Republic of the Philippines

National Police Commission

PHILIPPINE NATIONAL POLICE
NUEVA ECIJA POLICE PROVINCIAL OFFICE
ALIAGA POLICE STATION
Aliaga, Nueva Ecija

BADGE NO: ___________

TIN NO: _____________

PNP PERSONAL DATA SHEET PNP ID: _____________

Warning:

The correctness of all statements or entries made herein is subjected to verification and any deliberation omission or
distortion may give sufficient cause for Investigation.

I. GENERAL INFORMATION
1. NAME (Last Name, First Name, Middle, Qualifier)

2. RANK : 3. DESIGNATION : 4. DATE DESIGNATION:

5. UNIT : Police Regional Office 3 6. OFFICE TEL #

SUB UNIT : Nueva Ecija Police Provincial Office
STATION : Aliaga, Police station
ADDRESS : Poblacion Centro, Aliaga, Nueva Ecija

7. DATE OF BIRTH: 8. PLACE OF BIRTH:

9. HOME ADDRESS (House No/Street/Mun/City/Province: 10. PHONE/MOBILE #:

11. SEX: 12. CIVIL STATUS: 13. RELIGION:

14. COLOR OF EYES: 15. HEIGHT (ft): 16. WEIGHT (kgs):

17. BLOOD TYPE: 18. BUILD: 19. COMPLEXION:

20. COLOR OF HAIR: Black 21.IDENTIFYING MARKS:

22. LANGUAGES/DIALECT: 23. ETHNIC GROUP:

24. HOUSING DATA

Own House & Lot Own Lot Only Rent Room Others
Own House Only Rent House Occupying Gov’t Qtrs (Specify)_________
II. APPOINTMENT DATA
APPOINTMENT:
APPTING AUTH SOURCE ORDER1 AUTH DATE EFF DATE APPMT STAT MODE OF REMARKS
ENTRY2

ABSORPTION:
ORIG/ABSORB SOC3 FIRST UNIT AUTHORITY AUTH DATE DATE EFF
RANK ASSMT (Source/Auth#/Para#/Line3)

ATTESTATION:
APPOINTMENT4 RANK APPT OFFC’R APPT DATE ATTES ATTES DATE ELIG CRTL NO
OFFC’R

Continue on separate sheet, if necessary

1- SOURCE OF ORDER/AUTH#/PARA#/SEC#. Example: SO# 123/P2/S1

2- MODE OF ENTRY: Example New Recruit, Lat Entry, Absorption, PNPA, Reappointment, Presidential Appmt, Appmt
3- SOURCE OF COMMISSION: Example: PMA, PNPA, LAT ENTRY, PNP NCO, EX-INP NCO, EX-PC EF, Etc
4- APPOINMENT: Example: Rank Adjusted, Absorption, Promotion or None
25. NAME OF SPOUSE OR NEAREST KIN/ADDRESS:

26. DEPENDENTS:

NAME RELTN BDATE BIRTH PLACE OCCUPATION SOURC

(Continue on separate sheet, if necessary)

III EDUCATIONAL BACKGROUND
LEVEL COURSE SCHOOL ADDRESS
ELEMENTARY
HIGH SCHOOL
VOCATIONAL
COLLEGE

MASTERAL UNDER GRAD

MASTERAL EDUCATION
LLB UNDER GRAD
LLB GRAD
UNDER DOCTORAL EDUC
DOCTORAL EDUCATION
IV. TRAINING
COURSE SCHOOL LOCATION INCLUSIVE DATE NO. OF HOURS

(Continue on separate sheet, if necessary)

V. ELIGIBILITIES
TITLE CENTER LOCATION

(Continue on separate sheet, if necessary)

VI. PNP OCCUPATIONAL SPECIALTY (POS)/ QUALIFICATIO
POS/SKILLS PLACE OF PRACTICE RELEVA

VII. ASSIGNMENTS RECORDS

UNIT SUB UNIT STATION DESIGNATION ISSUING UNITS

(Continue on separate sheet, if necessary)

VIII. SERVICE RECORD
INCLUSIVE DATES RANK AGENCY ISSUING UNIT AUTHORITY
(Source Order/Auth date/Para#/Sec#/Line#)
 (Continue on separate sheet, if necessary)
IX. PROMOTION RECORD
PREVIOUS NEW RANK ISSUING UNIT AUTHORITY AUTH D
RANK (SOURCE Order/Auth Date/Para#/Sec#/Line#)

(Continue on separate sheet , if necessary)

X. MEDALS/AWARDS/COMMENDATION
NATURE OF AWARDS ISSUING UNIT AUTHORITY
(Source Order/Auth date/Para#/Sec#/Lin3#

(Continue on separate sheet, if necessary)

XI. FIREARMS RECORD
MR/LIC NO. KIND MAKE CALIBER SERIAL NO.

XII PHYSICAL AND MEDICAL RECORD

DATE OF LAST PHYSICAL/MENTAL EXAMINATION WHERE TAKEN:
DATE OF LAST DENTAL EXAMINATION WHERE TAKEN:
DATE OF LAST NP EXAMINATION WHERE TAKEN:
XIII. OFFENSE DATA
PERSNL STATUS OFFENSE COMMITTED OFFENSE STATUS5 INVESTIGATING AUTHORITY OFFE
UNIT

XIV. PERFORMANCE EVALUATION RATING

PERIOD YEAR UNIT ASSIGN DESIGNATION DATE RATED RATER/DESIGN

1ST SEM
2ND SEM

5- OFFENSE STATUS: Example: Pending, Dismissed or Resolved

6- OFFENSE CLASS: Example: Criminal or Administrative

XV. LEAVE RECORD

TYPE OF LEAVE WHERE SPENT7 DATE NO. OF DAYS ISSUING UNIT
Authorized Actual Used (
 (Continue on separate sheet, if necessary)
XVI. DATA ON PREVIOUS RETIREMENT/DISMISSAL/REGISTRATION/S

Have you ever been retired, dismissed, forced to resigned or suspended from any employment for XVII. REFERENCE (Perso
Reason other than lack of funds?
NAME
YES NO if YES, give particulars. ______________________________________________
1. __________________________

Have you ever been a candidate in a national or local election (including Barangay Election)? 2. __________________________
YES NO if YES, give particulars
3. __________________________
POSITION PLACE DATE

CERTIFICATION

THIS IS TO CERTIFY that the answers given above are true and correct to the best of my knowledge and belief.

____________

SUBSCRIBED AND SWORN TO before me this ________ day of __________________________ 20 ____

LV REC, WHERE SPEND: Example: Abroad, Locally, Hospital or Others (please specify)

Extra Sheet …..

ASSIGNMENTS RECRDS
UNIT SUB UNIT STATION DESIGNATION ISSUING UNIT

SERVICE RECORD
INCLUSIVE DATES RANK AGENCY ISSUING UNIT AUTHORITY
(Source Order/Auth date/Para#/Sec#/Line#)