NEW FORM COMPLETE BACKGROUND INVESTIGATION

(CBI) as of September 13, 2018 from DI

I. PERSONAL DATA:

Name:
Date of Birth:
Place of Birth:
Age:
Address:
Sex:
Civil Status:
Religion:
Blood Type:
Build:
Weight:
Complexion:
Ethnic Group:

II. EDUCATIONAL BACKGROUND:

School Location Dates of Year Awards

Attendance Graduated Received
Elementary

High school

College

Post
Graduate

(Verify and place here a summary of any information obtained, activities in

school(consist of but not limited to membership in societies ,fraternities,
clubs and results of interview with teachers classmates, and staff of the
school ) and the authenticity records including foreign languages
proficiency.
Affidavit of two dis interested person from his/her previous schools and a
certification from the school student affairs office on his group affiliation,
that he is not a member of any left leaning organizations.

III. PLACES OF RESIDENCE SINCE BIRTH:

Inclusive Date Address (Include number of street and

barangay)

Place here a summary of any information obtained, reasons of transfer and

results of interview with neighbor, reputation, character. attitude, family
background etc.
Affidavit of church leaders where he /she belongs, Lupon member of his
residence and a Barangay Certification that applicant is not a member of
left leaning organizations like GABRIELA,BAYAN MUNA,ANAK PAWIS etc.

IV. EMPLOYMENT RECORDS

AGENCY/COMPAN ADDRES TYPE/NATUR INCLUSIV REASON

Y S E OF E DATES S FOR
EMPLOYMEN AND NR. LIVING
T OF YEARS
OF
SERVICE

(Place here summary of any information obtained, employment records

reputation and attitude with co-employees and results of interview with
superior, co-employees, staff, etc. State the circumstances as to whether
the subject has ben discharged/dismissed resigned or suspended)

List of person interviewed with complete name “alyas” specific relationship

and jobs).Affidavit/certification from employer/ manager.

V. IF MARRIED:

Name of Spouse:
Date of Birth:
Place of Birth:
Address:
Nationality:
Date of Marriage:
Profession:
Occupation:
Name of Children Son/Daughter Date of Birth Place of Birth

(Place here a summary of any information obtained….)

Secure affidavit from in-laws.

VI. FAMILY HISTORY:

Fathers Complete Name:

Date of Birth:
Place of Birth:
Address:
Nationality:
Profession:
Occupation:
Affiliation:
Business/Financial Interests:
Fraternities:
Clubs:

Mothers Complete Maiden Name:

Date of Birth:
Place of Birth:
Address:
Nationality:
Profession:
Occupation:
Affiliation:
Business/Financial Interests:
Fraternities:
Clubs:

Brothers and Sisters:

Date of Birth:
Place of Birth:
Address:
Nationality:
Profession:
Occupation:
Affiliation:
Business/Financial Interests:
Fraternities:
Clubs:

VII. POLICE HISTORY: (Check the following: dates of service, nature of

work, assignment, service reputation, rank, etc).Certification from his
unit/service Reputation.

VIII. CHARACTER REFERENCES: (Summary of the information

obtained-interview of the character references, throw-offs, employers,
relatives who have known the subject for period of at least 3 years).

Affidavit/certification from character references citing probity of the

applicant.

IX. NEIGHBORHOOD INVESTIGATION: (Discuss results of the

investigation in the areas of the subject’s morality, integrity, loyalty,
discretion, character, reputation, attitude towards co-residence, social
standard, prestige and activities in the neighborhood.)

Conduct interview and include names of person interviewed, preferably to

barangay officials, school principal

X. CREDIT RECORDS: Check and discuss the credit records)

List of person interviewed with complete name “alias” specific

relationship and job)
XI. FOREIGN TRAVEL: Discuss all travel abroad, countries visited, the
nature of visit, purpose or reason for such travel, date and length of stay)

Secure certification from Bureau of Immigration

XII. FOREIGN CONNECTION: (Identify and briefly discuss any

connection with foreigners and/or foreign organizations in the Philippines or
abroad, including a friend, relative or associate in other countries)

Note: If there’s no info obtained, following are required to expound:

1.Efforts conducted

2. List of person interviewed with complete name “alyas” specific

relationship and job.)

XIII. CITIZENSHIP STATUS: (In all cases the citizenship status of the
subject shall be established: Filipino citizens- by birth certificate; alien-BID
records shall be examined to verify date and place of birth and legal entry;
and naturalized citizens-naturalization and date and place of birth shall be
verified)

XIV. ORGANIZATION: (Name, type and characteristics and influence of

the organization to the subject- include brief summary of membership and
involvement in social, religious, economic, cultural, political, communist or
subversive groups and other organizations)

XV. PRINCIPAL AMUSEMENT: (Give brief summary of subject’s

recreational activities, game, hobbies, or other form of entertainment that
make the subject occupied or entertained)

Certification from the community where he or she belongs.

XVI. AGENCY CHECK:

1. NATIONAL AGENCY CHECK: List down national agency and

discuss result of investigation conducted.)
2. LOCAL AGENCY CHECK: (List down local agency and discuss result
of investigation conducted.

XVII. USE OF INTOXICANTS AND DRUGS: (Give a brief summary of any

information obtained regarding the subject’s use of intoxicants (moderate,
heavy or none) and drugs- that causes changes of behavior and perception
of the subject)

Certification/Affidavit of two dis interested person interviewed.

XVIII. ANALYSIS: (Assessment, description, or explanation of the
information obtained based on careful consideration or investigation or
understanding of the situation)

XIX. RECOMMENDATIONS: (Suggestion or endorsement of the best

courses of action for the head of office to make decision)

Conducted By:

____________________
Rank/Name/Designation

Approved By:
_________________
Chief of Office