APPLICATION FORM (AP01)

2x2
INSTRUCTION:
1. Type or print in block letters, fill in single copy.
2. Attach photo, size 2X2 taken not more than a year ago.
ID PHOTO

Date (Petsa)

I. PERSONAL INFORMATION(Personal na Impormasyon)

Last Name(huling pangalan) First Name(unang pangalan) Middle Name(Gitnang Pangalan) Nickname(palayaw)

Civil Status SG/LG /SO License Number Date Issued Date Expiry
(Katayuang sibil) (numero ng lisensya) (araw ng pagkakaloob) (petsa ng pagkawalang bisa)

Date of Birth Place of Birth Special Bank Receipt#

(Araw ng kapanganakan) (Lugar ng Kapanganakan) (Resibo na galling sa bangko)

Complete Permanent Address (House #/ Street/ Brgy./ District/ City/ Province):

(Kumpletong permanenteng tirihan)

Complete Provincial Address (House #/ Street/ Brgy./ District/ City/ Province):

( Kumpletong tirahan sa probinsya)

Contact Numbers:
Landline Mobile (1) Mobile (2)

Age(Edad) Height(taas) Weight (Kg)(bigat) Complexion(Kulay ng balat) Eye Color(Kulay ng Mata) Tattoes (tatto)
Ee
(

Religion(Relihiyon) Dialect Spoken(Lingwahe) Distinguish Mark/s (marka /palatandaan)

SSS Number PHILHEALTH Number PAGIBIG Number TIN Number

I. FAMILYBACKGROUND(BACKGROUND NG PAMILYA)

Names Occupation Company/School/Address

Father:

Mother:

Spouse:

Children:
1.
2.
3.
4.
5.

In case of emergency,contact: _________________

Relationship: ContactNo:

Ikaw ba ay may iniinom na maintenance para sa iyong kalusugan?Ano?_______________________

Ikaw ba ay na ospital na? or naoperahan?Ano?_______________________________________________

Series of 2023 Signature

 ll. EDUCATIONALBACKGROUND (BACKGROUND NG PANG- EDUKASYON)

Levels Name of School Year Attended

Remarks
(Antas) (Pangalan ng Eskwelahan) (Taon)

Primary (Elementarya)

Secondary
(Pangalawa)
Tertiary
(Kolehiyo)
Post Graduate /
Master’s Degree

lll. PROFESSIONAL EXPERIENCE/S(PROPESYONAL NA KARANASAN)

Security Agency Name/s Date Inclusion

Address of Agency Detachment
(Pangalan ng Ahensya ng Seguridad) (simula sa pinakalatest na
(Address ng Ahensya) (Detatsment)
inalisan na trabaho)
1

*If Retired Police or Military please provide Order of Training/Assignment/Retirement*

(Kung ikaw ay retiradong pulis o military mangyari magbigay ng order ng pagsasanay/pagtatalaga/pagreretiro)

IV. SKILLS & TRAININGS / ORGANIZATIONSATTENDED(MGA KASANAYAN AT PAGSASANAY)


Organization/Affiliations:
(MGA 
ORGANISASYON/AFFLIATION)


1.

2.

3.
Seminars:
4.

5.

1.
Other skills / talents:
(IBA PANG KASANAYAN AT
2.
TALENTO)
3.

V. MILITARY BACKGROUND
Were you ever convicted to other crime? If Yes What? ____________________________
(Ikaw ba ay nahatulan na ng pagkakakulong base sa isang krimen?) (Ano ito?) Yes No

Are you willing to transfer to any Position/Location If No,Why?

(Ikaw baay pumapayag ng kahit anong posisyon at malipat sa ibang lokasyon?) Yes No (Bakit?)

Series of 2023 Signature

 Character References (At least 2) (Kaibigan,Kamaganak or Kakilala)

1.
Name/Occupation Address Mobile No.

2.
Name/Occupation Address Mobile No.

VI. AVAILABILITY & PROXIMITY:

ExpectedSalary(Inaasahan na Sahod)__________
Availability toStart:(Kailan pwede magsimula)________
Amenable to work on holidays / extended hours: ____YES ___NO
(Pumapayag na magtrabaho sa mga opisyal na pista at pinahabang oras)
Willing to travel for work-related responsibilities: -----YES ------NO
(Handang Maglakbay para sa mga responsibilidad na may kaugnay sa trabaho)

Have you or any of immediate relatives ever been accused in the Police Dept. / Fiscal Office/ Military Tribunals
of the following crime such as theft, robbery, estafa , coercion, rape, grave, threats, physical injury, murder,
rebellion, perjury, kidnapping, carnapping , drug pusher/ user?

(Ikaw ba o sinuman sa mga malapit na kamag-anak ay naakusahan sa Police Dept. / Fiscal Office/ Military Tribunals
ng sumusunod na krimen tulad ng pagnanakaw, pagnanakaw, estafa , pamimilit, panggagahasa, libingan,
pananakot, pinsala sa katawan, pagpatay, paghihimagsik, pagsisinungaling, kidnapping, carnapping , drug pusher/
user?

if so state briefly( Kung gayon pakisalaysay) __________________________________________________________________

Vll. DATA PRIVACY ACT:

You agree that we may obtain and have access to your personal data for your application with
MLJDR Security Agency you permitted with authorized applicant consent solely with respect to
your personal information. We shall not use personal information for any other purpose.

(Ikaw aySumasang-ayon na maaari kaming makakuha at magkaroon ng access sa iyong personal na data
para sa iyong aplikasyon sa MLJDR na iyong pinahintulutan nang may awtorisadong pahintulot ng
aplikante na may kinalaman lamang sa iyong sariling personal na impormasyon. Hindi kami gagamit ng
personal na impormasyon para sa anumang iba pang layunin.)

I hereby sign this application with MLJDR Security Agency with statement of valid & justifiable
information. Any false information written above may be considered for grounds for termination &
invalidity of application.

(Pinirmahan ko ang application na ito sa MLJDR na may pahayag ng wasto at makatwirang impormasyon. Anumang
maling impormasyon na nakasulat sa itaas ay maaaring isaalang-alang para sa mga batayan para sa pagwawakas at
kawalan ng bisa ng aplikasyon)

I hereby certify that the originals of the documents (other requirement attached) of this form are
inspected by me and the photo copies are in the safe keeping of our agency. The document shall be
made available upon request.

(Sa pamamagitan nito, pinatutunayan ko na ang mga orihinal ng mga dokumento (iba pang kinakailangan na
nakalakip) ng form na ito ay sinisiyasat ko at ang mga kopya ng larawan ay nasa ligtas na pag-iingat ng aming
ahensya. Ang dokumento ay dapat gawin kapag hiniling).

Signature over Printed Name Date and Time

Series of 2023 Signature