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 Nosares
NAME EXTENSION (JR., SR)
FIRST NAME Jemebel

MIDDLE NAME Abad

3. DATE OF BIRTH
(mm/dd/yyyy) 10/13/1983 16. CITIZENSHIP
✘ Filipino Dual Citizenship
by birth by
4. PLACE OF BIRTH Ilo-ilo City If holder of dual citizenship, Pls. indicate country: naturalization
please indicate the details.
5. SEX
Male ✘ Female
17. RESIDENTIAL ADDRESS 37 P Concepcion St.
6 CIVIL STATUS Single ✘ Married House/Block/Lot No. Street
Widowed Separate Tugatog
Other/s: d Subdivision/Village Barangay
7. HEIGHT (m) 5'0
City/Municipality Province
8. WEIGHT (kg) 52 Kilos ZIP CODE Malabon City

18. PERMANENT ADDRESS 37 P Concepcion St.

9. BLOOD TYPE A
House/Block/Lot No. Street
Tugatog
10. GSIS ID NO. 011103326790
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 121028069498

City/Municipality Province

12. PHILHEALTH NO. 020505366981 ZIP CODE 1470/Malabon City

13. SSS NO. 3377649780 19. TELEPHONE NO.

14. TIN NO. 296317978000 20. MOBILE NO. 09707284708

15. AGENCY EMPLOYEE NO. 4644819 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) Angel A. Nosares
FIRST NAME Paulo 2/16/2007

MIDDLE NAME Jimenez Paul Angelo A. Nosares

8/13/2013

OCCUPATION None

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Abad

NAME EXTENSION (JR., SR)
FIRST NAME Jimmy

MIDDLE NAME Panogadia

25. MOTHER'S MAIDEN NAME Portodo

SURNAME Abad

FIRST NAME Isabelita

MIDDLE NAME Ventora (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
(Write in full) HONORS
full) (if not graduated) RECEIVED
From To

ELEMENTARY Dagat-dagatan Elementary School Elementary Graduate 6/12/1990 3/18/1996 1996

SECONDARY /
VOCATIONAL Kaunlaran High School High School Graduate 6/4/1996 3/18/2000 2000

TRADE
COURSE
COLLEGE Navotas Polytechnic College College Graduate 6/4/2008 3/20/2008 2008

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE January 19, 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

LET EXAMINATION 75.6 4/1/2009 PHIL. CULTURAL COLLEGE 1059422 10/13/2025

(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)

7/1/2009 Substitute Teacher Salvador Araneta Memorial Institute 8000.00 N

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/19/2023

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

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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

Practicum Component of the Learning Delivery Modalities (LDM2)course for Teachers 10/27/2021 10/27/2021 8.0 WILFREDO E. CABRAL

Learning Delivery Modalities(LDM2) course for Teachers 7/6/2021 7/6/2021 8.0 WILFREDO E. CABRAL

MAURO C. DE GULAN
Division Inservice Training for Teachers 2020 12/14/2020 12/16/2020 24.0

(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)

Computer Literate N/a N/a

(Continue on separate sheet if necessary)

SIGNATURE DATE 01/19/2023

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
Barangay election)? YES ✘ NO
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: 1.5515000016003E+14
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
the last 6 months
Rowena Jimenez 5 Atis Rd. Potrero Malabon City 223-46-12 4.5 cm. X 3.5 cm
(passport size)

Carlito Nosares Concepcion St. Tugatog Malabon City 321-22;43

Computer generated
or photocopied picture
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.

Government Issued ID (i.e.Passport, GSIS, SSS, PRC, Driver's License, etc.)

PLEASE INDICATE ID Number and Date of
Issuance
Government Issued ID: 1059422

ID/License/Passport No.:
Signature (Sign inside the box)
01/19/2023
Date/Place of Issuance: 10/13 Manila
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