PERSONAL HISTORY STATEMENT

INSTRUCTIONS

1. Answer all the questions completely; if the question is not applicable, write
“NA.” Write “UNKNOWN” only if you do not know the answer and cannot obtain the
answer from personal records. Use the blanks pages at the back of this form for extra details
on any question for which you do not have sufficient space.

2. Type, print or write carefully, illegible or incomplete forms will not receive
consideration.

WARNING

1. The c o r r e c t n e s s of a l l s t a t e m e n t s of e n t r i e s m a d e h e r e i n w
i l l be investigated.

2. Any deliberate omission or distortion of material facts may give sufficient cause
for denial of clearance.

3. The statement made herein is classified “CONFIDENTIAL.” Revelation or use

for purposes other than that authorized is prohibited by pertinent provisions of AFPRG 200-
052.

I. PERSONAL DETAILS

A. Name: Alejo, Fersia Ajah (Last)

(Middle)
B. Rank: NA_ PCG/SN: NA Br/Svc: NA _

C. Present Job / Assignment: _ NA

D. Business or Duty Address: NA

E. Home Address (Include St. & Nr): Hilltop Drive, San Roque Zamboanga City _
_

F. Birth Date: August 22, 2005_ Place of Birth: Zamboanga City _

G. Change in Name (If by Court Action give details): NA

H. Nicknames: Cheng Nationality: Filipino _

I. TIN: NA PAGIBIG No: NA _ PhilHealth NO: NA

J. Religion: ISLAM _ Blood Type: NA _

K. Cellphone/ Telephone Number: 09261062920 _

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II. PERSONAL CHARACTERISTICS

A. Description: Sex: Female _ Age: _18 Height: 153_ (cms) Weight 43_
(kgs)
Build (heavy, Medium, Light): Light Complexion (Dark, Fair, Light): fair
Color of Eyes: black Color of Hair: black

Scars or marks and other distinguishing features: NA _

B. Physical Condition/Present State of health (Excellent, Good, Poor) Good

C. Physical or Mental Defects: NA Recent Serious Illness: NA _

III. MARITAL HISTORY

A. Marital Status: Single _

(Single, Married, Separated or Widow)
B. Name of Spouse: _ NA
(Full Name)
Date and Place of Marriage: NA

Occupation and Place of Employment: NA

C. Children:
Name Date of Birth Citizenship
NA NA NA
NA NA NA
NA NA NA

IV. FAMILY HISTORY AND INFORMATION

A. Father’s Name: Marghani Tawasil Alejo

(Full name)
Date and Place of Birth: May 10, 1969 / NA

Address: Hilltop Drive, San Roque Zamboanga City _

Occupation and Place of Employment: NA _

Citizenship: Filipino if naturalized, give date and place where

naturalized.

B. Mother’s Name: Nur-In Ajah Alejo

(Full Name)
Date and Place of Birth: April 04, 1969 _
Address: Hilltop Drive, San Roque Zamboanga City _
Occupation and Place of Employment: NA
Citizenship: Filipino naturalized. if naturalized, give date and place where

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 B. Brothers and Sisters
NAME AG ADDRESS OCCUPATIO
E N
Jaymar A. Alejo 33 Hilltop Drive, San Roque Zamboanga City
Claudia A. Alejo 28 Hilltop Drive, San Roque Zamboanga City
Jay-Ar A. Alejo 25 Hilltop Drive, San Roque Zamboanga City
Jayson A. Alejo 23 Hilltop Drive, San Roque Zamboanga City
Clarissa A. Alejo 20 Hilltop Drive, San Roque Zamboanga City

D. Step-parent or Guardian: _ NA _ _

Address NA

Occupation and Place of Employment _ NA

Citizenship _ NA _ if naturalized, give date and place where naturalized

E. Father-in-Law NA

Date and Place of Birth NA

Address NA
(Bo/Brgy) (Town/City)
Tel Nr _
(Province)
Occupation and Place of Employment _
Citizenship NA If naturalized, give date and place where naturalized

F. Mother-in-Law _ NA _
Date and Place of Birth NA _
Address NA
(Street) (Bo/Brgy) (Town/City)
NA Tel Nr NA
(Province)
Occupation and Place of Employment _
Citizenship NA if naturalized, give date and place where
naturalized

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 V. EDUCATIONAL BACKGROUND

A. Elementary
Scho Locati Date of Year Graduated
ol on Attendanc
e
San Roque Elementary School San Roque Zamboanga City 2018

B. High School
Scho Locati Date of Year Graduated
ol on Attendanc
e
ZNHS- WEST R.T LIM Boulevard 2022
Zamboanga City

C.College
Scho Course Location Date of Year
ol Attendance Graduated
NA NA NA NA NA

D. PostGraduate
Scho Course Location Date of Year
ol Attendanc Graduate
e d
NA NA NA NA NA
E.OtherSchoolsAttendedandDateofAttendance

School Course Location Date of Year

Attendanc Graduate
e d
NA NA NA NA NA
F.CivilServiceEligibility,ifany,andotherssimilarqualifications

