Republic of the Philippines

CAMARINES SUR POLYTECHNIC COLLEGES

Nabua, Camarines Sur
CS Form No. 212 Revised 2017

PERSONAL DATA SHEET

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 NUÑEZ
NAME EXTENSION (JR., SR)
FIRST NAME SHARMINE

MIDDLE NAME OROSCO

3. DATE OF BIRTH
(mm/dd/yyyy) 9/14/1994 16. CITIZENSHIP ✘ Filipino Dual Citizenship
by
by naturalization
birth
4. PLACE OF BIRTH PALSONG BULA CAMARINES SUR If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male ✘ Female

6 CIVIL STATUS
Single ✘ Married 17. RESIDENTIAL ADDRESS 97 Zone 1 Sogod Guilid guild
Widowed House/Block/Lot No. Street
Separated Palsong
Other/s:
Subdivision/Village Barangay
Bula Camarines Sur
7. HEIGHT (m) 1.58
City/Municipality Province
8. WEIGHT (kg) 59 ZIP CODE 4430

18. PERMANENT ADDRESS 97 Zone 1 Sogod Guilid guilid

9. BLOOD TYPE 0+
House/Block/Lot No. Street
Palsong
10. GSIS ID NO. N/A
Subdivision/Village Barangay
Bula Camarines Sur
11. PAG-IBIG ID NO. N/A
City/Municipality Province

12. PHILHEALTH NO. 102537859668 ZIP CODE 4430

13. SSS NO. 0511882306 19. TELEPHONE NO. N/A

14. TIN NO. 753-460-523 20. MOBILE NO. Globe - 09958941943 Smart -09498233188

15. AGENCY EMPLOYEE NO. COS ACAD 97 21. E-MAIL ADDRESS (if any) sharmineorosco091412@gmail.com
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME NUÑEZ 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)
NAME EXTENSION (JR., SR) SAMANTHA ALTHEA O. NUÑEZ
FIRST NAME ROEL 12/12/2013
SHONN RHYNZO O. NUÑEZ
MIDDLE NAME DE LIMA 1/21/2019

OCCUPATION FISH VENDOR

EMPLOYER/BUSINESS NAME N/A

BUSINESS ADDRESS N/A

TELEPHONE NO. N/A

24. FATHER'S SURNAME OROSCO

NAME EXTENSION (JR., SR)
FIRST NAME LORENZO

MIDDLE NAME PEÑALES

25. MOTHER'S MAIDEN NAME BENOSA

SURNAME OROSCO

FIRST NAME FRANCIA

MIDDLE NAME HOMBRE (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
HONORS
(Write in full)
full) (if not graduated) RECEIVED
From To

ELEMENTARY PALSONG ELEMENTARY SCHOOL PRIMARY EDUCATION 2001 2007 2007 3rd Honor

SECONDARY PALSONG HIGH SCHOOL SECONDARY EDUCATION 2007 2011 2011 N/A
VOCATIONAL /

GLOBAL SITE FOR I.T STUDIES 2 YEARS OFFICE ADMINISTRATION 2011 2013 2013 N/A

TRADE
COURSE
With
BACHELOR OF SCIENCE IN TOURISM
COLLEGE CAMARINES SUR POLYTECHNIC COLLEGES
MANAGEMENT
2014 2018 2018 Academic
Distinction

MASTER OF INTERNATIONAL HOSPITALITY AND

GRADUATE STUDIES LYCEUM OF THE PHILIPPINES - BATANGAS
TOURISM MANAGEMENT
2020 2021 36 units

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised 2017), Page 1 of 4

 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

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 (LET) 78.0 Sept. 29, 2019 Legazpi City, Albay 1820311 9/14/2022

(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 SALARY/ JOB/ PAY
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/
Contract of N)
8/10/2020 Present Instructor I Camarines Sur Polytechnic Colleges 17, 945.28 Y
Service
Contract of
1/15/2020 5/15/2020 Instructor I Camarines Sur Polytechnic Colleges 17, 945.28 Y
Service
Contract of
8/5/2019 12/5/2019 Instructor I Camarines Sur Polytechnic Colleges 11, 215. 80 Y
Service

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised 2017), Page 2 of 4

 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

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

(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) Supervisory/ (Write in full)
(mm/dd/yyyy)
Technical/etc)
From To

