JBCFORM No. 1

Amended: September 2015

PERSONAL DATA SHEET

PLEASE FILL OUT THIS FORM BY PRINTING OR TYPING THE REQUIRED INFORMATION.

DO NOT LEAVE ANY ITEM UNANSWERED. IF NOT APPLICABLE, WRITE “NA.”

Personal Background
1. Roll of Attorneys’ Number / 2. NAME
First Name Middle Name Surname
2a. Full Maiden Name, if married / 3. SEX
q Male
q Female / 4. CIVIL STATUS
q Single q Widowed
q Married q Separated
5. TAXPAYER’S IDENTIFICATION NUMBER (TIN) / 6. CITIZENSHIP
q Natural-born q Naturalized
7. AGE / 8. DATE AND PLACE OF BIRTH / 9. HEIGHT (meters) / 10. WEIGHT (kilos)
11. ADDRESSES / 12. TELEPHONE NUMBERS
a. Residence: / a. Residence:
b. Office: / b. Office:
c. E-mail: / c. Cellular:
d. Provincial Address: / d. Fax:
13. NAME OF FATHER / 13a. PLACE OF BIRTH / 14. NAME OF MOTHER / 14a. PLACE OF BIRTH
15. NAME OF SPOUSE / 15a. OCCUPATION OF SPOUSE
16. CHILDREN
NAME AGE NAME AGE
Education
17. / Level / School/College/University / Inclusive Period / Degree/Units
Earned / Honors/Awards/
Distinctions
Post Graduate
Bachelor of Laws
College
Vocational
Secondary
Elementary
Eligibility
18. CIVIL SERVICE ELIGIBILITY/ BOARD/BAR EXAMINATION TAKEN / No. of Times Taken / Date of Examination / Place of Examination / Rating
(including failed rating if applicable) / Year Admitted to the Bar / IBP Chapter
19. PREJUDICATURE PROGRAM / Inclusive Dates of Attendance / Rating
Relevant Trainings
20. SEMINARS, TRAININGS, SCHOLARSHIPS, AND FELLOWSHIP GRANTS (in inverse chronological order)
Course Title / Inclusive
Period / Place / Conducted by
(continue on separate sheet if necessary)
Professional Experience
21. SERVICE RECORD (include services in both private & government sectors in inverse chronological order)
Position / Inclusive Period / No. of
Years / Salary
Grade / Department/Agency (include current address & phone no.) / Nature of Work
(e.g. judicial, legal, administrative, corporate) / Supervisor
(include current address & phone no.)
From
(from date of oath of office)
(mm/dd/yy) / To
(mm/dd/yy)
22. BRIEF JOB DESCRIPTION OF EACH OF THE POSITIONS HELD

(continue on separate sheet if necessary)

23. PRACTICE OF LAW (including the holding of an office which requires admission to the bar as a pre-requisite)
a. Number of Years of Practice of Law: / b. Nature of Current Practice: / c. Latest MCLE Compliance or Exemption Certificate No. with Compliance Period:
24. LITIGATION EXPERIENCE
a.  Number of Years of Civil Litigation Experience: / b. Number of Years of Criminal Practice Experience:
c. Number and Nature of Cases Handled in the Past 5 Years: / d. Number and Nature of Cases Won in the Past 5 Years:
e. Number and Nature of Cases Lost in the Past 5 Years: / 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
(indicate if special court) / Date Filed / Date Decided / Names, Current Addresses & Tel. Nos. of Counsel for the other Parties
25. PROSECUTION EXPERIENCE
a. Number of complaints/inquests handled which are pending preliminary investigation as of date of application: / b. Number of complaints/inquests submitted for resolution as of date of application:
c. Number of resolutions affirmed by superiors for the past five (5) years: / d. Number of resolutions reversed by superiors for the past five (5) years:
26. JUDICIAL EXPERIENCE
a. Current Caseload: (with cut-off date) / b. Average Monthly Output:
as of:
c. Number and Percentage of Cases Disposed of in the Past 5 Years: / d. Number of Decisions Appealed or Pending Appeal:
e. Percentage of Affirmances in the Past 5 Years: / 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?
q No q Yes If Yes, give particulars.
Case Title / Docket No. / Type of Case / Date Filed / Date Submitted for Decision or Resolution / Date Extension of Time was Requested & Granted

(continue on separate sheet if necessary)

27. TEACHING EXPERIENCE
School / Inclusive Period / Nature of Appointment / Courses Taught
28. OTHER CREDENTIALS (Include awards received; expertise in field/fields of law pertinent to the specific field of the special court being applied for; special skills; law books or other legal articles written, edited, or published with citations, dates and general description of the subject matter; lectures, seminars, or trainings given; and membership in professional, civic, or other organizations or committees)
Record of Cases Filed Against You
29. 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?
q No q Yes If Yes, give particulars:
Case Title/Docket No. / Date Filed / Complainant’s Name, Address & Tel. No. / Type of Complaint / Court / Disposition
30. 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?
q No q Yes If Yes, give particulars:
Case Title/Docket No. / Date Filed / Complainant’s Name, Address & Tel. No. / Type of Complaint / Court / Status
31. 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?
q No q Yes If Yes, give particulars:
Case Title/Docket No. / Date Filed / Complainant’s Name, Address & Tel. No. / Type of Complaint / Court / Date Decided / Disposition
Other Matters
32. TERMINATION OF EMPLOYMENT
Have you been retired, dismissed, or forced to resign from employment? q Yes q No If yes, state particulars:
33. CANDIDACY FOR ELECTIVE OFFICE
Have you been a candidate for any elective office in any election? q Yes q No If yes, when and for what position?
34. RELATIVES in Government Service
Name / Position / Place of Assignment / Nature of Employment / Relationship
References
35. 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 and public documents submitted by me or gathered by the JBC, except personal information such as those under numbers 11 to 16, the addresses and telephone numbers of other persons, shall be open to the public.
Furthermore, I am willing to be nominated for appointment to any of the vacancies which I applied for. 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 current identification document issued by an official agency ______at ______
on ______and bearing his/her photograph and signature.
______
Notary Public
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of 20 _____.

PDS-Form-September 2015

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