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Written Examination Form (Rev. Form 2011)

Republic of the PhiliPPinesDepartment of the lnterior and Local Government

NATIONAL POLICE COMMISSION371 Sen. Gil PuyatAvenue, Makati City

polrcE ExEcurvE sERVrcE EL|GtBTLTTY (PESE) EXAMINATIONPHASE l- Written ExaminationApplication Form

ANNEXAAPPLICATION NO.

RecentPassport size

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IMPORTANT: Read the 'NOTICE TO APPLICANT' below before accomplishing this form.DO NOT APPLY IF YOU ARE NOT QUALIFIED.

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NOTICE TO APPLICANTI . An applicant must be a Filipino citizen of good moral character and must hold the rank of Police

Chief lnspector and above in permanent status.2. The following documents shall accompany this application form upon filing:

a. Copy of atlested appointment (KSS Porma Blg. 33)b. Service Recordc. Three (3) identiclal photographs (one size 1"x 1" and two passport size) with full name tag thatincludes the flrst name, middle initial and surname taken not more than three (3) months

before the flling of the application. Only one (1) passport size photograph and the one (1) 1" x'1" photographs shall be submitted upon filing of the application. The applicant shall keep thesecond passport size photograph and shall bring the same on the day of the examination forposting in the examinee seal plan. Pictures that are scanned, photocopied or computer-enhanced will not be accepted.d. Examination fee of Seven Hundred Pesos (P700.00) either in CASH or in POSTAL MONEY0RDER payable to the National Police Commission.e. Two (2) legal size window mailing envelope with mailing stamp worth F12.00

3. Accomplished application forms may be filed directly with the NAPOLCOM Central Office or withany of our Regional Offices who shall forward the same to the Cenkal Office for processing.Please do not fail to indicate your testing center preference (NCR, Cebu City or Davao City).

4. Application form must be accomplished in PRINT/BOLD letters.5, For inquiries, you may contact the NAPOLCOM Examination Division at Tel. Nos. (02) 8990085

and (02) 4032588 or you may visit our website: www,napolcom,gov,ph.

THIS FORM lS NOT FOR SALE. REPRODUCTION lS ALLOWED. more informatlon aithe back ---->

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t. SURNAME FIRST NAME MIDDLE NAME2. PERMANENT ADDRESS 3. CONTACT NUMBERS

LANDLINE:MOBILE iEMAIL :4. CURRENT ASSIGNMENT 5. PRESENT POSITION 6. PRESENT RANK7. DATE OF BIRTH 8. PLACE OF BIRTH 9. HEIGHT 10. WEIGHT11. SEXE MALE

D renalur12. CIVIL STATUStr SINGLEI umnteon wDow,ERE SEPARATED

13. NAME OF SPOUSE (if manied)

A. PERSOi/AL CTRCUMSIAI'JCES

B. EDUCATION (please use separale sheed if necessary)

C. POLICE ELIGIBILIT'ES

D, WORK ilQERIENCE (Start with fhe latesf Wo* Expeience' Please use separate sheet" ilnecessary)

INCLUSIVE DATES RANK ASSIGNMENT

LEVEL OFEDUCATION

SCHOOL GRADUATED II'ICLUSIVE DATES DEGREE RECEIVED ACADEMIC HONORSRECEIVED

COLLEGE

GRADUATE(MA'MS)

POSTGRADUATE(PhD)

EXAM (please specify) DATE OF EXAiI{mmJddlvwv}PLACE OF EXAM RATING

NAPOLCoM (PSUPT EXAftI)GSC:PRC:BAROTHERS:

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OTHER INFORMATION14. Do you have any pending adminishative and/or criminal case?

nature of the case and where it is pending.lf "yes", state the

15. Have you taken the PESE Exam Phase I - Written Phase before? lf "yes", specifythe dateis.F. IESI,I'JG CENTER PREFERENCE:(Request for change in testing center is not allowed) DATEOFD(AM:! rucn I CEBU CITY ! DAVAo CITYI DECLARE UNDER OATH THAT THIS APPLICATION HAS BEEN ACCOMPLISHED IN GOOD FAITH,VERIFIED BY ME AND TO THE BEST OF MY KNOWLEDGE AND BELIEF, IS A TRUE AND CORRECTSTATEMENT PURSUANT TO THE PROVISIONS OF PERTINENT LAWS, RULESOF THE REPUBLIC OF THE PHILIPPINES.

Signature ofApplicant

I appnovrofl orslppnoveo PROCESSOR

(Signature over Printed Name)

Date Right Thumb mark

=="EqkR=zx uJE6OEqkH=zx ulNOTICE OF ADMISSIONNAME

ADDRESS:Application No,:

Sir / Madam:This is to inform you that you have been admitted to take the POLICE EXECUTIVE SERVICEELlGlBltlTlY (PESE) EXAM - PHASE I (Written Exam) on AUGUST 25, 2013.

School :Address:

Room No. Seat No.JOSEPHMAR B, GIL, MPSA, CESO V

Acting Service Chiel PASBRING THE FOLLOWING ON DGMINATION DAY:l)This Notice ofAdmission; 2) Valid ldentification (lD) Card with picture; 3) Lead Pencil No,2; 4) BlacldBlue Ballpeni5) One (1) passport size photographDO NOT BRING FIREARMS, EXPLOSIVES OR ANY DEADLY WEAPON INSIDE THE EXAM CENTER/ROOM.REMINDERS:1. Report to the Exam Center in proper attire (Polo Barong),2, Examinees are required to be at the examination venue by 7:30 AM. Tardiness and/or failure of the applicant to

present his/her Notic ofAdmission will be a sufficient ground to disqualify him/her from taking the examination.3. An applicant who fails to present a valid Identification (lD) Card will not be allowed to take fie examination.4. A qualified applicant who failed to receive his/her Notice of Admission five (5) days before {he date of examinationshould notify the Examination Division, NAPOLCOM at 371 Sen, Gil Puyat Ave,, lMakati City or may contact Tel. Nos.(02)8990085 and (02)4032588tuzloJruur.r\.r dfl u tvz./'rvrz.roo5. The Examination Fee 0fP700.00 shall be forfeited in case of non-aDpearanc of tire applicant durinq the exam dsy,

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