Republic of the Philippines

PHILIPPINE NATIONAL POLICE

DIRECTORATE FOR PERSONNEL AND RECORDS MANAGEMENT
RECRUITMENT AND SELECTION DIVISION
Camp Crame, Quezon City

PO1 RECRUITMENT APPLICATION FORM

PLEASE CHECK UNIT WHERE YOU ARE APPLYING:
RECRUITING UNIT/OFFICE
PRO12 PROCARAGA PROCOR

WARNING: This application must be filled out personally by the applicant. Any false information or misinterpretation made in this information form is a
ground for disqualification and filing of criminal action against the applicant.

PART I - PERSONAL INFORMATION

LAST NAME : FIRST NAME : QUALIFIER : MIDDLE NAME :

Ancino Shem Bañez

PERMANENT MAILING ADDRESS (House No., Street, Town Province/City): ZIP CODE :

Purok Upper Cabuling, BANGA, SOUTH COTABATO, Region XII 9511

GENDER : CONTACT NUMBERS (Landline & Mobile) : E-MAIL ADDRESS :

MALE FEMALE /09268151393 ancinoshem21@gmail.com

CIVIL STATUS : DATE OF BIRTH (mm/dd/yyy): AGE : PLACE OF BIRTH (City, Town Province) :
SINGLE WIDOWER Banga, South Cotabato
MARRIED SEPARATED 09/24/1995 23 CITIZENSHIP : FILIPINO
WEIGHT (in kgs) : HEIGHT (in meters) : Member of NCIP/With NAPOLCOM Height/Age Waiver Only :

55.000 1.610 Tribe/Date Granted : /

ANY GOVERNMENT ELIGIBILITY

RA 1080 RA 6505 PD 907 CSC PRO CSC PO1 NAPOLCOM Other (Specify):
Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination,
end of term, finished contract, AWOL or phased out, in the public or private sector? NO YES
Have you ever been charged of any Administrative/Criminal Case in any Court or Investigative Body? NO YES
If Yes, please give the details: Kind of Offense, Date of Filing, Court/Investigative Body with Jurisdiction and Status of the Case.
Please attach here a copy of the decision and details ------------------------------------>
Have you ever applied for any position in the PNP? NO YES
If Yes, what vacancy? PO1 LATERAL ENTRY NUP DENIED? How many times? 0
Reason for DENIAL:
Have you been employed at any government office? NO YES
PART II - EDUCATIONAL INFORMATION
DEGREE COURSE COMPLETED DATE GRADUATED NAME OF SCHOOL LOCATION
PRIMARY Elementary Graduate 2009-04-03 E. Asion Elementary School Brgy. Cabuling, Banga, South Cotabato
SECONDARY High School Graduate 2013-03-18 Banga National High School Brgy. Benitez, Banga, South Cotabato
BACHELOR'S DEGREE Bs Criminology 2017-03-23 Marbel School Of Science And Technology Purok Upper Valley, Bo. 2, Koronadal City
GRADUATE DEGREE
PART III - PREVIOUS EMPLOYMENTS
NAME OF COMPANY/EMPLOYER ADDRESS YEAR EMPLOYED CONTACT NUMBER REASON FOR SEPARATION
0
PART IV - CHARACTER REFERENCE
NAME ADDRESS CONTACT NUMBER
Leny M. Buog Purok Malipayon, Brgy. Cabuling, Banga, South Cota 09055999541
Irene T. Borcillo Purok Malipayon, Brgy. Cabuling, Banga, South Cota 099398249660
Mae N. Bedicer Purok 19, Brgy. Fatima, General Santos City 09269726617

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 Over Printed Name of Applicant Date Accomplished

https://regularcy2019.pnp-dprm.com 2019-05-19 07:05:57