JBCFORM No.

1
Revised April 2014

2x2 I.D. Picture

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
Surname
4. CIVIL STATUS

Middle Name
3. SEX

First Name
2a. Full Maiden Name, if married

U Male
5.

TAXPAYER'S IDENTIFICATION NUMBER (TIN)

7.

AGE

U Female
6. CITIZENSHIP

U Single

LI Widowed

LI Married

U Separated

Naturalized
L.1
10. WEIGHT (kilos)

1:1 Natural-born
9. HEIGHT (meters)

8. DATE AND PLACE OF BIRTH

12. TELEPHONE NUMBERS

11. ADDRESSES
a.

Residence:

a.

Residence:

b.

Office:

b.

Office:

c.

E-mail:

c.

Cellular:

d.

Provincial Address:

d.

Fax:
PLACE OF BIRTH

14. NAME OF MOTHER

PLACE OF BIRTH

13. NAME OF FATHER

OCCUPATION

15. NAME 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

Page 1 of 6

Rating
(including
failed rating if
applicable)

Year Admitted to
the Bar / IBP
Chapter

Inclusive Dates of Attendance

19. PREJUDICATURE PROGRAM

Rating

RELEVANT TRAININGS
SEMINARS,
TRAININGS,
SCHOLARSHIPS,
AND FELLOWSHIP GRANTS (in inverse chronological order)
20.
Incl u sive
Conducted by
Place
Course Title
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
of
(include current address &
Position
(e.g. _judicial, legal,
From
To
address & phone
Grade
phone no.)
administrative,
Years
(mm/dclN )
(mm/c1d/yy)
no.)
corporate)

22. BRIEF JOB DESCRIPTION OF EACH OF THE POSITIONS HELD

(continue on separate sheet if necessary)

Page 2 qf 6

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 b. Nature of Current
c. Latest MCLE Compliance or Exemption Certificate No. with
Practice:
Practice of Law:
Compliance Period:

24.
a.

LITIGATION EXPERIENCE
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:

Court

Case Title/Docket No.

Type of Case

Date
Filed

(indicate if
special court)

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?
1:-.1 No

1:1 Yes

Case Title

If Yes, give particulars.

Docket No.

Type of Case

Date Filed

(continue on separate sheet if necessary)

Page 3 of 6

Date Submitted
for Decision or
Resolution

Date Extension of
Time was Requested
& Granted

27. TEACHING EXPERIENCE

Nature of Appointment

Inclusive Period

School

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?

CI No

L-.1 Yes

Case Title/Docket No.

If Yes, give particulars:

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?

CI No

C3 Yes

Case Title/Docket No.

If Yes, give particulars:

Date Filed

Complainant's Name, Address

& Tel. No.

Page 4 of 6

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?

LI No

CI Yes

Case Title/Docket No.

If Yes, give particulars:

Complainant's Name, Address
& Tel. No.

Date Filed

Type of
Complaint

Court

Date Decided /

Disposition

OTHER MATTERS
32. TERMINATION OF EMPLOYMENT
Have you been retired, dismissed, or forced to resign from employment? CI Yes

LI No

If yes, state particulars:

33. CANDIDACY FOR ELECTIVE OFFICE

Have you been a candidate for any elective office in any election? LI Yes

CI No

If yes, when and for what position?

34. RELATIVES in Government Service in the Region where you seek to be appointed
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

Page 5 of 6

Tel. No.

4
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
day of

, this

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-April 2014

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