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Written Examination Form 1 (Rev.

Form 2014)

APPLICATION NO,

Republic of the Philippines


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DILG.NAPOLCOM Center Recent
EDSA corner Quezon Avenue, West Triangle, euezon City 1 '100 Passport size
Photo

polrcE EXECUTTVE SERVTCE ELtctBtLtTy (PESE)


EXAMINATION

PHASE l- Written Examination


Application Form

IMPORTANT: Read the'NOTICE TO APPLICANT" below before accomplishing this form.


DO NOT APPLY IF YOU ARE NOT QUALIFIED.

NOTICE TO APPLICANT
1. 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. Copy of attested appointment (KSS Porma Blg. 33)


b. Three (3) identical lD photos (one size 1"x'1" and two passport size) with full name tag that
includes the first name, middle initial and surname taken not more than three (3) months
before the filing of the application. Only one (1) passport size lD photo and the one (1) 1" x
1" lD photo shall be submitted upon filing of the application. The applicant shall keep the
second passport size lD photo and shall bring the same on the day of the examination for
posting in the examinee seat plan. Pictures that are scanned, photocopied or computer-
enhanced will not be accepted
. c. Examination fee of Seven Hundred Pesos (P700.00) either in CASH or in POSTAL MONEY
ORDER payable to the National Police Commission
d. Two (2) legal size window envelopes with Twenty pesos (F20.00) worth of Mailins Stamp
AFFIXED on each

3, Accomplished application forms may be filed directly with the NAPOLCOM Central Office or with
any of our Regional Offices which shall fonruard the same to the Central Office for processing.
Please do not fail to indicate your testing center preference (NCR, Cebu City or Davao City).

4. Application form must be accomplished in pRINT/BOLD letters.

5. For inquiries, you may contact the NAPOLCOM Examination Division at Tel. No. (02) 8gg0085
and (02)4032588 or you may visit our website: www.napolcom,gov,ph

TH|S FoRM tS NOT FOR SALE. REPRoDUCTIoN tS ALLOWED. q_


{
A. PERSONAT CIRCUMSTATVCES
1. SURNAME FIRST NAME MIDDLE NAME

2. PERMANENTADDRESS 3. CONTACT NUMBERS


LANDLINE:
MOBILE :

EMAIL ADDRESS :
4. CURRENTASSIGNMENT 5. PRESENTPOSITION/DESIGNATION 6. PRESENT RANK

7. DATE OF BIRTH 8. PLI ,CE OF BIRTH 9. HEIGHT 10. WEIGHT

11. SEX 12. CIVIL STATUS 13, NAME OF SPOUSE (if married)
N MALE I stucle
I I uRnnreo
reulle n wroowten
I sepRRareo
B. EDUCATION (please use separafe sheef, if necessary)
LEVEL OF NAME OF SCHOOL INCLUSIVE DATES COURSEIDEGREE SCHOLARSHIPI
EDUCATION ACADEMIC HONORS
RECEIVED

COLLEGE

GRADUATE
STUDIES

POLICE ELIGIBILITIES

D' W1RK EXPERIENCE (Start with thg tatest Work Experience. Please use separa te sheet, if
' necessary/

/1

?
OTHER INFORMATION
14, Do you have any pending administrative and/or criminal case? lf "yes", state the
nature of the case and where it is pending,

15. Have you taken the PESE Exam Phase I - Written Phase before? lf "yes",
specify the date/s.

F. IESI/TVG CENTER PREFERENCE: DATE OF D(AM:


(Request for change in testing center is not allowed)

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IDECLARE 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 AND
REGULATIONS OF THE REPUBLIC OF THE PHILIPPINES. ,

Signature of Applicant Date Right Thumb mark

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I orsappnoveo
NAME OF PROCESSOR
(Signature over Printed Name)

NOTICE OF ADMISSION
NAME :
Application No,:
ADDRESS:

Sir / Madam:
This is to inform you that you have been admitted to take the POLICE EXECUTIVE SERVICE
ELlGlBlLlTlY (PESE) EXAM - PHASE I (written Exam)on August 1t,2017.
School : Room No. Seat No.
Address:

RAMON M, RANESES, MNSA, CESO IV


Service Chief, PAS

BRING THE FOLLOWING ON EXAMINATION DAY:


1)ThisNoticeofAdmission; 2) Validldentification(lD)Cardwithpicture; 3) LeadpencitNo.2; 4) Btack/BtueBalpen;
5) One (1) passport size photograph

DO NOT BRING FIREARMS, CELLPHONES, PAGERS OR ANY TWO.WAY RADIO SET, REVIEW MATERIALS,
CALCULATOR OR ANY ELECTRONIC GADGET AND EXPLOSIVES OR ANY DEADLY WEAPON INSIDE THE
EXAM
CENTER/ROOM.

REMINDERS:
l Repbrt to the Exam Center in proper attire (Polo Barong - Male / Corporate Attire - Female).
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 Notice of Admission will be a sufficient ground to disqualify him/her from taking
the examination.
3 An applicant who fails to present a valid ldentification (lD) Card will not be ailowed to take the eximination.
' 4. A qualified applicant who failed to receive his/her Notice of Admission five (5) days before the date of examination
should notify the Examination Division, NAPOLCOM at DILG-NAPOLCOM Center, EDSA corner euezon Avenue.
west rriangle, Quezon city or may contact ret. Nos. (02) s99008s and (02) 4032588.
5. The Examination Fee of F700.00 shall be forfeited in case of non-appearance of the applicant during the exam