For Evaluation Only. Revised 2011-A PNPA REGIST PNPA CAT Application Form Copyright (c) by VeryPDF.

com Inc Edited by VeryPDF PDF Editor Version 2.6

PHILIPPINE NATIONAL POLICE ACADEMY

P.O. Box # 37 Camp General Mariano N Castaneda, Silang, Cavite 4129 Tele Fax # (49) 545-5939/09282074255 Website: www.pnpa.edu.ph Email Add: info@pnpa.edu.ph

APPLICATION FOR CADET ADMISSION TEST

(IMPORTANT: READ THE INSTRUCTIONS AT THE BACK OF THIS PAGE BEFORE ACCOMPLISHING THIS APPLICATION FORM.)

SURNAME FIRST NAME MIDDLE NAME

F FD E O A L F L O Y D T I

E A M A R C O R E

E S

L L

RECENT PHOTO IN PASSPORT SIZE WITH NAME TAG AND WHITE BACKGROUND (DIGITAL
PHOTO IS NOT ACCEPTED)

SEX AGE . // MALE FEMALE E 17

WEIGHT(kg)

52

/ SINGLE
MARRIED

CIVIL STATUS SINGLE PARENT WIDOWED

SEPARATED ANNULLED

HEIGHT 5 BELOW 52
BELOW

54

COMPLETE MAILING ADDRESS with ZIP Code:

Boystown Complex, Parang Marikina City

BIRTHDATE(date/month/year) BIRTHPLACE (city/town/province) CITIZENSHIP

22/Dec/1993

San Miguel, Natividad Pangasinan

Filipino

FAMILY BACKGROUND Maximo S. dela Pea 09098734537 Maximo S. dela Pea a FATHERS NAME:____________________________ CONTACT NUMBER:_______________ Sta. Rosa Laguna ADDRESS: _________________________________________________________________ MOBILE PHONE NUMBER: Rowena E. dela Pea a MOTHERS NAME:___________________________ CONTACT NUMBER: ______________ 09352713761 ____________________ Sta. Rosa Laguna ADDRESS: _________________________________________________________________ ____________________ _ OTHERS Rodolfo Estillore Grandfather GUARDIANS NAME: _________________________ RELATIONSHIP:___________________ Boystown Complex, Parang Marikina City ADDRESS: _________________________________ CONTACT NUMBER:_______________ ___________ EDUCATIONAL ATTAINMENT COLLEGE/VOCATIONAL HIGH SCHOOL LEVEL: 1ST / 2ND 3RD 4TH 5TH Year Graduated:____________ : Valeriano E. Fugoso Pamantasan ng Lungsod ng Marikina SCHOOL________________________________ SCHOOL:___________________________________________________ BS Criminology GENERAL AVERAGE (RATING):_______________ COURSE: ___________________________________________________ ACADEMIC AWARDS: _____________________ ACADEMIC AWARDS: _________________________________________ OTHER AWARDS:_________________________ OTHER AWARDS: ____________________________________________ CIVIC ORGANIZATIONS/AFFILIATION:_________________________ POSITION HELD: _______________________________ Basketball SPORTS : _________________________________ HIGHEST SPORTS ACHIEVEMENT: _________________________________ OTHER SKILLS:___________________________________________________________________________________________ Have you ever been dismissed from any employment, forced to resign or otherwise disciplined as a result of an administrative case, or convicted for any violation of law, ordinance or regulations before any civil court and/or military tribunal? YES / NO If YES, please attach copy of the decision. 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 Do you have any parental and/or financial obligation, or have 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. __________________________ (Signature of Applicant)

52 53 54 55 56 57 58 59 510 511 60

EMAIL ADDRESS: ___________________ floydmarc01@ ___________________ yahoo.com TEL/LANDLINE NUMBER: ___________________ ___________________

NOTICE OF EXAMINATION OR ADMISSION NOTICE from the PNPA REGISTRAR shall be sent through mail. Applicants who fail to receive notice of examination may visit the PNPA website at www.pnpa.edu.ph to check if he/she is included in the List of Qualified Examinees. If found qualified, applicants may go directly at the designated examination areas on the date of examination even without the notice of examination. Applicants shall present valid personal identification cards (IDs) together with other requirements.

