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Bjmp.gov.ph PERSONAL PROFILE OF RANK NAME Last Name First Name Middle Name Qualifier 2 X 2 PICTURE GENERAL INFORMATION BADGE NO. Republic of the Philippines DEPARTMENT OF THE INTERIOR AND LOCAL GOVERNMENT BUREAU OF JAIL MANAGEMENT AND PENOLOGY National Headquarters 144 BJMP Building Mindanao Avenue Quezon City Trunkline 632 927-6383 Email Address director bjmp*gov*ph Website www. UNIT / REGION CONTACT NO. HOME ADDRESS House No*/Street/City/Province PLACE OF BIRTH DATE OF BIRTH dd/mm/yy GENDER CIVIL STATUS COLOR OF EYES BLOOD TYPE LANGUAGES RELIGION HEIGHT cm COMPLEXION NAME OF SPOUSE Signature over Printed Name COLOR OF HAIR DATE OF COMPULSORY RETIREMENT dd/mm/yy WEIGHT kg ETHNIC GROUP OCCUPATION DEPENDENT CHILDREN ADDRESS EDUCATIONAL BACKGROUND LEVEL SCHOOL DEGREE COMPLETED/ UNITS EARNED INCLUSIVE DATES/CLASS HONORS RECEIVED COLLEGE POST-GRADUATE Use separate sheets if necessary. WARNING all statements or entries in this form are subject to verification and any deliberate misrepresentation or distortion of information may give sufficient cause for Investigation* ELIGIBILITY NAPOLCOM/CSC/PRC/CESB TITLE DATE OF EXAMINATION /CONFERMENT PLACE OF EXAMINATION RATING NUMBER OF YEARS IN PRESENT RANK TIG STATUS OF ORIGINAL APPOINTMENT AUTHORITY GO/SO No* PRESENT STATUS DATE OF APPOINTMENT TO PRESENT RANK DATE WHEN THE DEFICIENCY WAS SATISFIED CAREER COURSES/TRAININGS/SEMINARS For present rank COURSE TAKEN/TITLE OF TRAINING/SEMINAR LOCATION INCLUSIVE DATES CLASS TRAINING HOURS CLASS STANDING/HONORS PERFORMANCE EVALUATION RATING Immediately preceding two 2 semesters RATING PERIOD IF THE ORIGINAL APPOINTMENT WAS IN TEMPORARY STATUS STATE THE DEFICIENCY NUMERICAL RATING DATA ON PENDING CASES If applicable OFFENSE COMMITTED AS CHARGED State whether Administrative or Criminal STATUS / DISPOSITION Pending Dismissed Penalty PENALTY IMPOSED DATE WHEN THE PENALTY WAS SERVED MAJOR DESIGNATIONS For present rank POSITION/DESIGNATION JAIL POPULATION For Wardens and Deputy Wardens UNIT SIGNIFICANT ACCOMPLISHMENTS For present rank SUMMARY/ DESCRIPTION OF ACCOMPLISHMENT PERIOD COVERED RECOGNITIONS RECIEVED AWARDING AUTHORITY OTHER AWARDS/MEDALS AND COMMENDATIONS For present rank TYPE OF AWARD DATE GIVEN AUTHORITY CERTIFICATION I hereby certify under penalty of perjury and/or dishonesty that all the above information are true and correct and based on authentic/verifiable documents. UNIT / REGION CONTACT NO. HOME ADDRESS House No*/Street/City/Province PLACE OF BIRTH DATE OF BIRTH dd/mm/yy GENDER CIVIL STATUS COLOR OF EYES BLOOD TYPE LANGUAGES RELIGION HEIGHT cm COMPLEXION NAME OF SPOUSE Signature over Printed Name COLOR OF HAIR DATE OF COMPULSORY RETIREMENT dd/mm/yy WEIGHT kg ETHNIC GROUP OCCUPATION DEPENDENT CHILDREN ADDRESS EDUCATIONAL BACKGROUND LEVEL SCHOOL DEGREE COMPLETED/ UNITS EARNED INCLUSIVE DATES/CLASS HONORS RECEIVED COLLEGE POST-GRADUATE Use separate sheets if necessary. WARNING all statements or entries in this form are subject to verification and any deliberate misrepresentation or distortion of information may give sufficient cause for Investigation* ELIGIBILITY NAPOLCOM/CSC/PRC/CESB TITLE DATE OF EXAMINATION /CONFERMENT PLACE OF EXAMINATION RATING NUMBER OF YEARS IN PRESENT RANK TIG STATUS OF ORIGINAL APPOINTMENT AUTHORITY GO/SO No* PRESENT STATUS DATE OF APPOINTMENT TO PRESENT RANK DATE WHEN THE DEFICIENCY WAS SATISFIED CAREER COURSES/TRAININGS/SEMINARS For present rank COURSE TAKEN/TITLE OF TRAINING/SEMINAR LOCATION INCLUSIVE DATES CLASS TRAINING HOURS CLASS STANDING/HONORS PERFORMANCE EVALUATION RATING Immediately preceding two 2 semesters RATING PERIOD IF THE ORIGINAL APPOINTMENT WAS IN TEMPORARY STATUS STATE THE DEFICIENCY NUMERICAL RATING DATA ON PENDING CASES If applicable OFFENSE COMMITTED AS CHARGED State whether Administrative or Criminal STATUS / DISPOSITION Pending Dismissed Penalty PENALTY IMPOSED DATE WHEN THE PENALTY WAS SERVED MAJOR DESIGNATIONS For present rank POSITION/DESIGNATION JAIL POPULATION For Wardens and Deputy Wardens UNIT SIGNIFICANT ACCOMPLISHMENTS For present rank SUMMARY/ DESCRIPTION OF ACCOMPLISHMENT PERIOD COVERED RECOGNITIONS RECIEVED AWARDING AUTHORITY OTHER AWARDS/MEDALS AND COMMENDATIONS For present rank TYPE OF AWARD DATE GIVEN AUTHORITY CERTIFICATION I hereby certify under penalty of perjury and/or dishonesty that all the above information are true and correct and based on authentic/verifiable documents..

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