JBC FORM No.

1
Revised March 2011

2x2 I.D. Picture

PERSONAL DATA SHEET

PERSONAL BACKGROUND
(Please print or type) 1. NAME (Last) 2. MAIDEN NAME (If married) (First) 3. SEX Female 6. CITIZENSHIP (Middle) 4. CIVIL STATUS

Male

Single Married

Widowed Separated

5. TAXPAYERS IDENTIFICATION NUMBER (TIN) 7. AGE 8. DATE AND PLACE OF BIRTH

9.

Natural-born HEIGHT (meters)

Naturalized 10. WEIGHT (kilos)

11. ADDRESSES a. b. c. d. Residence: Office: E-mail: Provincial Address: PLACE OF BIRTH

12. TELEPHONE NUMBERS a. b. c. d. Residence: Office: Cellular: Fax: PLACE OF BIRTH OCCUPATION

13. NAME OF FATHER 15. NAME OF SPOUSE 16. CHILDREN NAME

14. NAME OF MOTHER

AGE

NAME

AGE

EDUCATION
17. Level School/College/University Inclusive Period Degree/Units Earned Honors/Awards/ Distinctions Post Graduate College Vocational Secondary Elementary

18. CIVIL SERVICE ELIGIBILITY/BOARD/ BAR EXAMINATION TAKEN

ELIGIBILITY Date of Examination

Place of Examination

Rating
(Please indicate whether passed or failed)

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19. PREJUDICATURE PROGRAM

Inclusive Dates of Attendance

Rating

RELEVANT TRAININGS
20. SEMINARS, TRAININGS, SCHOLARSHIPS, AND FELLOWSHIP GRANTS (in inverse chronological order) Inclusive Course Title Place Conducted by Period

(continue on separate sheet if necessary)

PROFESSIONAL EXPERIENCE
21. SERVICE RECORD (include services in both private & government sectors in inverse chronological order) Nature of Inclusive Period Supervisor No. Department/Agency Work Salary (include current Position of (include current address & (e.g. judicial, legal, From To address & phone Grade phone no.) administrative, Years (mm/dd/yy) (mm/dd/yy) no.)
corporate)

22. BRIEF JOB DESCRIPTION OF EACH OF THE POSITIONS HELD

(continue on separate sheet if necessary)

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23. PRACTICE OF LAW

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a.

Number of Years of Practice of Law:

b. Nature of Current Practice:

24. LITIGATION EXPERIENCE a. Number of Years of Civil Litigation Experience: c. Number and Nature of Cases Handled in the Past 5 Years: Number and Nature of Cases Lost in the Past 5 Years:

b. d.

Number of Years of Criminal Practice Experience: Number and Nature of Cases Won in the Past 5 Years:

e.

f.

Number of Cases Handled in the Appellate Courts in the Past 5 Years:

g. Significant Cases Handled in the Past 5 Years: Case Title/Docket No. Type of Case Court Date Filed Date Decided
Names, Current Addresses & Tel. Nos. of Counsel for the other Parties

25. JUDICIAL EXPERIENCE a. Current Caseload: (with cut-off date) as of: c. Number and Percentage of Cases Disposed of in the Past 5 Years: Percentage of Affirmances in the Past 5 Years:

b. d.

Average Monthly Output: Number of Decisions Appealed or Pending Appeal:

e.

f.

Percentage of Reversals in the Past 5 Years:

g. Performance Rating in the past 3 Years: h. Cases Undecided or Unresolved within the Reglementary Period: Have you failed to decide cases or resolve motions within the reglementary period?

No

Yes

If Yes, give particulars. Docket No. Type of Case Date Filed

Date Submitted for Decision or Resolution Date Extension of Time was Requested & Granted

Case Title

(continue on separate sheet if necessary)

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26. TEACHING EXPERIENCE School

Inclusive Period

Nature of Appointment

Courses Taught

27. OTHER CREDENTIALS (Include awards received; special skills; law books or other legal articles written, edited, or published with citations, dates and general description of the subject matter; and membership in professional, civic, or other organizations or committees)

RECORD OF CASES FILED AGAINST YOU

28. FORMAL OR INFORMAL COMPLAINTS FILED AGAINST YOU (Civil, Criminal, or Administrative including disbarment and contempt of court) Have you ever been charged with violation of any law, decree, ordinance, administrative issuance, or regulation by any court, prosecution office, tribunal, or any other government office, agency or instrumentality in the Philippines or in any foreign country?

No

Yes

If Yes, give particulars: Date Filed Complainants Name, Address & Tel. No. Type of Complaint Court Disposition

Case Title/Docket No.

29. PENDING CASES OR COMPLAINTS AGAINST YOU Is there any pending civil, criminal, or administrative (including disbarment and contempt of court) case or complaint against you for violation of any law, decree, ordinance, administrative issuance, or regulation before any court, prosecution office, any other office, agency or instrumentality of the government, or the Integrated Bar of the Philippines or in any foreign country?

No

Yes

If Yes, give particulars: Date Filed Complainants Name, Address & Tel. No. Type of Complaint Court Status

Case Title/Docket No.

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30. DECIDED CASES AGAINST YOU Have you been found liable for, guilty of, or imposed a sanction or penalty for violation of any law, decree, ordinance, administrative issuance, or regulation by any court, tribunal, bar association, disciplinary committee, or any other government office, agency or instrumentality in the Philippines or any foreign country?

No

Yes

If Yes, give particulars: Date Filed Complainants Name, Address & Tel. No. Type of Complaint Court
Date Decided / Disposition

Case Title/Docket No.

31. TERMINATION OF EMPLOYMENT Have you been retired, dismissed, or forced to resign from employment?

Yes

No

If so, state the reason/s.

32. RELATIVES in the Judiciary in the Region where you seek to be appointed Name Position Place of Assignment Nature of Employment Relationship

REFERENCES
33. Persons not related to you by consanguinity or affinity who have knowledge of your personal or professional background. Name Address Tel. No.

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AGREEMENT
I declare under oath that the answers given above are true and correct to the best of my knowledge and belief. I bind myself to inform the Judicial and Bar Council (JBC) of any material changes that may arise in the future affecting the information contained herein. Likewise, I authorize the JBC and its agents or representatives to verify the truth of any of the above information or to conduct investigation on my background and qualifications from any and all available sources. In this regard, I authorize any government or law enforcement agency and its representatives or agents, as well as private individuals or entities, to release any document, record or information they may have about me that the JBC may request. I agree that the information contained herein, except personal information under numbers 11 to 16 as well as the addresses and telephone numbers of other persons, shall be open to the public. Furthermore, I am willing to be nominated for appointment to either my second or third preference if I would not be considered for my first preference. If I am not nominated at all, the JBC is not obliged to disclose the reason. In the event that I decide to withdraw my application or decline my nomination, I shall immediately notify the JBC in writing. Should I be appointed to the position I am applying for, I am committed to assume the duties and functions of the said office.

__________________________ Signature __________________________ Date

JURAT
SUBSCRIBED AND SWORN to before me in the City/Municipality of _______________________, this _____ day of ________________________ 20___, affiant exhibiting to me his/her Community Tax Certificate No. __________________________ issued at _____________________________ on _________________________.

__________________________ Notary Public Doc. No. ______; Page No. ______; Book No. ______; Series of 20___.

PDS-Form-March 2011 misc. folder/arf

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