CS Form No.

212
Revised 2017

PERSONAL DATA SHEET

WARNING: Any misinterpretation 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 NEPOMUCENO

NAME EXTENSION (JR., SR)

FIRST NAME CHRISTIAN JAMES

MIDDLE NAME ANGELES

3. DATE OF BIRTH
01/22/1996 16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH GUAGUA, PAMPANGA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS 427 PUROK 5

Widowed House/Block/Lot No. Street

Separate
SANTIAGO
Other/s: d
Subdivision/Village Barangay
LUBAO PAMPANGA
7. HEIGHT (m) 1.74
City/Municipality Province
8. WEIGHT (kg) 75 ZIP CODE 2005

18. PERMANENT ADDRESS 427 PUROK 5

9. BLOOD TYPE O
House/Block/Lot No. Street
SANTIAGO
10. GSIS ID NO. N/A
Subdivision/Village Barangay
LUBAO PAMPANGA
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 2005

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

14. TIN NO. N/A 20. MOBILE NO. 09399585174 / 09667308607

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) christianjamesnepomuceno2@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

OCCUPATION N/A

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME NEPOMUCENO

NAME EXTENSION (JR., SR)
FIRST NAME ROLLIE

MIDDLE NAME ALBANTE

25. MOTHER'S MAIDEN NAME

SURNAME ANGELES

FIRST NAME PERLITA

MIDDLE NAME CORDOVA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

NAME OF SCHOOL HIGHEST LEVEL/
26. PERIOD OF ATTENDANCE SCHOLARSHIP/
BASIC EDUCATION/DEGREE/COURSE UNITS YEAR
LEVEL (Write in EARNED GRADUATED
ACADEMIC HONORS
(Write in full) RECEIVED
full) (if not graduated)
From To

ELEMENTARY SANTIAGO ELEMENTARY SCHOOL PRIMARY EDUCATION 2002 2008 N/A 2008 VALEDICTORIAN

6TH HONORABLE
SECONDARY SAN PABLO 2ND NATIONAL HIGH SCHOOL HIGH SCHOOL 2008 2012 N/A 2012
VOCATIONAL / MENTION

FAR EAST COLLEGE OF SCIENCE AND

ASSOCIATE IN INFORMATION TECHNOLOGY 2012 2014 N/A 2002 N/A
TECHNOLOGY
TRADE
COURSE BACHELOR OF SECONDARY EDUCATION
COLLEGE MEGABYTE COLLEGE FOUNDATION INC. 2017 2O21 N/A 2021 N/A
MAJOR IN ENGLISH

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/22/2023 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

LICENSURE EXAMINATION FOR PROFESSIONAL TEACHERS 85.00% 02/10/2022 NUESTRA SENORA DEL PILAR HIGH SCHOOL 1989398 01/22/2026

CIVIL SERVICE EXAMINATION (SUB-PROFESSIONAL) 80.56% 04/08/2019 DON HONORIO VENTURA STATE UNIVERSITY 641756

(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)

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

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/22/2023 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 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

BASIC COMPUTER LITERACY 04/10/2023 04/19/2023 80 hrs TECHNICAL INIFINITECH TRAINING CENTER

DIVISION UPDATING AND ENHANCEMENT SEMINAR IN COACHING GYMNASTICS FOR ELEMENTARY

06/28/2019 06/30/2019 24 hrs TECHNICAL DIVISION OF PAMPANGA
AND SECONDARY GYMNASTICS COACHES AND GYMNASTS

9TH LEADERSHIP SEMINAR - WORKSHOP IN DANCE FOR GLOCAL TEACHERS 6/7/2018 8/7/2018 24 hrs TECHNICAL DIVISION OF PAMPANGA

KAPAMPANGAN FOLKDANCE WORKSHOP 11/29/2017 11/29/2017 8 hrs TECHNICAL THE FOUNDATION FOR LINGAP KAPAMPANGAN, INC.

KAPAMPANGAN FOLMUSIC SEMINAR - WORKSHOP 11/28/2017 11/28/2017 8 hrs TECHNICAL THE FOUNDATION FOR LINGAP KAPAMPANGAN, INC.

DIVISION ACCREDITATION COURSE FOR DEPED PAMPANGA SCHOOL SPORTS COACHES 11/13/2017 11/15/2017 24 hrs TECHNICAL DIVISION OF PAMPANGA

PART 3: DIVISION SEMINAR - WORKSHOP ON BASIC SOCIAL DANCES FOR K -12 TEACHERS ( LATIN &
09/28/2017 09/30/2017 24 hrs TECHNICAL DIVISION OF PAMPANGA
STANDARD)

INNOVATIVE INSTRUCTIONAL MATERIALS FOR K TO 12 LEARNERS 11/8/2017 11/8/2017 8 hrs TECHNICAL ARCZONE PROFESSIONAL DEVELOPMENT, INC.

CONTINUATION OF THE DIVISION SEMINAR - WORKSHOP FOR SOCIAL DANCES FOR K -12
07/28/2017 07/30/2017 24 hrs TECHNICAL DIVISION OF PAMPANGA
TEACHERS (BALLROOM BASIC STEPS: LATIN & STANDARD)
LEVEL 1 - DIVISION DANCESPORTS SEMINAR FOR TEACHERS & THE 8TH DANCE LEADERSHIP
05/17/2017 05/19/2017 24 hrs TECHNICAL DIVISION OF PAMPANGA
SEMINAR - WORKSHOP

VIII. OTHER INFORMATION

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

COMPUTER LITERATE BEST IN DEMO TEACHING Alliance of Capampangan Choreographers

BEST DEMO TEACHER

BEST THESIS PRESENTER

BEST IN THESIS WRITING

(Continue on separate sheet if necessary)

SIGNATURE DATE 05/22/2023 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 ✘ NO
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘ NO
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:
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
SIRUS C. SANTOS SAN ROQUE DAU, LUBAO, PAMPANGA 9672733554 3.5 cm. X 4.5 cm
(passport size)

RIZZAL MALLARI CONCEPCION, LUBAO, PAMPANGA 9771208850 With full and handwritten
name tag and signature over
printed name
JELEN P. GALAN SAN JOSE GUMI, LUBAO, PAMPANGA 9988676802
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
PROFESSIONAL REGULATION
Government Issued ID:
COMMISSION

ID/License/Passport No.: 1989398

Signature (Sign inside the box)
03/14/2023 ROBINSONS STARMILLS 05/22/2023
Date/Place of Issuance:
PAMPANGA Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.

HON. ERNESTO B. PANGAN

Person Administering Oath

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