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 NERA
FIRSTNAME JANVEN NAME EXTENSION (JR., SR)

MIDDLE NAME GARCIA

3. DATE OF BIRTH
06/29/1986
16. CITIZENSHIP P Filipino £ Dual Citizenship
(mm/dd/yyyy) P by birth £ by naturalization
If holder of dual citizenship,
4. PLACE OF BIRTH SANTA FE, NUEVA VISCAYA Pls. indicate country:

5. SEX P Male £ Female please indicate the details.

6. CIVIL STATUS £ Single P Married 17. RESIDENTIAL ADDRESS 85-A BADIHOY EXT.
£ Widowed £ Separated House/Block/Lot No. Street
£ Other/s GUISAD, SORONG
Subdivision/Village Barangay
7. HEIGHT (m)
BAGUIO CITY BENGUET
City/Municipality Province
8. WEIGHT (kg) 65
ZIP CODE 2600
18. PERMANENT ADDRESS
9. BLOOD TYPE B+
House/Block/Lot No. Street

10. GSIS ID NO. 2005762995

Subdivision/Village Barangay

11. PAGIBIG ID NO. 121228423249

City/Municipality Province
12. PHILHEALTH NO. 40250590115 ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 418-452-514 20. MOBILE NO. 09270741894

15. AGENCY EMPLOYEE NO. 2010165 21. E-MAIL ADDRESS ( if any ) janvennera29@gmail.com
II. FAMILY BACKGROUND
DATE OF BIRTH
22. SPOUSE'S SURNAME 23. NAME of CHILDREN (Write full name and list all)
(mm/dd/yyyy)

FIRST NAME NAME EXT (JR., SR) MARIA RAVEN T. NERA 02/17/2013
MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME NERA

FIRST NAME ARTURO BENJAMIN NAME EXT (JR., SR)

MIDDLE NAME NABUA

25. MOTHER'S MAIDEN NAME GARCIA
SURNAME NERA
FIRST NAME SIMONA
MIDDLE NAME GARCIA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY BEEHIVE LEARNING CENTER 06/07/1994 03/25/2000 ELEMENTARY GRADUATE 2000

SECONDARY UNIVERSITY OF BAGUIO 06/05,2002 03/26/2004 SECONDARY 2004

VOCATIONAL/
TRADE COURSE

COLLEGE UNIVERSITY OF BAGUIO BACHELOR OF SCIENCE IN NURSING 11/4/2004 03/29/2010 GRADUATE 2010 ACADEMIC SCHOLAR

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 SPECIAL LICENSE (if applicable)
RATING DATE OF EXAMINATION /
LAWS/ CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT
(If Applicable) CONFERMENT NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE
Validity

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

(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
INCLUSIVE DATES

NAME & ADDRESS OF ORGANIZATION NUMBER OF

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

Basic Occupational Safety and Health 06/01/2022 06/01/2022 8.0 BGHMC

PRIME-HRM 06/01/2022 06/01/2022 2.0 BGHMC

Basic Occupational Safety and Health 06/01/2022 06/01/2022 8.0 BGHMC

PRIME-HRM 06/01/2022 06/01/2022 2.0 BGHMC

USAPANG SALUN-AT SA KOMUNIDAD SESSION 1: AUTISMO AT
GOITER,
01/26/2022 01/26/2022 3.0 Technical BGHMC-PHU
USAPANGATING ALAMIN
SALUN-AT SA KOMUNIDAD SESSION 10: "BONE AT
JOINT CARE, ATING ALAMIN" AND "KUMAIN NG SAFE, PARA 10/20/2021 10/20/2021 4.0 Technical BGHMC-PHU
KATAWAN AY SAFE"
ORIENTATION ON THE PHILIPPINES ORGAN AND TISSUE
TRANSPLANT AND DONATION PROGRAM AMONG EMPLOYEES
10/06/2021 10/06/2021 6.0 Technical BGHMC-PHU
WEBINAR ON ALCOHOL ADDICTION AND DRUG FREE
WORKPLACE
09/03/2021 09/03/2021 3.0 Technical BGHMC-PHU
WECOPE: WEB-BASED MODULE ON NORMS OF CONDUCT OF
PUBLIC OFFICIALS AND EMPLOYEES
03/23/2021 03/23/2021 8.0 Core BGHMC-PETRO

