Pnpa Application Form R-2009

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 Castañeda, Silang, Cavite 4129 Tele Fax # (049) 545-5940/(02) 396-4076 Website: www.pnpa.edu.ph Email Add: [email protected]

Recent Photo With name tag Original Copy (Passport Size) [1.5’x2”]

PNPACAT Application Form Revised 2009

APPLICATION FOR PNPA CADET ADMISSION TEST (IMPORTANT: READ INSTRUCTIONS AT THE BACK OF THIS FORM. ACCOMPLISH THIS FORM COMPLETELY & ACCURATELY) TEST CENTER PREFERENCE:__________________________________________________________________________ CODE: ___________

1. SURNAME

2.GENDER : Male Female

FIRST NAME MIDDLE NAME 3. COMPLETE MAILING ADDRESS with ZIP Code: 4. CIVIL STATUS: 8. AGE :

BIRTHDATE:

5. CITIZENSHIP:

Month Date

Year

REGION:______

Email Address:______________________ TEL NO.: (Res)_____________________ (Mobile)___________________________ 6. HEIGHT: (cm) 7. WEIGHT: (kg)

9. BIRTHPLACE:_______________________________________________ (City/Town/Province)

10. FATHER’S NAME: _____________________________ ADDRESS ______________________________________________ 11. MOTHER’S NAME: _____________________________ ADDRESS______________________________________________ 12. GUARDIAN’S NAME: ___________________________ Relationship ________________ ADDRESS___________________ 13. EDUCATION (Please check highest educational achievement only)

High School Graduate: College Undergraduate: College Graduate: Degree: _________________________________________ School: _______________________ Year 1st 2nd 3rd 4th 5th ______________________________ Level: [ ] [ ] [ ] [ ] [ ] School: ________________________ Year Graduated: ________________ Course: ____________________________ _______________________________ School: Year Graduated: _________________ 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 Prosecutor’s 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. _______________________________ (Signature of Applicant) Region

AREAS

1

Laoag City 001 San Fernando City, La Union 002 Tuguegarao City 003 Cauyan, Isabela 004 Cabanatuan City 005 San Fernando City, Pampanga 006 Calamba City 007 Lucena City 008 Daet, Camarines Norte 009 Legazpi City 010 Iloilo City 011 Bacolod City 012

2 3 4A&B 5 6

CODE

Region

AREAS

7 8 9 10 11 12 NCR

Cebu City Tacloban City Zamboanga City Cagayan de Oro City Davao City General Santos City Taguig City Quezon City City of Manila CAR Baguio City Lamut, Ifugao CARAGA Butuan City ARMM Cotabato City

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

CODE

013 014 015 016 017 018 019 020 021 022 023 024 025

INSTRUCTIONS Please read instructions carefully. Strictly comply with the qualification requirements. Inaccurate or incomplete information shall be a ground for disqualification. PLEASE SUBMIT ONLY ONE (1) APPLICATION. 1. Check if you have the following INITIAL REQUIREMENTS FOR ADMISSION. (PLEASE DO NOT APPLY if you are NOT QUALIFIED) • • • • • • • •

A natural born Filipino citizen; Of good moral character; Male or female, single and with no legal obligation to support a child or children; 17 to 21 years old (Born between May 2, 1988 – May 1, 1993); Height of at least 162.5 cm (5ft 4 in) for male, and 157.5 cm (5ft 2 in) for female; Weight of not more nor less than five (5) kilograms of the standard weight measurement corresponding to height, age and sex; At least high school graduate; Must be able to perform the following physical fitness exercises: Exercises Pull-Ups Full Arms Hanging 2 min Push-Ups 2 min Sit-Ups 100 meter dash 1000 meter run

• • •

Female 40 sec 35 50 20 sec 5:30

Male 10 40 55 17 sec 4:30

Physically and mentally fit for cadetship training; No criminal, administrative, or civil case on file before any Prosecutor’s Office or any Court of Justice and other derogatory record(s); Not a former cadet of PNPA or other service academies.

2. GROUNDS FOR MEDICAL DISQUALIFICATION: • • •

• • • •

Defective Visual Perception (color blindness, near sighted/far sighted with corrective eyeglasses or lens); 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 operations; communicable diseases (such as AIDS, Hepatitis, VD etc.) Full dentures, upper and lower, Cleft lip and palate, Malocclusion, Deformities of the face, Open bite, Tongue-tied; Missing of four anterior or front teeth & Missing of six (6) posterior/molar teeth; Tattoos and other brotherhood marks, ear piercing (male only) Add’l for Females: 1. Goiter 2. History of pregnancy 3. Presence of breast mass 4. Painful menstruation

3. COVERAGE OF EXAMINATION: • • • • •

Communication Skills Math and Sciences Logical and Reasoning Ability General Information and Current Events Values and Aptitude for the Service

4. 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 Castañeda, 4129 Silang, Cavite. 5. DEADLINE FOR SUBMISSION OF APPLICATION: September 30, 2009 6. NOTICE OF EXAMINATION shall be sent through mail or you may visit our website: www.pnpa.edu.ph for the list of qualified examinees, place of examination, and other test requirements. APPLY NOW : The PNPA Cadet Admission Test will be on October 25, 2009 (Sunday), 7:00am

MOTTO: TO LEARN TODAY, TO LEAD TOMORROW