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
ITMS LSS MG
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 :
Fabuna Catherine Joy Diaz
PERMANENT MAILING ADDRESS (House No., Street, Town Province/City): ZIP CODE :
Purok San Isidro Lamian, SURALLAH, SOUTH COTABATO, Region XII 9512
GENDER : CONTACT NUMBERS (Landline & Mobile) : E-MAIL ADDRESS :
MALE FEMALE /09977307644 cath_joy0725@yahoo.com
CIVIL STATUS : DATE OF BIRTH (mm/dd/yyy): AGE : PLACE OF BIRTH (City, Town Province) :
SINGLE WIDOWER Brgy Udtong, Lambayong, Sultan Kudarat
MARRIED SEPARATED 03/22/1993 26 CITIZENSHIP : FILIPINO
WEIGHT (in kgs) : HEIGHT (in meters) : Member of NCIP/With NAPOLCOM Height/Age Waiver Only :
59.000 1.651 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 2005-03-28 Udtong Elementary School Udtong, Lambayong, Sultan Kudarat
SECONDARY Highschool 2009-04-02 Libertad National High School Libertad, Surallah South Cotabato
BACHELOR'S DEGREE Bachelor Of Science In Information Technoloy Major 2015-04-06 Sultan Kudarat State University Isulan, Sultan Kudarat
GRADUATE DEGREE
PART III - PREVIOUS EMPLOYMENTS
NAME OF COMPANY/EMPLOYER ADDRESS YEAR EMPLOYED CONTACT NUMBER REASON FOR SEPARATION
MERCURY DRUG CORPORATION Cp Garcia Highway, Buhangin, Davao City 2015 241-2181 I Am Not Yet Resigned.
PART IV - CHARACTER REFERENCE
NAME ADDRESS CONTACT NUMBER
Melanie S. Lauren Mintal, Davao City 09771276935
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 2019-06-06 00:33:16