G.Skillsandotherexpertise NA

Communication Skills

MILITARY HISTORY
VI.
A. Date Enlisted in the PCG : NA

B. DateofCommissionship NA_SourceofCommission_
NA

C. Important Unit Assignment since Enlistment/CAD:

Unit Assignment Designation Inclusive Dates

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NA NA NA

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D. Military Schools Attended
Name of Schools &Location Date of Attendance Nature of Rating
Training
NA NA NA NA
NA NA NA NA
NA NA NA NA
NA NA NA NA
E. Decorations and Awards or Commendations Received
Type of Award Authority
NA NA
NA NA
NA NA

VII. PLACES OF RESIDENCE SINCE BIRTH

Inclusive Dates Places/Address

2000-2024 Hilltop Drive, San Roque Zamboanga City

VIII. EMPLOYMENT

Inclusive Dates Type of Employment Name/Address Reason

of of
Employment Leavin
g
NA NA NA NA
NA NA NA NA
NA NA NA NA

Have you ever been dismissed or forced to resign from a position? Yes _ No √_
Ifyes, explain _

IX. FOREIGN COUNTRIES VISITED (In chronological order)

Date Country Visited Purpose of Visit

NA NA NA
NA NA NA
NA NA NA
NA NA NA

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 X. CREDIT REPUTATION

A. Are you entirely dependent on your salary? Yes ✔ No __ if no, state other
sources of income
_
B. Name and Address of Banks or other Credit/Institution with which your have
accounts/loans:
NA
C. Have you filed a statement of your Assets and Liabilities with any government
agency
Yes No _✔ If so, what, agency? _NA _

D Have you filed your last income tax return

. ?

E. Three (3) credit references in the Philippines: NA

Name Address
NA NA

NA NA

NA NA

XI. ARREST RECORD AND CONDUCT

A. Have you ever investigated / arrested, indicted or convicted for any violation of
law? NO ? If so, state name of court, nature of offense and disposition of case.
_
C. Has any member of your family ever been investigated / arrested, indicated
or convicted for any violation of law? NO If so, state name of
court, nature of case and disposition of cas
the e.

D. Have you, ever been charged in any Administrative Case?

NO
E. Have you ever been arrested or detained pursuant to the provision of PD 1081 and its
implementation order (GO, PO, LOI)? NO If so, state the nature of the case and
the place of your detention

F. Do you use intoxicating liquor or narcotics? NO If so, what extent?

_ _

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XII. GENERAL REPUTATION
A. Give five (5) character references (not relatives) known three years or longer, who
are not your relatives:

Na Business Address/Residence
me (Include Street & Number)
Mary Angel Q. Aghon Daap, Sangali Zamboanga City
Angel Cristine Aghon Daap, Sangali Zamboanga City
Tommy Jupakal Sinunuc Zamboanga City
Nursha Harun Sangali Zamboanga City
Janbres Gagaracruz Ayala Zamboanga City

B. Listdownthree(3)neighborsatyourpresentresidence:

Name Business Address/Residence

(Include Street & Number)
Matthew Alvarez San Roque Zamboanga City
Rapfhael Seseh San Roque Zamboanga City
Jayvie Manalo San Roque Zamboanga City

XIII. ORGANIZATION

Listoforganizationorsocialgroupswhichyou havebeenamember:

Organization Address Date of Membership

&
Position held
NA NA NA
NA NA NA
NA NA NA
NA NA NA
NA NA NA
MISCELLANEOUS
XIV.
A.Hobbies,sportsandpasttimes
Watching TV, Playing Online Games, Reading Books,
Riding bike, playing badminton
_

B. Language and Dialect (indicate ability as fluent, fair or poor):

Language Speak Read Write

or
Dialect
English Fair Fair Fair
Tagalog Fluent Fluent Fluent

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Tausug Fluent Fluent Fluent

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 C. Are you willing to undergo periodic lie detection test?
Yes
D. Copy exactly the following paragraph in your own handwriting

As Luis E Rapazo III of 105 th Xavier Ave guzzled his way trhough three
bottles of brandy, Josephine Z Quinsing, a partner in law firm of San Diego and
Ballesteros located at 2879 Valley Forge St., Quezon City turned to Richard Ting
Sr., a Chinese food expert from O.W. Kwantung Company, Ltd., 346 HadjiJairul
Hussein Blvd., and said, “I can’t speak for my Government but I’m quite sure your
country and mine better get together for closer understanding.”

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I certify that the foregoing answers are true and correct to the best of my knowledge
and belief and I agree that my misstatement or omission as to material facts will constitute
ground for denial of my application for clearance.

Signed at _ Date

(Signature of Applicant)

_ _
(Witness) (Witness)

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 THUMBMARKS

LEFT RIGHT

Subscribed and sworn to before me this_day of 20

Philippines, affiant exhibited to me his /her Community
Certificate Nr _ _Issuedon_ at

_(AdministrativeOfficer/NotaryPublic)

_(Rank and Designation)

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