PERSONAL HISTORY SHEET

I.PERSONAL INFORMARTION
2. SURNAME SIMON
FIRST NAME JIORDAN GABRIEL
3. NAME EXTENSION (e.g. Jr.,
MIDDLE NAME FALTADO Sr)
4. DATE OF BIRTH (mm/dd/yyyy) 06/02/1994 16. RESIDENTIAL 33-B MAYAMAN ST., UP
ADDRESS
5. PLACE OF BIRTH MANILA
VILLAGE, QUEZON CITY
6. SEX Male Female
7. CIVIL STATUS Single Widowed ZIP CODE 1101
Married Separated 17. TELEPHONE NO. (02) 926-0149
Annulled Others,specify_student___ 18. PERMANENT 188-A BLOCK 6,T. ALONZO
ADDRESS
8. CITZENSHIP FILIPINO ST., ZONE 2, WEST
REMBO, FORT BONIFACIO,
9. HEIGHT (ft) 5’ 10” MAKATI CITY
10. WEIGHT (kg) 65 kilograms ZIP CODE
11. BLOOD TYPE B+ 19. TELEPHONE NO. (02) 751-6093
12. GSIS ID NO. Not applicable 20. E-MAIL ADDRESS jiosim@yahoo.com
(if any)
13. PAG-IBIG ID NO. Not applicable 21. CELLPHONE NO (if 09205620001
any)
14. PHILHEALTH NO. N/A 22. AGENCY N/A
EMPLOYEE NO.
15. SSS NO. N/A 23. TIN N/A
II. FAMILY BACKGROUND
24. FATHER’S SIMON
SURNAME
FIRST NAME JAMES MARCEL
MIDDLE NAME PABLO
25. MOTHER’S FALTADO
MAIDEN NAME
FIRST NAME ANNA VICTORIA
MIDDLE NAME GAPUZ
III. EDUCATIONAL BACKGROUND
HIGHEST GRADE/
INCLUSIVE DATES OF
NAME OF SCHOOL LEVEL/ UNITS
EARNED ATTENDANCE
LEVEL SCHOLARSHIP/ ACADEMIC HONORS RECEIVED
(Write in full) (if not graduated) From To

ELEMENTARY CLARET SCHOOL OF GRADUATE SY 2007 o Honorable Mention

QUEZON CITY to 2008
o Medal for bringing honors to the
school

o Journalism Award

o Editor-in-chief, Claretian Magazine

(grade school official magazine)

o Certificate of Participation in the

Philippine Interschool Cyberfair
2008

SECONDARY CLARET SCHOOL OF 2ND YEAR SY 2008 SY 2009 o Quarter Finalist, CMLI National
QUEZON CITY HS to 2009 to 2010 Schools’ Debate Championship
o Silver Award for “Music is Our
Language,” International Interschool
Cyberfair 2009
o ASEAN Children’s Forum –
Philippine Delegate
 o Platinum Award for “Genesis of
Independence” project in the Philippine
Interschool Cyberfair 2008
o CMLI Asian Debate Parliament-
broke 12 finalist Inter-school Competition

IV. VOLUNTARY WORK OR INVOLVEMENT IN CIVIC/ NON-GOVERNMENT/ PEOPLE/ VOLUNTARY

ORGANIZATIONS

NAME & ADDRESS OF ORGANIZATION

NUMBER OF HOURS POSITION / NATURE OF WORK
(Write in full)

UP Debate Society Support Staff

Claret Debate Society – Summer Training Secretary/ Trainer

Batang UP Village Planner/ Organizer

UP Village- Barangay Council on the Protection of

Child Representative
Children

Immaculate Heart of Mary Parish Community Service Member

Family Planning of the Philippines – ARH book

Child reactor
launching

VII. TRAINING PROGRAMS (Start from the most recent training)

TITLE OF SEMINAR/ CONFERENCE/ WORKSHOP/ SHORT INCLUSIVE DATES OF

COURSES ATTENDANCE CONDUCTED/ SPONSORED BY (Write in full)
(Write in full)

Philippine National Children’s Conference 28- 30 August, 2009 Unicef, DSWD and CWC

Philippine Rural Reconstruction Youth

Youth Leadership Course 27-28 April, 2009 Association
7th National Summer Youth Training Camp
Philippine Rural Reconstruction Youth
“Youth empowerment for Sustainability and Good 20-30 April, 2009 Association
Governance”
“Good Governance Orientation and the Role of National College on Public Administration and
March 2008
Youth in Government” Governance, University of the Philippines

You Rule Convention January 2008 Ateneo Grade school

Quezon City- Marikina Consortium October 2007 Miriam College Grade school

Department of Social Welfare and

2nd NCR Children and Youth Summit 2007 Development-NCR

Department of Social Welfare and

1st NCR Children and Youth Summit 2006 Development-NCR
VIII. OTHER INFORMATION
 26. SPECIAL SKILLS / HOBBIES 27. NON-ACADEMIC DISTINCTION / 28. MEMBERSHIP IN
RECOGNITION (Write in full) ASSOCIATION / ORGANIZATION
(Write in full)
o Medal for bringing honors to the
Writing and Journalism school Claret Debate Society

Digital Art (Adobe Photoshop and Adobe After o Journalism Award UP Village –BCPC
Effects)
Computer Literate (Microsoft Word, Microsoft o Editor-in-chief, Claretian
Magazine (grade school official Batang UP Village
Powerpoint, Microsoft Publisher)
magazine)
Visual Art (Oil Pastel Paintings, Abstract and Honorary Member,
Still-Life) o Platinum Award for “Genesis of Education Network
Independence” project in the
Philippine Interschool Cyberfair
2008 Philippine Rural
Reconstructive Youth
Association
o Quarter Finalist, CMLI National
Schools’ Debate Championship
Public Speaking, Debate and Argumentation
o Silver Award for “Music is Our
Language,” International
Interschool Cyberfair 2009 Hope for Youth Foundation

o ASEAN Children’s Forum –

Philippine Delegate
29. REFERENCES (Persons not related by consanguinity or affinity to applicant/ appointee

NAME ADDRESS TEL. NO

Vice Mayor HERBERT M 2/F LEGISLATIVE WING BLDG, QC City HALL COMPOUND, 921- 7711
BAUTISTA BRGY CENTRAL, QC
ATTY. VIRGILIO FERER BRGY UP VILLAGE QC 435- 8369
Director Rosalinda Marcelino Commission on Population, Wellfare Vill., Mandaluyong 531- 6650
City
ASec Parisha H.Taraji Council for the Welfare of Children, 9 Apo St., QC 7811035
Ms Aleta Santos Hope for Youth Foundation, Manila 09198813239
30. I declare under oath that this Personal History Sheet has been accomplished by me, and is a true, correct and
complete statement pursuant to the provisions of pertinent laws, rules and regulations of the Republic of the
Philippines.
I also authorize the agency head / authorized representative to verify / validate the contents stated herein. I trust
that this information shall remain confidential.

SIGNATURE (Sign inside the box)

December 12, 2009

DATE ACCOMPLISHED RIGHT
THUMBMARK