Republic of the Philippines

PHILIPPINE NATIONAL POLICE

DIRECTORATE FOR PERSONNEL AND RECORDS MANAGEMENT
RECRUITMENT AND SELECTION DIVISION
Camp Crame, Quezon City

PO1 RECRUITMENT APPLICATION FORM

PLEASE CHECK UNIT WHERE YOU ARE APPLYING:
RECRUITING UNIT/OFFICE
NCRPO PRO 6 PRO 13 HSS CL
PRO 1 PRO 7 PRO 18 ITMS HPG
PRO 2 PRO 8 PRO ARMM PCRG PNPDEG
PRO 3 PRO 9 PRO COR EOD K9 PSPG
PRO 4A PRO 10 AVSEGROUP WCPC
PRO 4B PRO 11 SAF IG
PRO 5 PRO 12 MG CIDG
WARNING: This application must be filled out personally by the applicant. Any false information or misinterpretation made in this information form is a
ground for disqualification and filing of criminal action against the applicant.

PART I - PERSONAL INFORMATION

LAST NAME : FIRST NAME : QUALIFIER : MIDDLE NAME :

De Vera Ariel Ellery Bustillo

PERMANENT MAILING ADDRESS (House No., Street, Town Province/City): ZIP CODE :

#93 Gen. Funston St. Pob. Zone Iv, VILLASIS, PANGASINAN, Region I 2427
GENDER : CONTACT NUMBERS (Landline & Mobile) : E-MAIL ADDRESS :
MALE FEMALE n/a/09499706335 [email protected]
CIVIL STATUS : DATE OF BIRTH (mm/dd/yyy): AGE : PLACE OF BIRTH (City, Town Province) :
SINGLE WIDOWER Villasis, Pangasinan
MARRIED SEPARATED 09/30/1989 28 CITIZENSHIP : FILIPINO
WEIGHT (in kgs) : HEIGHT (in meters) : Member of NCIP/With NAPOLCOM Height/Age Waiver Only :

62.000 170.000 Tribe/Date Granted : /

ANY GOVERNMENT ELIGIBILITY

RA 1080 RA 6505 PD 907 CSC PRO CSC PO1 NAPOLCOM Other (Specify):
Have you ever been separated from the service in any of the following modes: resignation, retirement, dropped from the rolls, dismissal, termination,
end of term, finished contract, AWOL or phased out, in the public or private sector? NO YES
Have you ever been charged of any Administrative/Criminal Case in any Court or Investigative Body? NO YES
If Yes, please give the details: Kind of Offense, Date of Filing, Court/Investigative Body with Jurisdiction and Status of the Case.
Please attach here a copy of the decision and details ------------------------------------>
Have you ever applied for any position in the PNP? NO YES
If Yes, what vacancy? PO1 LATERAL ENTRY NUP DENIED? How many times? 0
Reason for DENIAL:
PART II - EDUCATIONAL INFORMATION
DEGREE COURSE COMPLETED DATE GRADUATED NAME OF SCHOOL LOCATION
PRIMARY Elementary 2018-06-01 Villasis 1 Central School Villasis Pangasinan
SECONDARY High School 2018-06-01 Don Ramon E. Costales Memorial National High Schoo Villasis Pangasinan
BACHELOR'S DEGREE Bs Criminology 2018-06-01 Lyceum Northern Luzon Urdaneta City Pangasinan
GRADUATE DEGREE
PART III - PREVIOUS EMPLOYMENTS
NAME OF COMPANY/EMPLOYER ADDRESS YEAR EMPLOYED CONTACT NUMBER REASON FOR SEPARATION
N/A 0
PART IV - CHARACTER REFERENCE
NAME ADDRESS CONTACT NUMBER
Brgy. Kgd Hans Peter Olivar Villasis Pangasinan 0930 919 5590
Nestor Raposas Villasis Pangasinan 09388136869
Kgd. Liwayway De Guzman Villasis Pangasinan 09293385386

I HEREBY CERTIFY that the information and/or statements in this application are all true and correct, and I am fully aware that any
false information or statement provided by me in this application shall render me liable for criminal prosecution.

Signature Over Printed Name of Applicant Date Accomplished

https://regular.pnp-dprm.com 2018-06-01 08:33:23