CS Form No.

212

PERSONAL DATA SHEET

Revised 2017

W AR N IN G : An y m is re p re s e n ta tio n m a d e in th e P e rs o n a l D a ta S h e e t a n d th e W o rk E x p e rie n c e S h e e t s h a ll c a u s e th e filin g o f a d m in is tra tiv e /c rim in a l c a s e /s a g a in s t th e p e rs o n

c o n c e rn e d .
R E AD T H E AT T AC H E D G U ID E T O F IL L IN G O U T T H E P E R S O N AL D AT A S H E E T (P D S ) B E F O R E AC C O M P L IS H IN G T H E P D S F O R M .
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 GENON
NAME EXTENSION (JR., SR)
FIRST NAME CHERRY

MIDDLE NAME OTUM

3. DATE OF BIRTH
(mm/dd/yyyy)
AUGUST 1, 1987 16. CITIZENSHIP Filipino Dual Citizenship
by birth by naturalization
4. PLACE OF BIRTH LIBERTAD TUNGAWAN, ZAMBOANGA SIBUGA If holder of dual citizenship, Pls. indicate country:
please indicate the details.
5. SEX Male Female

Single Married 17. RESIDENTIAL ADDRESS PUROK 2

6 CIVIL STATUS
Widowed Separated House/Block/Lot No. Street
LANTAWAN
Other/s:
Subdivision/Village Barangay
SAN MIGUEL ZAMBOANGA DEL SUR
7. HEIGHT (m) 5'1
City/Municipality Province
8. WEIGHT (kg) 69 ZIP CODE

18. PERMANENT ADDRESS PUROK 2

9. BLOOD TYPE "O"
House/Block/Lot No. Street
LANTAWAN
10. GSIS ID NO. N/A
Subdivision/Village Barangay
S AN M IG U E L Z AM B O AN G A D E L S U R
11. PAG-IBIG ID NO. 121275821729
City/Municipality Province

12. PHILHEALTH NO. N/A ZIP CODE 7029

13. SSS NO. 34-9818144-4 19. TELEPHONE NO. N/A

14. TIN NO. 385-737-807-000 20. MOBILE NO. 09153926354

15. AGENCY EMPLOYEE NO. N/A 21. E-MAIL ADDRESS (if any) [email protected]
II. FAMILY BACKGROUND
22. SPOUSE'S SURNAME GENON 23. NAME of CHILDREN (Write full name and list all) DATE OF BIRTH (mm/dd/yyyy)

FIRST NAME JIMMY

NAME EXTENSION (JR., SR)
EMMANUEL O. GENON DECEMBER 28, 2016

MIDDLE NAME ARCOJITAS AIRAH FAITH O. GENON DECEMBER 25, 2019

OCCUPATION N/A
EMPLOYER/BUSINESS NAME N/A
BUSINESS ADDRESS N/A
TELEPHONE NO. N/A
24. FATHER'S SURNAME OTUM
NAME EXTENSION (JR., SR)
FIRST NAME ROGELIO
MIDDLE NAME ORBITA
25.

SURNAME TARUC
FIRST NAME ENERIA
MIDDLE NAME APELANIO (Continue on separate sheet if necessary)

III. EDUCATIONAL BACKGROUND

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

ELEMENTARY LANTAWAN PRIMARY ELEMENTARY SCHOOL PRIMARY 1997 2001 GRADUTE 2001 N/A

ZAMBOANGA DEL SUR NATIONAL HIGH

SECONDARY SECONDARY 2005 2009 GRADUATE 2009 N/A
SCHOOL
VOCATIONAL /
TRADE COURSE
N/A N/A N/A N/A N/A N/A N/A

COLLEGE LUCAN CENTRAL COLLEGES COLLEGE 2011 2016 GRADUATE 2016 N/A

GRADUATE STUDIES J.H. CERILLERES STATE COLLEGE MAED-EDAD PRESENT PRESENT UNDERGRDUATE

(Continue on separate sheet if necessary)

SIGNATURE DATE SEPTEMBER 24, 2023

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