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 ACORDON
NAME EXTENSION (JR., SR)
FIRST NAME KRISTEL

MIDDLE NAME BANAG

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) ✘ Filipino Dual Citizenship
9/28/1988 by
by naturalization
birth
4. PLACE OF BIRTH PABANLAG, FLORIDABLANCA, 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 PUROK 4

Widowed House/Block/Lot No. Street

Separate
PABANLAG
Other/s: d
Subdivision/Village Barangay
FLORIDABLANCA PAMPANGA
7. HEIGHT (m) 5'5''
City/Municipality Province
8. WEIGHT (kg) 69 KLS ZIP CODE

18. PERMANENT ADDRESS PUROK 4

9. BLOOD TYPE 0
House/Block/Lot No. Street
PABANLAG
10. GSIS ID NO. 2004597632
Subdivision/Village Barangay

11. PAG-IBIG ID NO. 1210-7243-3630 FLORIDABLANCA PAMPANGA

City/Municipality Province

12. PHILHEALTH NO. 070506359943 ZIP CODE 2006

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 411-670-816-000 20. MOBILE NO. 09279726939

15. AGENCY EMPLOYEE NO. 025 21. E-MAIL ADDRESS (if any) kristel.acordon@deped.gov.ph
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME ACORDON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) N/A
FIRST NAME JAN MICHAEL N/A

MIDDLE NAME ROMERO

OCCUPATION CARPENTER

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO.

24. FATHER'S SURNAME BANAG

NAME EXTENSION (JR., SR)
FIRST NAME ERNESTO

MIDDLE NAME MALLARI

25. MOTHER'S MAIDEN NAME

SURNAME DABU

FIRST NAME LETICIA

MIDDLE NAME PALAD (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

FLORIDABLANCA NEW SETTLEMENT ELEMENTARY

ELEMENTARY
SCHOOL
PRIMARY 1995 2001 GRADUATED 2001 ACHIEVERS

FLORIDABLANCA NATIONAL AGRICULTURAL

SECONDARY /
VOCATIONAL SCHOOL
SECONDARY 2001 2005 GRADUATED 2005 N/A

N/A N/A

TRADE
COURSE
COLLEGE BATAAN PENINSULA STATE UNIVERSITY TERTIARY 2005 2009 GRADUATED 2009 N/A

GRADUATE STUDIES BATAAN PENINSULA STATE UNIVERSITY GRADUATED STUDIES 2014 2018 GRADUATED 2018 N/A
 (Continue on separate sheet if necessary)

SIGNATURE DATE March 2, 2021

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 TEACHERS 79.4 MARCH 13, 2013 PHILIPPINE WOMENS UNIVERSITY 1193329 9/28/2023

(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)

2011 2013 PRIVATE SCHOOL TEACHER MC'EWEN'S SCHOOL INCORPORATED 9000.00 N/A CONTRACTUAL N
FLORIDABLANCA NATIONAL SALARY
2014 2017 TEACHER I 25, 232.00 PERMANENT Y
AGRICULTURAL SCHOOL GRADE 12
FLORIDABLANCA NATIONAL SALARY
2017 PRESENT TEACHER III 28, 608.00 PERMANENT Y
AGRICULTURAL SCHOOL GRADE 13

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 02 2021

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

0 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
NATIONAL TRAINING WORKSHOP ON LOCALIZATIONAND CONTEXTUALIZATION IN THE K- PHILIPPINE CONTINUING PROFESSIONAL
12/22/2020 12/22/2020 8 SUPERVISORY
12 CURRICULUM DEVELOPMENT
NATIONAL TRAINING WORKSHOP ON BLENDED AND FLIPPED INSTRUCTION: COVID 19 PHILIPPINE CONTINUING PROFESSIONAL
12/20/2020 12/20/2020 8 SUPERVISORY
ALTERNATIVE LEARNING MODALITY DEVELOPMENT
NATIONAL SEMINAR WORKSHOP ON INSTRUCTIONAL DEVELOPMENT DESIGN AND PHILIPPINE CONTINUING PROFESSIONAL
12/19/2020 12/19/2020 8 SUPERVISORY
ASSESSMENT IN A FLEXIBLE LEARNING DEVELOPMENT DEVELOPMENT
PHILIPPINE CONTINUING PROFESSIONAL
11/22/2019 11/29/2019 16 SUPERVISORY
PROMOTING CREATIVE SCHOOLS THROUGH QUALITY TEACHERS DEVELOPMENT
TRAINING OF SCHOOL DRRM COORDINATORS ON BASIC DRRM MODULES AND
11/18/2019 11/22/2019 40 SUPERVISORY SCHOOLS DIVISION OF PAMPANGA
STANDARD FIRST AID

SCHOOL BASED ORIENTATION ON RPMS FOR SCHOOL YEAR 2019-2020 5/31/2019 7/1/2019 32 SUPERVISORY FLORIDABLANCA NATIONAL AGRICULTURAL SCHOOL

SCHOOL ROLL-OUTON RESULTS- BASED PERFORMANCE MANAGEMENT SYSTEM FLORIDABLANCA NATIONAL AGRICULTURAL
7/13/2018 7/14/2018 32 SUPERVISORY
MANUAL FOR TEACHERS AND SCHOOL HEADS SCHOOL
FLORIDABLANCA NATIONAL AGRICULTURAL
AWARENESS ON HYDROPHONICS TECHNOLOGY 6/8/2018 6/8/2018 8 SUPERVISORY
SCHOOL
FLORIDABLANCA NATIONAL AGRICULTURAL
BUILDING ON ENHANCED INSTRUCTIONAL COMPETENCE FOR TEACHERS 10/24/2018 10/26/2018 24 SUPERVISORY
SCHOOL
TECHNICAL EDUCATION AND SKILLS
NATIONAL CERTIFICATE II COOKERY 7/20/2017 7/26/2017 60 TECHNICAL
DEVELOPMENT AUTHORITY

(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)

COOKING, SINGING, DANCING DEMO TEACHING ON FRUIT WINE- MAKING N/A

TEACHER COACH (SARDINES MAKING)

DEMO TEACHING ON MEAT PROCESSING ( TOCINO MAKING)

HONORING, EXEMPLARY, ATTENTIVE AND RESPECTABLE TEACHER (TEACHERS DAY)

 (Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 02, 2021

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
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
RENATO BASTO PABANLAG FLORIDABLANCA PAMPANGA 3.5 cm. X 4.5 cm
(passport size)

JAN JAN C. LANSANGAN PABANLAG FLORIDABLANCA PAMPANGA With full and handwritten
name tag and signature over
printed name
GLENDA C. MAGNO DINALUPIHAN, BATAAN
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 ID

ID/License/Passport No.: 1193329

Signature (Sign inside the box)
MARCH 02, 2021
Date/Place of Issuance: 04/18/2013/MANILA
Date Accomplished Right Thumbmark

SUBSCRIBED AND SWORN to before me this MARCH 02, 2021 , affiant exhibiting his/her validly issued government ID as indicated above.

Person Administering Oath

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