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Subad Jerick Carbonel 6/9/1997 Estrella, Rizal, Nueva Ecija: I. Personal Information
Subad Jerick Carbonel 6/9/1997 Estrella, Rizal, Nueva Ecija: I. Personal Information
212
Revised 2017
I. PERSONAL INFORMATION
2. SURNAME SUBAD
NAME EXTENSION (JR., SR)
FIRST NAME JERICK
MIDDLE NAME CARBONEL
3. DATE OF BIRTH
(mm/dd/yyyy) 6/9/1997 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH ESTRELLA, RIZAL, NUEVA ECIJA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female
6 CIVIL STATUS
✘ Single Married 17. RESIDENTIAL ADDRESS PARUMOG ST.
Widowed Separated House/Block/Lot No. Street
SANGITAN EAST
Other/s:
Subdivision/Village Barangay
CABANATUAN CITY NUEVA ECJA
7. HEIGHT (m) 1.68 m
City/Municipality Province
8. WEIGHT (kg) 68 KG ZIP CODE 3100
18. PERMANENT ADDRESS PROVINCIAL ROAD, ZONE 1
9. BLOOD TYPE "O"
House/Block/Lot No. Street
ESTRELLA
10. GSIS ID NO. N/A
Subdivision/Village Barangay
RIZAL NUEVA ECIJA
11. PAG-IBIG ID NO. 1212-2477-4589
City/Municipality Province
SURNAME CARBONEL
FIRST NAME LIZA
MIDDLE NAME ISIDRO (Continue on separate sheet if necessary)
ELEMENTARY ESTRELLA ELEMENTARY SCHOOL ELEMENTARY DIPLOMA 1/6/2004 04/03/209 N/A 2009 N/A
SECONDARY /
VOCATIONAL CABUCBUCAN NATIONAL HIGH SCHOOL HIGH SCHOOL DIPLOMA 1/6/2009 03/22/13 N/A 2013 N/A
NATIONAL CERTIFICATE III EVENTS MANAGEMENT 12/29/2020 01/23/2021 N/A N/A N/A
TRADE
COURSE
COLLEGE CENTRAL LUZON STATE UNIVERSITY BSEd-MAPEH 1/6/2013 06/30/2017 N/A 2017 N/A
SIGNATURE DATE
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 TEACHER 82.00% 9/24/2017 BAGUIO CITY 1588947 9/6/2023
07/30/2018 10/4/2020 FULL-TIME FACULTY GOOD SAMARITAN COLLEGES 12000.00 N/A CONTRACTUAL N/A
2ND NATIONAL MAPEH SYMPOSIUM 7/15/2017 7/15/2017 8HRS UNIVERSITY OF THE PHILIPPINES DILIMAN
RISE UP TO HIV/AIDS: VOICE IN UNITY, STRENGTHENING THE COMMUNITY 4/21/2017 4/21/2017 8HRS CENTRAL LUZON STATE UNIVERSITY
A BRIDGE TO PROFFESIONAL PRACTICE 5/16/2017 5/16/2017 8HRS CENTRAL LUZON STATE UNIVERSITY
19TH PSYCHOLOGICAL STUDENT RESEARCH CONGRESS 9/30/2013 9/30/2013 8HRS CENTRAL LUZON STATE UNIVERSITY
SALIKSIKAN 2013: SERYE NG PANANALIKSIK SA WIKA, KULTURA AT PANITIKAN 8/19/2013 8/19/2013 8HRS CENTRAL LUZON STATE UNIVERSITY
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:
SHASTA CROISSAN QUILALA CABANATUAN CITY 9358392159 With full and handwritten
name tag and signature over
printed name
JINGGOY DE JESUS CABANATUAN CITY 9972432040
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.
SUBSCRIBED AND SWORN to before me this , affiant exhibiting his/her validly issued government ID as indicated above.