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Po1 Recruitment Application Form

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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
ACG AKG ASG CES CIDG
CL EOD/ K9 HS HSS IG
ITMS LSS MG NCRPO PNPDEG
PRBS PRO1 PRO10 PRO11 PRO12
PRO2 PRO3 PRO4A PRO4B PRO5
PRO6 PRO7 PRO8 PRO9 PROARMM
PROCARAGA PROCOR PSPG TS WCPC
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 :

Gonzaga Wilfredo Cancio


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

Block-196 Lot-18 8b Phase-4 San Isedro, RODRIGUEZ (MONTALBAN), RIZAL, Region IV-A 1860
GENDER : CONTACT NUMBERS (Landline & Mobile) : E-MAIL ADDRESS :
MALE FEMALE None/09270275812 gonzagagerald77@gmail.com
CIVIL STATUS : DATE OF BIRTH (mm/dd/yyy): AGE : PLACE OF BIRTH (City, Town Province) :
SINGLE WIDOWER Balibadon Cortes Surigao Del Sur
MARRIED SEPARATED 08/12/1992 26 CITIZENSHIP : FILIPINO
WEIGHT (in kgs) : HEIGHT (in meters) : Member of NCIP/With NAPOLCOM Height/Age Waiver Only :

63.000 1.640 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 2006-03-28 Balibadon Elementary School Cortes Surigao Del Sur (mindanao)
SECONDARY Highschool 2010-04-05 Buenavista National Highschool Tandag Surigao Del Sur(mindanao)
BACHELOR'S DEGREE Ba. Political Science 2014-04-08 Surigao Del Sur State University Tandag Surigao Del Sur(mindanao)
GRADUATE DEGREE
PART III - PREVIOUS EMPLOYMENTS
NAME OF COMPANY/EMPLOYER ADDRESS YEAR EMPLOYED CONTACT NUMBER REASON FOR SEPARATION
SHERIDAN MARKETING INC. Quezon City 2018 none End Of Contruct
PART IV - CHARACTER REFERENCE
NAME ADDRESS CONTACT NUMBER
Juliebert L. Abao Balibadon Cortes, Surigao Del Sur 09125817374
Riza Devie C. Mendez Balibadon Cortes, Surigao Del Sur 09480543122

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 2019-05-02 20:20:41

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