CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

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 Mones
NAME EXTENSION (JR., SR)
FIRST NAME Neresa

MIDDLE NAME Gomez

3. DATE OF BIRTH
16. CITIZENSHIP Dual Citizenship
(mm/dd/yyyy) 05/05/1983 / Filipino
/ by birth by naturalization

4. PLACE OF BIRTH Negros Occidental If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male / Female

6 CIVIL STATUS / Single Married 17. RESIDENTIAL ADDRESS Maringyan Miagao Iloilo
Widowed Separated House/Block/Lot No. Street

Other/s: Maringyan Miagao Iloilo

Subdivision/Village Barangay

7. HEIGHT (m) 1.6 Iloilo City Iloilo

City/Municipality Province
8. WEIGHT (kg) 76 ZIP CODE 5023

9. BLOOD TYPE 18. PERMANENT ADDRESS

O+
House/Block/Lot No. Street

10. GSIS ID NO. Maringyan Miagao Iloilo

Subdivision/Village Barangay

11. PAG-IBIG ID NO. Miagao Iloilo

City/Municipality Province

12. PHILHEALTH NO. 190263818389 ZIP CODE 5023

13. SSS NO. 07-2190341-5 19. TELEPHONE NO. 033-327-1971

14. TIN NO. 20. MOBILE NO. 09167873808

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS (if any) bluefeathers_05@yahoo.com

II. FAMILY BACKGROUND

22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR)
FIRST NAME

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME Mones

NAME EXTENSION (JR., SR)
FIRST NAME Serafin Jr.
MIDDLE NAME Jalandoni

25. MOTHER'S MAIDEN NAME

SURNAME Gomez

FIRST NAME Corazon

MIDDLE NAME Nangan (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

San Rafael Elementary School Primary SALUTATORI

ELEMENTARY 1990 1996 1996 AN

San Rafael National High School Highschool SALUTATORI

SECONDARY 1996 2000 AN

VOCATIONAL /
TRADE COURSE

Iloilo Science And Technology University - Miagao Bachelor in Secondary Education CUMLAUDE
COLLEGE Campus 2000 2004 2004

GRADUATE STUDIES

(Continue on separate sheet if necessary)

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 Date of
(If Applicable) NUMBER
BARANGAY ELIGIBILITY / DRIVER'S LICENSE CONFERMENT Validity

CIVIL SERVICE COMMISSION HONOR GRADUATE

ELIGIBILITY PURSUANT TO P.D. NO.907
0.000 03-25-2004 Mandurriao Iloilo 047543 03/31/2004

LICENSURE EXAMINATION FOR TEACHERS

75.000 08-13-2004 Iloilo 0869253 12/13/2004

TEST OF ENGLISH AS A FOREIGN LAGUAGE (TOEFL)

0.000 09-14-2019 CHESHIRE, UNITED KINGDOM 00007149 09/21/2019

HONOR GRADUATE ELIGIBILITY

0.000 03-30-2004

(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.
28. INCLUSIVE DATES SALARY/ JOB/ PAY
GRADE (if GOV'T
(mm/dd/yyyy) POSITION TITLE DEPARTMENT / AGENCY / OFFICE / COMPANY MONTHLY STATUS OF
applicable)& STEP SERVICE
(Write in full/Do not abbreviate) (Write in full/Do not abbreviate) SALARY (Format "00-0")/ APPOINTMENT
(Y/ N)
From To INCREMENT

Volunteer Teacher SAN RAFAEL NAT?L HIGH SCHOOL

07/06/04 06/08/06 3,000.00 volunteer Yes

OFW N/A
07/06/07 06/06/12 20,000.00 contractual No

PRIVATE TUTOR (Abu Dhabi, UAE ) N/A

03/06/13 08/06/15 25,000.00 contractual No

ESL Teacher ENGLISH ONLINE TEACHER TALKSTATION

12/06/15 09/06/16 18,000.00 contractual/renewal No

ESL Teacher ABC360

05/17/17 07/06/21 25,000.00 Continuing Service No

(Continue on separate sheet if necessary)

