Republic of the Philippines
Department of the Interior and Local Government
NATIONAL POLICE COMMISSION
POLICE REGIONAL OFFICE 10 (PRO 10)
Camp 1LT Vicente G. Alagar, Lapasan, Cagayan de Oro City
BADGE NO:
TIN NO:
PNP ID:
PNP PERSONAL DATA SHEET
Warning !
The correctness of all statements or entries made herein is subject to verification and any deliberate omission or
distortion of information may give sufficient cause of investigation.
I.
1. NAME
(Last Name,
First Name,
2. RANK
GENERAL INFORMATION
Middle Name,
Qualifier)
3. DESIGNATION
UNIT
SUBUNIT :
STATION :
ADDRESS :
7. DATE OF BIRTH
4. DATE DESIGNATED
5.
9.
6.
TEL #
8. PLACE OF BIRTH
10. PHONE #
HOME ADDRESS (House No. / Street / Mun. / City / Province)
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
21. IDENTIFYING MARKS
22. LANGUAGES/DIALECT (Read/Write/Speak)
23. ETHNIC GROUP
24. HOUSING DATA
25. DEPENDENTS
NAME
RELATIONSHIP
BIRTH DATE
ADDRESS
II. APPOINTMENT DATA
26. EFF. DATE OF PRESENT APPNTMT
27. STATUS OF PRESET APPNTMT
28. IF TEMPORARY STATE REASON
29. CHARACTER OF PRESENT APPNTMT 30. ORIGINAL RANK
31. FIRST UNIT ASSIGNMT
32. DATE OF ENLISTMENT
34. SOURCE OF COMMISSION
33. ORIGINAL APPNTMNT STATUS
III. EDUCATIONAL BACKGROUND
LEVEL
COURSE
SCHOOL
COLLEGE
HIGH SCHOOL
ELEMENTARY
__________________________
Signature
INCLUSIVE DATE
IV. TRAINING
CLASS FINAL
NO. GRADE
COURSE TITLE
LOCATION
AUTHORITY
INCLUSIVE DATE
TESTING CENTER
RATING
V. ELIGIBILITIES
DATE
TITLE
VI. PNP OCCUPATIONAL SPECIALTY (POS) / QUALIFICATION/SKILLS
POS/SKILL
YRS. EXPERIENCE
PLACE OF PRACTICE
RELEVANT COURSE TRAINING
VII. ASSIGNMENT RECORD
ASSIGNMENT, DESIGNATION
AUTHORITY
SOURCE
EFFECTIVITY DATE
VIII. PROMOTION RECORD
RANK
AUTHORITY
EFFECTIVITY DATE
REMARKS
IX. MEDALS / AWARDS / COMMENDATION
NATURE OF AWARD
SSC # BAL #
AUTHORITY
__________________________
Signature
AWARDED BY
REMARKS
X. FIREARMS RECORD
MR/LIC NO
KIND
MAKE
CALIBER
SERIAL NO
AMMO
ISSUING UNIT
XI. PHYSICAL AND MEDICAL RECORD
DATE OF LAST PHYSICAL/MENTAL EXAMINATION:
DATE OF LAST DENTAL EXAMINATION:
DATE OF LAST NP EXAMINATION:
WHERE TAKEN:
WHERE TAKEN:
WHERE TAKEN:
XII. OFFENSE DATA
OFFENSE AS CHARGED
OFFENSE
OFFENSE STATUS
DATE
COMMITTED
XIII. PERFORMANCE EVALUATION RATING
RATING PERIOD
NUMERICAL RATING
ADJECTIVAL RATING
XIV. DATA ON PREVIOUS RETIREMENT/DISMISSAL/RESIGNATION/SUSPENSION/OTHER
Have your ever been retired, dismissed, forced to resigned or suspended from any employment for reason other than lack of funds?
( ) YES ( ) NO If Yes, give particulars. ______________________________________________________________________
_____________________________________________________________________________________________________
Have you ever been a candidate in a national or local election (Including Barangay Election) ? ( ) YES
POSITION
( ) NO If Yes, give particulars
PLACE
DATE
XV. REFERENCES (Persons not related by consanguinity or affinity)
NAME
ADDRESS
PLEASE COPY IN OWN HAND WRITING
Our London Business is good but Vienna and Berlin are quiet, Mr. D Lord has gone to Switzerland and I hope for
goodness. He will be there for a week at 1946 Zenatt St., and then goes to Turnie and Rome and will join Co. Perry.
_________________________________________________________________________________________________________________
_________________________________________________________________________________________________________________
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CERTIFICATION
THIS IS TO CERTIFY that the answers given above are true and correct to the best of my knowledge and belief.
__________________________
SIGNATURE OVER PRINTED NAME
LEFT THUMBMARK
RIGHT THUMBMARK
SUBSCRIBED AND SWORN TO before me this ___ day of _______________ 20___ at _______________________
________________________________
(Printed Name and Signature)
Administering Officer
__________________________
Signature
