Philippine Coast Guard Auxiliary Application Form
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4ANNEX II. PCGA APPLICATION FORM
PHILIPPINE COAST GUARD AUXILIARY
________ AUXILIARY SQUADRON
MEMBERSHIP APPLICATION
( ) New Enrollment
( ) Re-enrollment
( ) Transfer of Squadron
LAST NAME
FIRST NAME
MIDDLE NAME
SUFFIX
GENDER
( ) Male
( ) Female
OTHER NAMES USED:
HOME ADDRESS
MARITAL STATUS
NAME OF SPOUSE
NO. OF CHILDREN
( ) Single ( ) Married ( ) Separated
( ) Widow/Widower
HEIGHT
WEIGHT
COLOR OF EYES
COLOR OF HAIR
SCARS OR MARKS AND OTHER DISTINGUISHING FEATURES:
SSS/GSIS NO.
DATE OF BIRTH
PLACE OF BIRTH
CITIZENSHIP
RELIGION
BLOOD TYPE
TEL. NO. (HOME)
TEL. NO. (BUSINESS)
MOBILE PHONE
EMAIL 1
EMAIL 2
FAX NO.
ACR NO. (IF ALIEN)
PASSPORT NO./EXPIRY DATE
TYPE OF VISA ISSUED
TIN NO.
SECTION II – EDUCATIONAL BACKGROUND – College/Post-Grad/Special Studies
NAME OF SCHOOL
DEGREES OBTAINED
INCLUSIVE DATES
YEAR GRADUATED
(Attached photocopies of either the transcript of records, diploma or PRC certificate)
SECTION III – EMPLOYMENT/OCCUPATIONAL BACKGROUND
( ) EMPLOYED
( ) OWN BUSINESS
COMPANY
COMPANY
COMPANY
COMPANY
(Attached latest employment’s certification, SEC Registration, Art. Of Incorporation or DTI Registration)
FOR PAST OR CURRENTLY IN GOVERNMENT POSITION – Please state highest Appointment/Elected Office
Position/Period Assumed:
Nature of Office:
(Attached certification from the Office concerned)
SECTION IV – ADDITIONAL DATA
PROFESSIONAL LICENCES:
SPECIAL TRAININGS:
SPECIAL INTERESTS/SKILLS:
(Attached photocopies of license/s or certificate/s)
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