Beruflich Dokumente
Kultur Dokumente
1
Revised: August 2017
b. Office: b. Office:
c. E-mail: c. Cellular:
13. NAME OF FATHER 13a. PLACE OF BIRTH 14. MOTHER’S MAIDEN NAME 14a. PLACE OF BIRTH
EDUCATION
17. Degree/Units Honors/Awards/
Level School/College/University Inclusive Period
Earned Distinctions
Post Graduate
Law
College
Vocational
Secondary
Elementary
ELIGIBILITY
18. CIVIL SERVICE No. of Date of Place of Examination Rating Year IBP Chapter
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ELIGIBILITY/ (including
Times Admitted (& Number, if
BOARD/BAR Examination failed rating if
Taken applicable) to the Bar applicable)
EXAMINATION TAKEN
RELEVANT TRAININGS
20. SEMINARS, TRAININGS, SCHOLARSHIPS, AND FELLOWSHIP GRANTS (start from most recent seminar)
Inclusive
Course Title Place Conducted by
Period
23. PRACTICE OF LAW (including the holding of an office which requires admission to the bar as a prerequisite)
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a. Number of Years of b. Nature of Current c. Latest MCLE Compliance or Exemption Certificate No. with
Practice of Law: Practice: Compliance Period:
c. Number and Nature of Cases Handled in the Past 5 d. Number of Cases Handled in the Appellate Courts in
Years: the Past 5 Years:
25. JUDICIAL EXPERIENCE (separately indicate caseload performance in acting, assisting, or pairing capacities, if applicable)
a. Current Caseload: (with cut-off date) b. Average Monthly Output:
as of:
c. Number and Percentage of Cases Disposed of in the d. Number of Decisions Appealed or Pending Appeal:
Past 5 Years:
26. EXPERIENCE IN OTHER GOVERNMENT AGENCIES (e.g., Office of the Solicitor General, Office of the Ombudsman,
National Prosecution Service, Public Attorney’s Office)
a. Number of complaints/cases handled which are pending as b.Number of complaints/cases submitted for resolution as of
of the date of application: the date of application:
c. Number of resolutions affirmed by superiors for the past d.Number of resolutions reversed by superiors for the past
five (5) years: five (5) years:
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)
OTHER MATTERS
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30. TERMINATION OF EMPLOYMENT
Have you been retired, dismissed, or forced to resign from employment? Yes No If yes, state particulars:
32. RELATIVES in Government Service (within the fourth degree of consanguinity or affinity, including “Bilas,” “Balae,” and “Inso”)
Name Position Place of Assignment Nature of Employment Relationship
33. REFERENCES (Persons not related to you by consanguinity or affinity who have knowledge of your personal or professional
background)
Name Address Tel. No.
AGREEMENT
I declare that the answers given above are true, correct, and complete to the best of my knowledge and belief. I
bind myself to inform the Judicial and Bar Council (JBC) of any development that may affect any of 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.
In the event that I decide to withdraw my application, I shall immediately notify the JBC in writing.
__________________________
Signature
__________________________
Date
JURAT
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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-August 2017
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