formally chaged?
□ YES
□ NO
If YES, give details:

b. Have you ever been guilty of any administrative offense?
□ YES
□ NO
If YES, give details:

38. Have you ever been convicted of any crime or violation of any law, decree, ordinance or
□ YES
□ NO
regulation by any court or tribunal? If YES, give details:

39. Have you ever been separated from the service in any of the following modes: resgnation,
□ YES
□ NO
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract, AWOL If YES, give details:
or phased out, in the public or private sector?

40. Have you ever been a candidate in a national or local election (except Barangay election)?
□ YES
□ NO
If YES, give details:

41. Pursuant to: (a) Indigenous People’s Act (RA 8371); (b) Magna Carta for Disabled Persons (RA
□ YES
□ NO
7277); and © Solo Parents Welfare Act of 2000 (RA 8972), please answer the following items: If YES, give details:

a. Are you a member of any indigenous group?

If YES, please specify._____________
b. Are you differently abled?
□ YES
□ NO
If YES, please specify._____________
c. Are you a solo parent?
□ YES
□ NO
If YES, please specify._____________
42. REFERENCES (Person not related by consanguinity or affinity to applicant / appointee) (SURNAME, FIRST NAME, MIDDLE INITIAL)
NAME ADDRESS TEL. NO.
Jovito Taborada Jr. Brgy. Captain – Lahug Cebu City

43. I declare under oath that this Personal Data Sheet has accomplished by me, and is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of
the Philippines.
I also authorized the agency head / authorized representative to verify / validate the contents stated herein.
I trust that this information shall remain confidential.

8948081
COMMUNITY TAX CERTIFECATE NO.
Cebu City
ISSUED AT SIGNATURE (Sign Inside the box)
8/26/2015 Sept. 1, 2016
ISSUED ON (mm/dd/yyyy) DATE ACCOMPLISHED
RIGHT THUMBMARK