Written Examination Form (Rev.

Form 2011)

ANNEXA
APPLICATION NO.

Republic of the PhiliPPines Department of the lnterior and Local Government

NATIONAL POLICE COMMISSION 371 Sen. Gil PuyatAvenue, Makati City

Recent
Passport size Photo

polrcE ExEcurvE sERVrcE
PHASE

EL|GtBTLTTY (PESE) EXAMINATION

Written Examination Application Form

l-

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

NOTICE TO APPLICANT I 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. b.

c.

Copy of atlested appointment (KSS Porma Blg. 33) Service Record Three (3) identiclal photographs (one size 1"x 1" and two passport size) with full name tag that includes 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 the second passport size photograph and shall bring the same on the day of the examination for posting in the examinee seal plan. Pictures that are scanned, photocopied or computerenhanced will not be accepted. Examination fee of Seven Hundred Pesos (P700.00) either in CASH or in POSTAL MONEY 0RDER payable to the National Police Commission. Two (2) legal size window mailing envelope with mailing stamp worth F12.00

d.
e.
3.

Accomplished application forms may be filed directly with the NAPOLCOM Central Office or with any 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). Application form must be accomplished in PRINT/BOLD letters. 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.

4. 5,

^t
THIS FORM lS NOT FOR SALE. REPRODUCTION lS

T
ALLOWED.
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more informatlon aithe back

A.

PERSOi/AL CTRCUMSIAI'JCES
SURNAME FIRST NAME MIDDLE NAME

t. 2.

PERMANENT ADDRESS

3.

CONTACT NUMBERS LANDLINE: MOBILE i

EMAIL

:

4.

CURRENT ASSIGNMENT

5.

PRESENT POSITION

6.
HEIGHT

PRESENT RANK

7.
11.

DATE OF BIRTH

8.
12.

PLACE OF BIRTH

9.
13.

10.

WEIGHT

SEX MALE

E D

CIVIL STATUS SINGLE

tr

NAME OF SPOUSE (if manied)

renalur

I

n

umnteo
wDow,ER
SEPARATED

E

B.

EDUCATION (please use separale sheed
SCHOOL GRADUATED

if necessary)
DEGREE RECEIVED ACADEMIC HONORS RECEIVED

LEVEL OF EDUCATION COLLEGE

II'ICLUSIVE DATES

GRADUATE (MA'MS)
POST

GRADUATE (PhD)

C.

POLICE ELIGIBILIT'ES
DATE OF EXAiI PLACE OF EXAM RATING

EXAM (please specify)

{mmJddlvwv} NAPOLCoM (PSUPT EXAftI)
GSC: PRC:

BAR OTHERS:

D,

WORK ilQERIENCE (Start with fhe latesf necessary)
INCLUSIVE DATES

Wo* Expeience'

Please use separate sheet"

il

RANK

ASSIGNMENT

OTHER INFORMATION

14. 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
the dateis.

I

-

Written Phase

before?

lf "yes", specify

F.

IESI,I'JG CENTER PREFERENCE:
(Request for change in testing center is not allowed)

DATEOFD(AM:

!

rucn

I

CEBU CITY

!

DAVAo CITY

I 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 CORRECT STATEMENT PURSUANT TO THE PROVISIONS OF PERTINENT LAWS, RULES OF THE REPUBLIC OF THE PHILIPPINES.

Signature ofApplicant

Date

Right Thumb mark

I appnovro
fl
orslppnoveo
PROCESSOR (Signature over Printed Name)

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NOTICE OF ADMISSION
NAME

H= R=
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ADDRESS:

Application No,:
Sir / Madam:

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

School

:

Room

No.

Seat No.

Address:

JOSEPHMAR B, GIL, MPSA, CESO V
Acting Service Chiel PAS BRING THE FOLLOWING ON DGMINATION DAY: l)This Notice ofAdmission; 2) Valid ldentification (lD) Card with picture; 5) One (1) passport size photograph

3)

Lead Pencil No,2;

4)

BlacldBlue Ballpeni

DO 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 examination
5.
should notify the Examination Division, NAPOLCOM at 371 Sen, Gil Puyat Ave,, lMakati City or may contact Tel. Nos. (02)8990085 dfl (02)4032588 and u tvz./'rvrz.roo tuzloJruur.r\.r The Examination Fee 0fP700.00 shall be forfeited in case of non-aDpearanc€ of tire applicant durinq the exam dsy,

/44.