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 NOROÑA
NAME EXTENSION (JR., SR)
FIRST NAME JULIUS ROMEO

MIDDLE NAME CABORNEY

3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 3/4/1985 ✘ Filipino Dual Citizenship
by
✘ by naturalization
birth
4. PLACE OF BIRTH EASTERN AMAR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX ✘ Male Female

6 CIVIL STATUS ✘ Single Married 17. RESIDENTIAL ADDRESS N/A 4TH ST., 2ND AVE.

Widowed House/Block/Lot No. Street

Separate
N/A BRGY. TIGUIB
Other/s: d
Subdivision/Village Barangay
ORAS EASTERN SAMAR
7. HEIGHT (m) 1.68m
City/Municipality Province
8. WEIGHT (kg) 75kg ZIP CODE

18. PERMANENT ADDRESS N/A 4TH ST., 2ND AVE.

9. BLOOD TYPE N/A
House/Block/Lot No. Street
N/A BRGY. TIGUIB
10. GSIS ID NO. N/A
Subdivision/Village Barangay
ORAS EASTERN SAMAR
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 6818

13. SSS NO. 3384869760 19. TELEPHONE NO. N/A

14. TIN NO. 230634439 20. MOBILE NO. 0916 - 331 - 4782

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

FIRST NAME N/A

NAME EXTENSION (JR., SR) 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 NOROÑA

NAME EXTENSION (JR., SR)
FIRST NAME ROMEO

MIDDLE NAME LABRO

25. MOTHER'S MAIDEN NAME

SURNAME CABORNEY

FIRST NAME JULIETA

MIDDLE NAME NACARIO (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

WITH
ELEMENTARY ORAS EAST ELEMENTARY SCHOOL PRIMARY 3/6/1985 12/3/1991 1991
HONOR

SECONDARY /
VOCATIONAL HOLY CROSS ACADEMY SECONDARY 10/6/1991 03/26/1995 1995

ST. AUGUSTINE SCHOOL OF NURSING PROFESSIONAL CAREGIVING 2/9/2009 8/7/2010 2010

TRADE
BACHELOR OF SECONDARY EDUCATION major DOST
COURSE
COLLEGE EASTERN SAMAR STATE UNIVERSITY 06/16/2015 7/6/2019 2019
in MATHEMATICS SCHOLAR

GRADUATE STUDIES

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 31, 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

PROFESSIONAL TEACHER 75.8 MARCH 27,2022 TACLOBAN CITY 1926986 3/4/2025

(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)
HANDMAIDS OF MARY FOR CHILDREN
5/7/2010 8/7/2010 CAREGIVER N/A N/A N/A N
CENTER INC.
PHILIPPINE LONG DISTANCE TELEPHONE
06 28 2000 7/9/2000 CUSTOMER ASSISTANT N/A N/A N/A Y
COMPANY

(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 31, 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

CIVIC WELFARE TRAINING PROGRAM 06/16/2015 10/3/2016 COMMUNITY SERVICE

(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

WEB PAGE DESIGN AND DEVELOPMENT 11/8/2000 11/8/2000 INTERFACE COMPUTER COLLEGE

CAREGIVING NC II 9/2/2009 7/8/2010 830.0 ST. AUGUSTINE SCHOOL OF NURSING

FIRE DRILL SEMINAR 04 20 2010 04 20 2010 BUREAU OF FIRE PROTECTION

FIRST AID (STANDARD) 06 7-9 2010 12/6/2010 32.0 THE PHILIPPINE NATIONAL RED CROSS

BASIC LIFE SUPPORT (CPR TRAINING FOR HEALTHCARE PROVIDER) 10/6/2010 11/6/2010 16.0 THE PHILIPPINE NATIONAL RED CROSS

LEADERSHIP SEMINAR 2/2/2017 3/2/2017 EASTERN SAMAR STATE UNIVERSITY

DISASTER RISK REDUCTION MANAGEMENT 1114 2017 11 15 2017 EASTERN SAMAR STATE UNIVERSITY
CAPABILITY BUILDING on DIFFERENT APPROACHES of BEGINNING READING
INSTRUCTION for the UNTRAINED KINDERGARTEN, ALS, GRADE 1 to GRADE 12 4/3/2023 5/4/2023 12.0 ORAS WEST CENTRAL ELEMENTARY SCH
LANGUAGE TEACHERS AND SCHOOL HEADS

(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 RECOGNITION FOR PASSING THE LICENSURE EXMINATION FOR TEACHERS EASTERN SAMAR STATE UNIVERSITY
DEPARTMENT OF SCIENCE AND
MICRO COMPUTER (PC) ASSEMPBLY CERTIFICATE FOR PARTICIPATION
TECHNOLOGY
DANCE CHOREOGRAPHY CERTIFICATE OF APPEARANCE ( IT SUPPORT STAFF ) COMMISSION ON ELECTIONS

A LITTLE BIT OF SINGING PARTICIPATION and SUPPORT on the MEDICAL MISSION ( February 25, 2010) ST. AUGUSTINE SCHOOL OF NURSING

WATCHING ENGLISH MOVIES PARTICIPATION and SUPPORT on the MEDICAL MISSION (March 17, 2010) ST. AUGUSTINE SCHOOL OF NURSING

PLAYING CONSOLE GAMES PARTICIPATION and SUPPORT on the MEDICAL MISSION (May 29, 2010) ST. AUGUSTINE SCHOOL OF NURSING

TENNIS PARTICIPATION and SUPPORT on the MEDICAL MISSION (June 23,2010) ST. AUGUSTINE SCHOOL OF NURSING
(Continue on separate sheet if necessary)

SIGNATURE DATE MARCH 31, 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
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
BRGY. CAMANGA, ORAS, EASTERN the last 6 months
JAN THEL B. LIBANAN SAMAR
0 9079226848 4.5 cm. X 3.5 cm
(passport size)

BONIFACIO A. MAESTRE BRGY TIGUIB, ORAS, EASTERN SAMAR 0 9391487861

Computer generated
BRGY. PAYPAYON, ORAS, EASTERN or photocopied picture
PAUL MARK BERGONIO SAMAR
0 9057657894 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: PRC

ID/License/Passport No.: 1926986

Signature (Sign inside the box)

Date/Place of Issuance: 11/05/2021 EASTERN SAMAR

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