Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE
POLICE REGIONAL OFFICE CALABARZON
Camp Vicente Lim, Brgy. Mayapa, Calamba City

PO1 RECRUITMENT APPLICATION FORM

PLEASE CHECK PROVINCE WHERE YOU ARE APPLYING:
UNIT/OFFICE
2X2 size photo
taken within 3 months
With Name Tag

BATANGAS PPO
CAVITE PPO

LAGUNA PPO
RIZAL PPO

QUEZON PPO
RHQ

WARNING: This application must be filled out personally by the applicant. Any false statement or
misrepresentation made in this information sheet is a ground for disqualification and filing of criminal
action against the applicant.
PART I PERSONAL INFORMATION

BY PO1 Seneta

LAST NAME

FIRST NAME

MIDDLE NAME

PRESENT ADDRESS( House No., Street, Brgy., Town/City, Province)

ZIP CODE

PERMANENT MAILING ADDRESS( House No., Street, Brgy., Town/City, Province)

ZIP CODE

CONTACT NUMBERS (LANDLINE & MOBILE)

GENDER
MALE

CIVIL STATUS
SINGLE
MARRIED

EMAIL ADDRESS

FEMALE

DATE OF BIRTH

WIDOWER
SEPARATED

WEIGHT (in kgs)

AGE

PLACE OF BIRTH (Town/City, Province)

(mm/dd/yyyy)
CITIZENSHIP:

HEIGHT(in centimeters)

Member of NCIP/With NAPOLCOM Height / Age Waiver

ONLY. Tribe/ Date Granted:___________________________

ANY GOVERNMENT ELIGIBILITY

RA1080
RA6506
PD 907
CSC PROFESSIONAL
CSC PO1
NAPOLCOM
Others (Specify):
Elig. Rating:_________________
Date taken:____________________ General Weighted Average (TOR): _________
HAVE YOU EVER BEEN CONVICTED WITH FINAL JUDGEMENT BY ANY COURT AND/OR HAVE ANY PENDING CRIMINAL CASE?

NO

YES

(if yes, attach here a copy of the decision and etails________________________)

Have you ever applied for any position in the PNP?

YES
NO
If YES, what vacancy?
PO1
LATERAL ENTRY
NUP
DENIED?______ How many times?_____
Reasons for DENIAL/What Year?_________/___________; __________/____________;_____________/___________
DEGREE

COURSE COMPLETED

DATE GRADUATED
(mm/dd/yyyy)

NAME OF SCHOOL

LOCATION

BACHELORS DEGREE
GRADUATE DEGREE
PART III PREVIOUS EMPLOYMENT
NAME OF COMPANY

NAME

YEAR EMPLOYED

REASON FOR RESIGNATION / RELIEF /

END OF CONTRACT

PART IV CHARACTER REFERENCE

ADDRESS

CONTACT NUMBER

I HEREBY CERTIFY that the information and/or statements in this application are all true and correct, and I am fully aware that any
false information or statement provided by me in this application shall render me liable for criminal prosecution.

_____________________________________________
Signature of Applicant

______________________________________
Date Accomplished