Beruflich Dokumente
Kultur Dokumente
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME ANDALLON
NAME EXTENSION (JR., SR
FIRST NAME NERE CRIS
15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) nerecris25@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ANDALLON 23. NAME of CHILDREN (Write full name and list all)
NAME EXTENSION (JR., SR) MA. ZHOPIA CHRIXAINE P. ANDALLON
FIRST NAME CROMWELL RAYMOND
ZEUS TYRONNE P. ANDALLON
MIDDLE NAME MAULA
BUSINESS ADDRESS EDSA CORNER APELO CRUZ ST. PASAY CITY, METRO MANILA
SURNAME MALLON
SECONDARY /
VOCATIONAL BUCANA BUNGLAS NATIONAL HIGH SCHOOL
TRADE
COURSE
COLLEGE THE NATIONAL TEACHERS COLLEGE BACHELOR OF SECONDARY EDUCATION
GRADUATE STUDIES
SIGNATURE DATE
CS FORM
L DATA SHEET
erience Sheet shall cause the filing of administrative/criminal case/s against the person
Dual Citizenship
by naturalization
CRUZADA
Street
389 QUIAPO
Barangay
METRO MANIL
Province
1001
ODIONG
Street
CAMPAASAN
Barangay
ORIENTAL MINDORO
Province
241-4429
09291149942
nerecris25@gmail.com
2/23/2014
3/20/2019
(Continue on separate sheet if necessary)
SCHOLARSHIP/
YEAR
ACADEMIC
GRADUATED
HONORS
RECEIVED
1998
2002
2017
SIGNATURE DATE
CS FORM 212 (Revised 20
LICENSE (if applicable)
Date of
Validity
GOV'T
SERVICE
(Y/
N)
arate sheet if necessary)
N/A
N/A
(Continue on separate sheet if necessary)
SIGNATURE DATE
/ PEOPLE / VOLUNTARY ORGANIZATION/S
CONDUCTED/ SPONSORED BY
(Write in full)
eparate sheet if necessary)
MEMBERSHIP IN ASSOCIATION/ORGANIZATION
(Write
in full)
b. within the fourth degree (for Local Government Unit - Career Employees)? YES ✘
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:
ATTY. ROLANDO BERNALES, Ed. D THE NATIONAL TEACHERS COLLEGE 9985754701 With full and handwritten
name tag and signature over
printed name
LIEZL EVANGELISTA CAYETANO ARELLANO HIGH SCHOOL 9989518551
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: PRC
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.