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 ABRASALDO
NAME EXTENSION (JR., SR)
FIRST NAME GENESIS

MIDDLE NAME VENDIOLA

3. DATE OF BIRTH
(mm/dd/yyyy)
1/8/1995 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH DUMAGUETE CITY If holder of dual citizenship, Pls. indicate country:
Male Female please indicate the details.
5. SEX
Single Married CAPITOL SITE
6 CIVIL STATUS 17. RESIDENTIAL ADDRESS
Widowed Separated House/Block/Lot No. Street
DARO
Other/s:
Subdivision/Village Barangay
DUMAGUETE CITY NEGROS ORIENTAL
7. HEIGHT (m) 1.473 M
City/Municipality Province
8. WEIGHT (kg) 65 KG ZIP CODE 6208

18. PERMANENT ADDRESS

9. BLOOD TYPE 0+
House/Block/Lot No. Street
ALANGILANAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay

11. PAG-IBIG ID NO. MANJUYOD NEGROS ORIENTAL

City/Municipality Province

12. PHILHEALTH NO. 12-025755016-3 ZIP CODE 6208

13. SSS NO. 07-3840328-3 19. TELEPHONE NO. N/A

14. TIN NO. 351-708407 20. MOBILE NO. 0950 682 4815/0935 462 0530

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

FIRST NAME REYMAR

NAME EXTENSION (JR., SR) ZACHY VENDIOLA 5/17/2013

MIDDLE NAME CULANCULAN ZHOE V. ABRASALDO 11/4/2019

OCCUPATION SECURITY GUARD

EMPLOYER/BUSINESS NAME QUIAMBAO SECURITY SPECIALIST AGENCY

BUSINESS ADDRESS BACOLOD CITY

TELEPHONE NO. 0935 462 0530

24. FATHER'S SURNAME VENDIOLA

NAME EXTENSION (JR., SR)
FIRST NAME ROGELIO SR.

MIDDLE NAME PIÑERO

25. MOTHER'S MAIDEN NAME

SURNAME INFANTE

FIRST NAME GEMMA

MIDDLE NAME LEGASPINA (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY MAGATAS ELEMENTARY SCHOOL ELEMENTARY 2001 2007 N/A 2007 N/A

SECONDARY NEGROS ORIENTAL HIGH SCHOOL SECONDARY 2007 2011 N/A 2011 N/A

VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A

NEGROS ORIENTAL STAT UNIVERSITY (MAIN BACHELOR OF SCIENCE IN INDUSTRIAL TECHNOLOGY MAJOR IN PRESIDENTIAL ACADEMIC
COLLEGE
CAMPUS I) COMPUTER TECHNOLOGY 2015 2019 N/A 2019 AWARD/PRESIDENTIAL
TECHNOLOGY AWARD

(Continue on separate sheet if necessary) GRADUATE STUDIES

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