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
PRO 1 PRO 7 PRO 18 ITMS
PRO 2 PRO 8 PRO ARMM PCRG
PRO 3 PRO 9 PRO COR EOD K9
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 :

Gutierrez Irish Pacunla

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

Purok 5, Tipanoy Iligan City Tipanoy, PS 5 - Poblacion, ILIGAN CITY POLICE OFFICE, Region X 9200
GENDER : CONTACT NUMBERS (Landline & Mobile) : E-MAIL ADDRESS :
MALE FEMALE 0632217633/09055916535 irishgutierrez88@gmail.com
CIVIL STATUS : DATE OF BIRTH (mm/dd/yyy): AGE : PLACE OF BIRTH (City, Town Province) :
SINGLE WIDOWER Purok 3, Donggo-an, Kapatagan Lanaobdel Norte
MARRIED SEPARATED 06/26/1988 28 CITIZENSHIP : FILIPINO
WEIGHT (in kgs) : HEIGHT (in meters) : Member of NCIP/With NAPOLCOM Height/Age Waiver Only :

66.000 1.630 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 2000-03-30 Kapatagan East Central School
Poblacion, Kapatagan, Lanao Del Norte
SECONDARY High School 2004-04-01 Saint Francis Xavier Academy
Poblacion, Kapatagan Lanao Del Norte
BACHELOR'S DEGREE Bachelors Of Science In Nursing 2011-04-08 Iligan Medical Center College
San Miuel Village, Palao Iligan City
GRADUATE DEGREE N/a 1970-01-01 N/A N/a
PART III - PREVIOUS EMPLOYMENTS
NAME OF COMPANY/EMPLOYER ADDRESS YEAR EMPLOYED CONTACT NUMBER REASON FOR SEPARATION
LBC EXPRESS, INC Pasay City, Metro Manila 2014 0633020372
PART IV - CHARACTER REFERENCE
NAME ADDRESS CONTACT NUMBER
Sean Chito Lucas Picardal Purok Madasigon, Suarez Iligan City 09058866140
Elizabeth Alagar Rn, Man San Miguel Village, Palao Iligan City
Sp02 Bonifacio Bahian Gasang ( Manticao Police Station, Manticao Misamis Oriental

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