NOMINATION FORM
2015
Attach here your latest
2”x2” ID photo. It must
be front, facial closeup, with your printed
name & signature at
the back of the photo.
1. Please fill out this nomination form completely and
legibly.
2. Submit copy of this form to the Metrobank
Foundation, Inc. or through the nearest Metrobank
or PSBank Branch in your area on or before
February 21, 2015.
I, _______________________________, is honored to nominate _________________________________________
(name of nominator)
(name of nominee)
to the 2015 Metrobank Foundation Search for the Country’s Outstanding Police Officers in Service (COPS). This
nomination is in recognition of his/her achievements and contributions to attainment of the mandate of the Philippine
National Police in maintaining peace and order in our country.
________________________________________
Signature Over Printed Name of Nominator
_______________
Designation
_____________________________
Name of Unit / Organization
I. PERSONAL INFORMATION
Full Name:
Last
First
Current Rank: (please do not abbreviate)
Current Position:
Middle
Category:
❏ Commissioned
Officer
Previous Rank:
❏
Date
Date of Last
entered the
Promotion:
PNP:
Date of Birth
Place of Birth:
(mm/dd/yyyy):
No. of Years in
active duty:
(e.g.Intelligence, Community
Relations etc.)
___________________
Name of Spouse:
No. of
Children:
❏ Legally Separated
❏ Others ______________
Year Graduated:
Permanent Home Address (House No., Street, Brgy, Municipality or City or
Province):
Residence Phone #:
Have you ever won other National
Award similar to COPS sponsored
by private organization/ NGO?
❏ YES ❏ NO
If yes, indicate the award and year
won.
___________________________
Highest Educational Attainment / Name of School:
Course/Degree:
Have you been a Finalist in the
Search?
❏ YES ❏ NO
If yes, in what year/s?______
Field of Specialization:
Age:
Civil Status: Civil Status:
❏ Single ❏ Married
Gender:
❏M ❏ F
Police Non
Commissioned
Officer
Have you joined the COPS
before? ❏ YES ❏ NO
If, yes, in what year/s?_____
Mobile #:
Are you due for schooling/training abroad for
the period of June 2015 – October 2015?
❏ YES ❏ NO
If yes, where & what type of schooling/ training?
__________________________________
Email Address:
Current/Specific Unit Assignment: (please do not abbreviate)
City or Municipality:
Province:
Region:
Complete Office Mailing Address/ Unit Assignment:
Office Phone #:
Fax No:
Office Mobile:
II. CRIMINAL, CIVIL & ADMINISTRATIVE RECORD
Have you been CHARGED with any of the following offenses at
any time before or during the time you joined the PNP?
❏ Administrative ❏ Civil ❏ Criminal
____ NO
____ YES
Status: ❏ Case Dismissed
❏ Pending
Have you been CONVICTED of any of the following
offenses at any time before or during the time you joined
the PNP?
❏ Administrative ❏ Civil ❏ Criminal
____ NO
____ YES
REPRODUCTION / PHOTOCOPYING OF THIS NOMINATION FORM IS AUTHORIZED
This may also be downloaded at www.mbfoundation.org.ph/excellence-awards-program-cops and www.cops.ph
IF Charged or Convicted, PLEASE PROVIDE DETAILS ON THE FOLLOWING IN A SEPARATE SHEET OF PAPER:
A. Type of Case (e.g. Administrative, Civil or Criminal)
B. Nature of Charge/Complaint (e.g. Frustrated Murder, Physical Abuse, etc.)
C. Date the charge/complaint was filed
D. Where the charge/complaint was filed (e.g., Commission on Human Rights, Ombudsman, etc.)
E. Circumstances surrounding the charge/complaint
F. Status/Final Resolution (e.g. Result of Preliminary Investigation, Certified True Copy of Case Dismissal/Final Resolution,
etc.)
III. CERTIFICATION
(For the Nominee)
This is to certify that I voluntarily submit myself to the rules of the Search. I agree to provide the supporting
documents should I qualify for the next phase of the Search.
Moreover, I certify that I am physically fit to undergo the evaluation process and voluntary submit myself to the rules
of the Search. I will also cooperate in the conduct of background investigation of the organizers should I qualify as one
of the finalists of COPS. In this regard, I hereby exempt, discharge, release and free Metrobank, Metrobank
Foundation, PSBank and Rotary Club of New Manila East their directors/trustees, officers and staff, and the judges
from any claim or liability arising from my participation in the Search.
I hereby certify to the best of my knowledge that all the information contained in this form is true and correct. I am
aware that any willful misrepresentation of facts stated herein shall be used as basis for my disqualification or the
withdrawal of any award slot.
.
Signed of this day (date) ___________________ at (place) __________________________________________.
_____________________________________________
________________________________________
Rank/Complete Name of Nominee
Signature
WHERE DID YOU LEARN ABOUT THE COPS SEARCH?
___ COPS Posters
___ COPS Website
___ COPS Facebook page
___ Radio/TV announcement
___ PNP Publications
___ Newspaper announcement
___ PNP Regional Offices
___ Colleagues in the PNP
___ COPS Information Campaign
___ COPS Awardee
Awardee’s name: ___________________
Others: _____________________
(For the Nominator): Please discuss in brief, What makes the nominee deserving of the distinction of a Country’s
Outstanding Police Officer in Service (COPS)?
________________________________
Signature Over Printed Name of Nominator
FOR MORE DETAILS: Contact Hero Hernandez or Third Salang at (02) 898-8757, (0922) 854-8503 or email at
hshernandez@metrobank.com.ph. You may also visit our website at www.mbfoundation.org.ph.
REPRODUCTION / PHOTOCOPYING OF THIS NOMINATION FORM IS AUTHORIZED
This may also be downloaded at www.mbfoundation.org.ph/excellence-awards-program-cops and www.cops.ph