WORK ATTITUDE AND VALUES ENHANCEMENT 03/04/2020 03/05/2020 16.0 BGHMC PETRO

(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)

(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? r YES ü NO

b. within the fourth degree (for Local Government Unit - Career Employees)? r YES ü NO
if YES, give details:

35. a. Have you ever been found guilty of any administrative offense? r YES ü NO
if YES, give details:

b. Have you been criminally charged before any court? r YES ü NO

if YES, give details:
Date filed:
Status of cases:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation r YES ü 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, r YES ü 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 r YES ü NO
Barangay election)? if YES, give details:

b. Have you resigned from the government service during the three (3)-month period before the last r YES ü 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? r YES ü 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? r YES ü NO
if YES, please specify:
b. Are you a person with disability? r YES ü NO
if YES, please specify ID No.:
c. Are you a solo parent? r YES ü 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. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete is not acceptable
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 administrative/criminal case/s against me.
PHOTO

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

 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

FIRSTNAME NAME EXTENSION (JR., SR)

MIDDLE NAME
3. DATE OF BIRTH 16. CITIZENSHIP £ Filipino £ Dual Citizenship
(mm/dd/yyyy) £ by birth £ by naturalization
If holder of dual citizenship,
4. PLACE OF BIRTH Pls. indicate country:

5. SEX £ Male £ Female please indicate the details.

6. CIVIL STATUS £ Single £ Married 17. RESIDENTIAL ADDRESS

£ Widowed £ Separated House/Block/Lot No. Street
£ Other/s
Subdivision/Village Barangay
7. HEIGHT (m)

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

18. PERMANENT ADDRESS

9. BLOOD TYPE
House/Block/Lot No. Street

10. GSIS ID NO.

Subdivision/Village Barangay

11. PAGIBIG ID NO.

City/Municipality Province
12. PHILHEALTH NO. ZIP CODE

13. SSS NO. 19. TELEPHONE NO.

14. TIN NO. 20. MOBILE NO.

15. AGENCY EMPLOYEE NO. 21. E-MAIL ADDRESS ( if any )

II. FAMILY BACKGROUND

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

FIRST NAME NAME EXT (JR., SR)

MIDDLE NAME

OCCUPATION

EMPLOYER/BUSINESS NAME

BUSINESS ADDRESS

TELEPHONE NO.

24. FATHER'S SURNAME

FIRST NAME NAME EXT (JR., SR)

MIDDLE NAME

25. MOTHER'S MAIDEN NAME

SURNAME

FIRST NAME

MIDDLE NAME (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY

SECONDARY

VOCATIONAL/
TRADE COURSE

COLLEGE

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 SPECIAL LICENSE (if applicable)
RATING DATE OF EXAMINATION /
LAWS/ CES/ CSEE BARANGAY PLACE OF EXAMINATION / CONFERMENT
(If Applicable) CONFERMENT NUMBER Date of
ELIGIBILITY / DRIVER'S LICENSE
Validity

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

(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
INCLUSIVE DATES

NAME & ADDRESS OF ORGANIZATION NUMBER OF

29. HOURS POSITION / NATURE OF WORK
(Write in full) (mm/dd/yyyy)
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
ATTENDANCE Type of LD
30. TITLE OF LEARNING AND DEVELOPMENT
NUMBER OF ( Managerial/ CONDUCTED/ SPONSORED BY
INTERVENTIONS/TRAINING PROGRAMS HOURS Supervisory/
(mm/dd/yyyy) (Write in full)
(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)

(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? r YES r NO

b. within the fourth degree (for Local Government Unit - Career Employees)? r YES r NO
if YES, give details:

35. a. Have you ever been found guilty of any administrative offense? r YES r NO
if YES, give details:

b. Have you been criminally charged before any court? r YES r NO

if YES, give details:
Date filed:
Status of cases:
36. Have you ever been convicted of any crime or violation of any law, decree, ordinance or regulation r YES r 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, r YES r 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 r YES r NO
Barangay election)? if YES, give details:

b. Have you resigned from the government service during the three (3)-month period before the last r YES r 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? r YES r 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? r YES r NO
if YES, please specify:
b. Are you a person with disability? r YES r NO
if YES, please specify ID No.:
c. Are you a solo parent? r YES r 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. or photocopied picture
I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete is not acceptable
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 administrative/criminal case/s against me.
PHOTO

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