SIGNATURE DATE
CS FORM 212 (Revised 2017), Page 2 of 4
VI. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC / NON-GOVERNMENT / PEOPLE / VOLUNTARY ORGANIZATION/S
NAME & ADDRESS OF ORGANIZATION INCLUSIVE DATES
29.
(Write in full) (mm/dd/yyyy) NUMBER OF HOURS POSITION / NATURE OF WORK
From To

(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 Type of LD

30. TITLE OF LEARNING AND DEVELOPMENT INTERVENTIONS/TRAINING PROGRAMS ATTENDANCE ( Managerial/ CONDUCTED/ SPONSORED BY
NUMBER OF HOURS
(Write in full) (mm/dd/yyyy) Supervisory/ (Write in full)
Technical/etc)
From To

(Continue on separate sheet if necessary)

VIII. OTHER INFORMATION

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

Open minded athlete's of the year NOPTI ( National Organization of Profession

Problem solver Certificate of Participation on Research Paper Preparation and data management

Risk- taker TESOL

Critical Thinker TEYL

Optimistic

Willing to Listen

(Continue on separate sheet if necessary)

SIGNATURE DATE
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 by YES / NO
any court or tribunal?
If YES, give details:
________________________________

37. Have you ever been separated from the service in any of the following modes: resignation, retirement, YES / NO
dropped from the rolls, dismissal, termination, end of term, finished contract or phased out (abolition) If YES, give details:
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
3.5 cm. X 4.5 cm
(passport size)

With full and handwritten

name tag and signature over
printed name

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:

ID/License/Passport No.:
Signature (Sign inside the box)

Date/Place of Issuance:
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

Attachment to CS Form No. 212

WORK EXPERIENCE SHEET

Instructions: 1. Include only the work experiences relevant to the position being applied to.

2. The duration should include start and finish dates, if known, month in abbreviated form, if known, and year
in full. For the current position, use the word Present, e.g., 1998-Present. Work experience should be listed
from most recent first.

• Duration: May 17, 2017 - July 06, 2021

• Position: ESL Teacher
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: ABC360
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

Preparing lesson plans in accordance with students' learning needs.
Designing and presenting educational material.
Tailoring lessons to accommodate differences in learning style and speed.
Evaluating students' progress.
Preparing and disseminating progress reports at regular intervals.
Remaining knowledgeable about and respectful of cultural differences within the classroom.
Assisting students with their technical difficulties, where possible.

• Duration: December 06, 2015 - September 06, 2016

• Position: ESL Teacher
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: ENGLISH ONLINE TEACHER TALKSTATION
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

Preparing lesson plans in accordance with students' learning needs.
Designing and presenting educational material.
Tailoring lessons to accommodate differences in learning style and speed.
Evaluating students' progress.

• Duration: March 06, 2013 - August 06, 2015

• Position: PRIVATE TUTOR (Abu Dhabi, UAE )
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: N/A
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

Top priority is to ensure student?s academic needs are met.
To tutor Reading, Writing, Math and English and other

• Duration: July 06, 2007 - June 06, 2012

• Position: OFW
• Name of Office/Unit:
• Immediate Supervisor:
• Name of Agency/Organization and Location: N/A
• List of Accomplishments and Contributions (if any)

• Summary of Actual Duties

• Duration: July 06, 2004 - June 08, 2006

• Position: Volunteer Teacher
• Name of Office/Unit: SAN RAFAEL NAT?L HIGH SCHOOL
• Immediate Supervisor: Miss Marissa Sedicol
• Name of Agency/Organization and Location: SAN RAFAEL NAT?L HIGH SCHOOL
• List of Accomplishments and Contributions (if any)
 Holding lessons
preparing lesson plans
assigning tasks to students
administering tests
grading student?work
• Summary of Actual Duties
Holding lessons
preparing lesson plans
assigning tasks to students
administering tests
grading student?work

Neresa G. Mones
(Signature over Printed Name of
Employee/Applicant)
Date: