Download as pdf or txt
Download as pdf or txt
You are on page 1of 1

Republic of the Philippines

Department of the Interior and Local Government


BUREAU OF JAIL MANAGEMENT AND PENOLOGY
REGIONAL OFFICE VI
2nd & 3rd Floor, Ignie’s Place, Brgy. Buhang, Jaro, Iloilo City
Tel No. (033) 503-4018
Email Address: rbjmp6@gmail.com Website: www.bjmpr6.com

BJMP JO1 APPLICANT PAT FORM

___________________________________________________
Name (Family Name, First Name, Middle Name, Qualifier)

GENERAL INFORMATION
Age:
Date of Birth: Gender:
Age: Gender: CivilCivil
Status:
Status:
Weight: Address: Religion:

STRENGTH AND AGILITY TEST


RAW
EVENTS POINTS SCORER’S NAME SIGNATURE
SCORE
PULL-UP/HANGING
PUSH-UP
JUMPING JACK
100 M SPRINT
1000 M RUN

AVERAGE REMARKS: PASSED FAILED

Evaluated by:

___________________________
(Name & Signature of Evaluator)

I hereby certify that I have been duly informed of the mechanics of the above
examinations.

____________________________
(Name & Signature of Examinee)

_________________________
Date

“Changing Lives, Building a Safer Nation”

You might also like