TO LEARN TODAY, TO LEAD TOMORROW

(REPRODUCTION OF THIS FORM IS ALLOWED) Application form can be downloaded at www.pnpa.edu.ph

For Evaluation Only. Copyright (c) by VeryPDF.com Inc Edited by VeryPDF PDF Editor Version 2.6

INSTRUCTIONS
Please read instructions carefully. Be sure to meet the qualification requirements. Inaccurate or incomplete information will be ground for disqualification. SUBMIT ONLY ONE (1) APPLICATION. 1. QUALIFICATIONS/ INITIAL REQUIREMENTS FOR ADMISSION: (DO NOT APPLY if you are NOT QUALIFIED) Natural born Filipino citizen; Of good moral character; Male or female, single and with no parental and financial obligation to anybody; 17 to 21 years old at the time of admission; Height of at least 162.5 cm (5ft 4in) for male, and 157.5cm (5ft 2in) for female; Weight must not be more than or not less than five (5) kilograms of the standard weight corresponding to height, age, and sex; At least high school graduate; Must be able to perform the following physical fitness exercises: Exercises Male Female Pull-Ups 3 Full Arms Hanging 30 sec 2 min Push-Ups 25 25 2 min Sit-Ups 30 25 100 meter dash 18 sec 20 sec 3 km run 27 mins 30 mins Physically and mentally fit for cadetship training; No criminal, administrative, or civil case and other derogatory record(s); Not a former cadet of PNPA or other service academies; 2. GROUNDS FOR MEDICAL DISQUALIFICATIONS: Defective Visual Perception (color blindness, near sighted/far sighted with corrective eyeglasses or lens, nystagmus); Physical Deformities Example: bowlegged or congenital defects; Perforated ear drum, chronic sinusitis, bleeding tendencies, hemorrhoids, hernia (if not treated), varicocoele, extensive skin disorders; History of heart disease, hypertension, asthma, active PTB, kidney and liver diseases, epileptic seizure disorders, major surgical operations; communicable diseases (such as AIDS, Hepatitis, VD etc.); Full dentures, Cleft lip and palate, malocclusion, Deformities of the face, Open bite, Speech defect, four(4) missing front teeth and/or six (6) posterior/molars; Tattoos and other brotherhood marks, ear piercing (male only); Goiter; History of pregnancy; Presence of breast mass; Painful menstruation; Any other similar defects which may hinder in the Cadetship Training Program. 3. The PNPA Cadetship Program is a government Scholarship Program. Admitted Cadets must complete the Cadetship Program and serve the government either in the PNP, BFP or BJMP services for the prescribed period (two years of service for every year of scholarship). Admitted cadets shall pay back the expenses incurred for his/her scholarship should he/she fail to complete the Cadetship Program. Graduates shall reimburse the government the expenses incurred during their Cadetship Program if they fail to complete the required years of service. 4. COVERAGE OF EXAMINATION Communication Skills General Information and Current Events Logical and Reasoning Ability Values and Aptitude for the Service Math and Sciences
5. Submit duly accomplished application together with a self-stamped WINDOW ENVELOPE to the Office of the Registrar or mail to: The Director, (Attn: Registrar), Philippine National Police Academy, Camp General Mariano N Castaeda, 4129 Silang, Cavite. 6. DEADLINE FOR SUBMISSION OF APPLICATION: September 30, 2011 PNPA Cadet Admission Test will be on October 30, 2011 7. PLEASE CHOOSE YOUR TEST CENTER PREFERENCE INDICATED BELOW. PUT A CHECK ON THE BOX BESIDE THE TEST CENTER CODE. REGION I II III IV A & B V VI LOCATION Laoag City San Fernando City, La Union Tuguegarao City Cauyan, Isabela Cabanatuan City City of San Fernando, Pampanga Calamba City Lucena City Legazpi City Daet, Camarines Norte Iloilo City Bacolod City TEST CENTER PREFERENCE CODE REGION 001 002 003 004 005 006 007 008 009 010 011 012 VII VIII IX X XI XII NCR NCR CAR CAR CARAGA ARMM LOCATION Cebu City Tacloban City Zamboanga City Cagayan de Oro City Davao City General Santos City Quezon City Manila Baguio City Lamut, Ifugao Butuan City Cotabato City CODE 013 014 015 016 017 018 019 020 021 022 023 024