PNPA CAT Application Form Revised 2012-A PNPA REGIST

PHILIPPINE NATIONAL POLICE ACADEMY

Camp General Mariano N Castaneda, Silang, Cavite 4129 Tele Fax # (049) 545-5939/ (0939) 9393769 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

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

SEX . MALE

AGE FEMALE E

WEIGHT(kg)

CIVIL STATUS SINGLE SINGLE PARENT MARRIED WIDOWED

SEPARATED ANNULLED

HEIGHT 5 BELOW 52
BELOW

54

COMPLETE MAILING ADDRESS with ZIP Code: BIRTHDATE(date/month/year) BIRTHPLACE (city/town/province) CITIZENSHIP

FAMILY BACKGROUND FATHERS NAME:____________________________ CONTACT NUMBER:_______________ ADDRESS: _________________________________________________________________ MOBILE PHONE NUMBER: MOTHERS NAME:___________________________ CONTACT NUMBER: ______________ ____________________ ADDRESS: _________________________________________________________________ ____________________ GUARDIANS NAME: _________________________ RELATIONSHIP:___________________ ADDRESS: _________________________________ CONTACT NUMBER:_______________ EDUCATIONAL ATTAINMENT COLLEGE/VOCATIONAL HIGH SCHOOL LEVEL: 1ST 2ND 3RD 4TH 5TH Year Graduated:____________ SCHOOL________________________________ SCHOOL:___________________________________________________ GENERAL AVERAGE (RATING):_______________ COURSE: ___________________________________________________ ACADEMIC AWARDS: _____________________ ACADEMIC AWARDS: _________________________________________ OTHER AWARDS:_________________________ OTHER AWARDS: ____________________________________________ CIVIC ORGANIZATIONS/AFFILIATION:_________________________ POSITION HELD: _______________________________ 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 NO case, or convicted for any violation of law, ordinance or regulations before any civil court and/or military tribunal? YES 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 ___ OTHERS

EMAIL ADDRESS: ___________________ ___________________ 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

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. REQUIREMENTS FOR ADMISSION: (DO NOT APPLY if you are NOT QUALIFIED) Natural born Filipino citizen; Of good moral character; No financial obligations; Male or female, single and with no parental obligation; 17 to 21 years old at the time of admission; Preferably 5feet 4inches in height for male, and 5feet 2inches for female except for indigenous people; 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 pass the minimum required physical fitness exercises: Exercises Male Female Pull-Ups 3 Full Arms Hanging 30seconds Push-Ups(2 minutes) 15 10 Sit-Ups (2 minutes) 30 25 100 meter dash 18seconds 20seconds 3 km run 27minutes 30minutes Physically and mentally fit for cadetship training; Have no criminal, administrative, or civil case and other derogatory record(s); Must not be 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 (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; sexually transmitted infection 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(4) anterior or front teeth & Missing of six (6) posterior/molar teeth; Tattoos and other brotherhood marks, ear piercing (male only); For Females: 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). Cadets shall reimburse the government expenses for his/her scholarship should he/she fail to complete the Cadetship Program. 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 24, 2012 PNPA Cadet Admission Test will be on October 28, 2012 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

LOCATION
Vigan City Dagupan City Tuguegarao City Cauayan, Isabela Cabanatuan City City of San Fernando, Pampanga Calamba City Lucena City Odiongan, Romblon Dasmarias City

TEST CENTER PREFERENCE CODE REGION

001 002 003 004 005 006 007 008 025 029 009 010 011 012 026 CARAGA ARMM CAR X XI XII NCR IX VII VIII

LOCATION
Cebu City Tacloban City Catarman, Northern Samar Zamboanga City Pagadian City Cagayan de Oro City Davao City General Santos City Quezon City Manila Baguio City Lamut, Ifugao Butuan City Cotabato City Bongao, Tawi-Tawi

CODE
013 014 030 015 027 016 017 018 019 020 021 022 023 024 028

V VI

Legazpi City Naga City Iloilo City Bacolod City Kalibo, Aklan