212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME BASILIO
NAME EXTENSION (JR., SR)
FIRST NAME EDUARD JHOURELL
4. PLACE OF BIRTH CALOOCAN CITY If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX
6 CIVIL STATUS
17. RESIDENTIAL ADDRESS BLK. 4 LOT 9 BURGOS STREET
House/Block/Lot No. Street
VILLA ROMA PH. 4 SAOG
Subdivision/Village Barangay
9. BLOOD TYPE
18. PERMANENT ADDRESS BLK. 4 LOT 9 BURGOS STREET
House/Block/Lot No. Street
VILLA ROMA PH. 4 SAOG
10. GSIS ID NO.
Subdivision/Village Barangay
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) eduardbasilio@yahoo.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
MIDDLE NAME
OCCUPATION
EMPLOYER/BUSINESS NAME
BUSINESS ADDRESS
TELEPHONE NO.
SURNAME BASILIO
MARCH
ELEMENTARY ST. MICHAEL ACADEMY 2002 2008
2008
MARCH
SECONDARY
VOCATIONAL / ST. MICHAEL ACADEMY 2008 2012
2012
N/A
TRADE
UNIVERSITY OF THE EAST - APRIL
COURSE
COLLEGE BS ELECTRONICS ENGINEERING 2012 2017
CALOOCAN 2017
ELECTRONICS ENGINEER BOARD EXAM OCT.21-22, 2017 UNIVERSITY OF THE EAST - MANILA 67313 02/25/2020
ELECTRONICS TECHNICIAN BOARD EXAM OCT.23, 2017 UNIVERSITY OF THE EAST - MANILA 13951.00 02/25/2020
STRYKER 1488HD VISUALIZATION SYSTEM TECHNICAL TRAINING 1/17/2018 1/17/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ STRYKER
BASIC OPERATION OF FLUKE BIOMEDICAL ESA 615 ELECTRICAL SAFETY ST. LUKE'S MEDICAL CENTER-QC/ AMI
6/19/2018 6/19/2018 4.0 TECHNICAL
ANALYZER EQUIPMENT SERVICES AND SOLUTIONS
BASIC OPERATION AND TROUBLESHOOTING OF DRAEGER TI500 TRANSPORT
1/30/2018 1/30/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ MEDILINES
INCUBATOR
BASIC OPERATION AND TRROUBLESHOOTING OF DRAEGER CALEO INCUBATOR 1/23/2018 1/23/2018 4.0 TECHNICAL ST. LUKE'S MEDICAL CENTER-QC/ MEDILINES
BASIC TROUBLESHOOTING FOR GE CASE PREMIUM WITH T2100-ST2 TREADMILL ST. LUKE'S MEDICAL CENTER-QC/ RG
1/9/2019 1/9/2019 4.0 TECHNICAL
AND SUZUKEN KENZ 1215 ECG MACHINE MEDITRON
PLAYING BADMINTON
SKETCHING
35. a. Have you ever been found guilty of any administrative offense?
If YES, give details:
________________________________
________________________________
b. Have you been criminally charged before any court?
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?
If YES, give details:
________________________________
________________________________
37. Have you ever been separated from the service in any of the following modes: resignation,
retirement, dropped from the rolls, dismissal, termination, end of term, finished contract or phased out If YES, give details:
(abolition) in the public or private sector? ________________________________
CONTRACTUAL JOB
________________________________
38. a. Have you ever been a candidate in a national or local election held within the last year (except
Barangay election)?
If YES, give details:
b. Have you resigned from the government service during the three (3)-month period before the last
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?
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?
If YES, please specify:
b. Are you a person with disability?
If YES, please specify ID No:
c. Are you a solo parent?
If YES, please specify ID No:
ENGR. FRANCIS P. GUBANGCO CALOOCAN CITY 09324173283 With full and handw
name tag and signatu
printed name
KIMHAZEL R. NAVARRO BATANGAS 09991489804
Computer genera
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and or photocopied pic
is not acceptab
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
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated ab
Computer generated
or photocopied picture
is not acceptable
PHOTO
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