Application Form PSSUPT ENTRY
Application Form PSSUPT ENTRY
Application Form PSSUPT ENTRY
A. GENERAL INFORMATION
RANK/COMPLETE NAME: PRESENT UNIT ASSIGNMENT:
________________________________________________
(Signature over Printed Name)
Continuation of Position/Designation and Assignment Records...
INCLUSIVE DATES DESIGNATION/POSITION UNIT
FROM FROM (Please include the Sub-Unit) (NHQ/PRO/NSU)
E. SUMMARY OF THREE (3) MOST SIGNIFICANT ACCOMPLISHMENT (please attach certification and other proof if
necessary)
1.
2.
3.
F. AWARDS AND RECOGNITION RECEIVED IN PRESENT RANK (continue on a separate page if necessary)
NATURE OF AWARDS/ Number of Awards/
RECOGNITION Recipient for how many times
________________________________________________
(Signature over Printed Name)
G. INFORMATION ON ADMINISTRATIVE AND CRIMINAL CASES AND PENALTIES
1. Have you ever been formally charged or have any record of criminal/administrative cases and disciplinary penalties
incurred? YES NO If YES, please give details:
2. Have you ever been relieved for cause? YES NO If YES, please give details:
CERTIFICATION
This is to certify to the truthfulness and accuracy of the above information to the best of
my knowledge; and that any falsehood that may be found in the future shall be grounds for the
nullification of my application for 3 rd level placement and promotion as well as the possible filing of
administrative charges against me if warranted.
I further certify that I am physically fit and medically sound to perform the functions of
the position and or promotion I am applying for.
__________________________________________
Rank/Name and Signature
Date Accomplished: ___________________
_____________________
(Notary Public)
Doc No._____
Page No.____
Book No.____
Series of ____