CSR: Looking Beyond for the future of Tourism and Hospitality Industry 2/13/2021 2/13/2021 2hrs MANAGERIAL Lyceum of the Philippines - Batangas

Tourism Recovery Scheme for Sustainable Development in the New Normal 12/19/2020 12/19/2020 3hrs SUPERVISORY TEAM Philippines, CALABARZON Chapter

University of the Philipines Diliman - Department of Hotel,

Changes in Hospitality Management and Research 8/6/2020 8/6/2020 2hrs SUPERVISORY
Restaurant, and Institutional Management

Formula for Aspiring Flight Attendant 7/24/2020 7/24/2020 2hrs SUPERVISORY Sky Aviation Learning Center Inc.

21st Century Skills Requirement Essentials of Communication 7/17/2020 7/17/2020 2hrs SUPERVISORY Sky Aviation Learning Center Inc.

Transformation Towards Bigger Challeges 7/10/2020 7/10/2020 2hrs SUPERVISORY Sky Aviation Learning Center Inc.

Association of Administrators of Hospitality Hotel and

Creating Offline and Online Learning Environment in Flexible Learning 7/10/2020 7/10/2020 2hrs SUPERVISORY
Restaurant Management Educational Institutions
Human Resource Challenges and the role of HEI in the new normal for the Hospitality and
6/13/2020 6/13/2020 2hrs SUPERVISORY Tourism Educators and Movers Philippines
Tourism Industry.

Charismatic Public Speaking Series 6/10/2020 6/10/2020 2hrs SUPERVISORY Lyceum of the Philippines - Batangas

Strengthening Hospitality Management Skills: Recovery Strategies to thrive in new travel demand. 5/30/2020 5/30/2020 2hrs SUPERVISORY Lyceum of the Philippines - Batangas

RethinkingWorkplace Learning During COVID-19 5/21/2020 5/21/2020 2hrs SUPERVISORY OMNI Cavin Crew Training School

The Tourism and Hospitality Summit, Skills Competition and Pageantry 2020 3/7/2020 3/7/2020 8hrs SUPERVISORY Mayon Global Careers Co.

Excellence in Education Outcomes 2/19/2020 2/20/2020 24hrs SUPERVISORY Association Carrer Professionals International

Human Explore Travel and Tours and the Provincial

3rd Regional Food and Travel Expo (ReFTEx) 2019 10/25/2019 10/25/2019 8hrs SUPERVISORY
Government of Albay

9th National Hospitality and Tourism Annual Convention 9/28/2019 9/28/2019 8hrs SUPERVISORY Mayon Global Careers Co.

AIRLINE SERVICES 10/6/2016 10/6/2016 4hrs SUPERVISORY OMNI AVIATION, CLARK PAMPANGA

MAGSAYSAY CENTER FOR HOSPITALITY AND

CAREER ORIENTATION SEMINAR IN THE CRUISE LINE INDUSTRY 10/5/2016 10/5/2016 4hrs SUPERVISORY
CULINARY ARTS

BAR EXPOSURE PROGRAM 10/5/2016 10/5/2016 4hrs SUPERVISORY TGI FRIDAYS

(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)

Singing

Dancing

(Continue on separate sheet if necessary)

SIGNATURE DATE CS FORM 212 (Revised 2017), Page 3 of 4

 Republic of the Philippines
CAMARINES SUR POLYTECHNIC COLLEGES
Nabua, Camarines Sur

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 NO
YES ✘
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)

ID picture taken within

NAME ADDRESS TEL. NO. the last 6 months
3.5 cm. X 4.5 cm
MARIA LUISA O. SOTERO BUHI, CMARINES SUR 9178821767 (passport size)
MUN. COUNCILOR SHERLYN JOY HOMBRE BULA CAMARINES SUR 9480038738 With full and handwritten
AGNES A. DINERO BULA CAMARINES SUR 9239309327 name tag and signature over
printed name
42. I declare under oath that I have personally accomplished this Personal Data Sheet which is a true, correct and complete
Computer generated
statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the Philippines. I or photocopied picture
authorize the agency head / authorized representative to verify/validate the contents stated herein. I agree that any is not acceptable
misrepresentation made in this document and its attachments shall cause the filing of administrative/criminal case/s PHOTO
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: DFA

ID/License/Passport No.: P1445012A Signature (Sign inside the box)

Date/Place of Issuance: JAN.4,2017/LEGAZPI

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