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CS Form No.

212

PERSONAL DATA SHEET


Revised 2017

WARNING: Any misinterpretation 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 VENDER
NAME EXTENSION (JR., SR.) N/A
FIRST NAME GERICK DAVE
MIDDLE NAME MONENCILLO
3. DATE OF BIRTH
16. CITIZENSHIP
(mm/dd/yyyy) 12/09/1997 Filipino Dual Citizenship
by birth by naturalization

4. PLACE OF BIRTH SURIGAO CITY, SURIGAO DEL NORTE If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

6 CIVIL STATUS Single Married 17. RESIDENTIAL ADDRESS 03405 BORROMEO


Widowed Separated House/Block/Lot No. Street

Other/s: N/A TAFT


Subdivision/Village Barangay

7. HEIGHT (m) 1.604 METERS SURIGAO SURIGAO DEL NORTE


City/Municipality Province

8. WEIGHT (kg) 55 KILOGRAMS ZIP CODE 8400

9. BLOOD TYPE A+ 18. PERMANENT ADDRESS 03405 BORROMEO


House/Block/Lot No. Street

10. GSIS ID NO. N/A N/A TAFT


Subdivision/Village Barangay

11. PAG-IBIG ID NO. N/A SURIGAO SURIGAO DEL NORTE


City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 8400

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

14. TIN NO. N/A 20. MOBILE NO. +639301674472

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) gerickvender97@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)
NAME EXTENSION (JR., SR.)
FIRST NAME N/A
MIDDLE NAME

OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME VENDER
FIRST NAME GENARO NAME EXTENSION (JR., SR.) JR.

MIDDLE NAME FORTUITO


25. MOTHER'S MAIDEN NAME REMIA YPARRAGUIRRE MONENCILLO
SURNAME VENDER
FIRST NAME REMIA
MIDDLE NAME MONENCILLO (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) GRADUATED HONORS
(if not graduated)
RECEIVED
From To
SURIGAO CITY CENTRAL ELEMENTARY
ELEMENTARY PRIMARY EDUCATION 2004 2010 2010 N/A
SCHOOL
SURIGAO DEL NORTE NATIONAL HIGH
SECONDARY HIGH SCHOOL 2010 2014 2014 N/A
SCHOOL
VOCATIONAL / COMPUTER SERVICING SYSTEMS
ST.PAUL UNIVERSITY-SURIGAO 01/06/2017 01/08/2017 2017 N/A
TRADE COURSE (CSS) NC II
SURIGAO STATE COLLEGE OF BACHELOR OF SECONDARY EDUCATION major
COLLEGE 2014 2018 2018 N/A
TECHNOLOGY in BIOLOGICAL SCIENCE

GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A

(Continue on separate sheet if necessary)

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

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