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Republic of the Philippines

Department of the Interior and Local Government


Philippine Public Safety College
PHILIPPINE NATIONAL POLICE ACADEMY
P.O. Box # 37 Camp General Mariano N Castaeda, Silang, Cavite 4129
Tele Fax # (049) 545-5940/(02) 396-4076
Website: www.pnpa.edu.ph Email Add: info@pnpa.edu.ph

PNPACAT Application Form
Revised 2010
PNPA REG
APPLICATION FOR PNPA CADET ADMISSION TEST

(IMPORTANT: READ INSTRUCTIONS AT THE BACK OF THIS FORM. ACCOMPLISH THIS FORM COMPLETELY & ACCURATELY)

1.SURNAME 2.GENDER :

Male
FIRST NAME
Famale

MIDDLE NAME

A N T E R O
D A R Y L
B E T O C L O N G

3. COMPLETE MAILING ADDRESS with ZIP code: REGION: CAR Email Address:bishopdaryl@yahoo.com
#4057 Purok 4 Kias, Baguio City, TEL NO.: (Res)___NONE____________
2600 (Mobile) 09462589977__________
4. CIVIL STATUS:
SINGLE
5. CITIZENSHIP:
FILIPINO
6. HEIGTH: (cm) 7. WEIGTH: (kg)
172 cm 77 kg

8. AGE:
19

BIRTHDATE:

MAR 21 1995
9.BIRTHPLACE:BAGUIO GENERAL HOSPITAL, BAGUIO CITY

Month

Date

Year

10. FATHERS NAME: ALFREDO ANTERO JR.________________ADDRESS: ITOGON,BENGUET
11. MOTHERS NAME: ERLINDA BETOCLONG__________________ADDRESSKIBUNGAN, BENGUET
12. GUARDIANS NAME: _ALPRESTONE ANTERO_______________Relationship _BROTHER______________
ADDRESS_#4057 Purok 4 Kias, Baguio City__________________

13. EDUCATION (Please check highest educational attainment only)

High School Graduate:
School: FORT DEL PILLAR ANNEX
(BCNHS)
Year Graduated: ___2012_______


College Undergraduate:
Year 1
st
2
nd
3
rd
4
th
5
th

Course:__BScrim______________
School:UNIVERSITY OF THE
CORDILLERAS

College Graduate:
Degree:_______________________________
School: ________________________

14. Have you ever been dismissed from any employment, forced to resign or otherwise disciplined as a result of
administrative case,
or convicted of any violation of law, ordinance or regulations before any civil court and/or military tribunal? : _ YES _ NO
If YES, attach copy of decision:
15. Do you have any pending criminal or administrative case, or civil case on file before any Prosecutors Office or Court of
Justice or
other derogatory record(s)? _ YES _ NO
16. Do you have any parental obligation, or has sired a child or children? _ YES _ NO

I hereby declare under the penalties of perjury that this application has been accomplished in good faith, verified by me and to the
best of my knowledge and belief and is a true, correct and complete statement pursuant to the provisions of pertinent laws, rules and
regulations of the Republic of the Philippines.



(Siganature of Applicant)