PPA FORM 37

REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF JUSTICE
PAROLE AND PROBATION ADMINISTRATION
NATIONAL CAPITAL REGION
CALOOCAN CITY PAROLE AND PROBATION OFFICE

VPA APPLICATION FORM

PERSONAL DATA:

Name: Sex: Civil Status:

Last First Middle
Date of Birth: Place of Birth: Citizenship: Age:
Height: Weight: Identifying Marks:
Highest Education Attainment: Occupation:
Present Home Address: No. of yrs. Tel./Cel. No.
Business Address: No. of yrs. Tel./Cel. No.

Special Skills/Interests/Hobbies:
Trainings Attended:
MEMBERSHIP IN ORGANIZATIONS:
Name of Organization
Position
 (use additional sheet if necessary)

VOLUNTEER EXPERIENCE:
Name of Organization: Role:
Period of Involvement:

REASONS FOR WANTING TO BE A VOLUNTEER:

CLASSIFICATION AS VOLUNTEER: Case Supervisor Resource Individual

Will you be able to perform the following functions expected of a Volunteer Probation Aide?
YES NO
1. Works in close consulting and cooperation with the Supervising Officer.
2. Keeps all information about your supervisee in strict confidentiality.
3. Maintains an honest recording and monthly reporting of activities to the Supervising Officer.
Supervises clients by devoting a substantial and scheduled time for supervision and
performing additional task:
Offer client guidance and counseling
Acts as placement facilitator
Implements objectives as provided for in the program of supervision
Refers to corresponding agencies those client with various needs, spiritual, mental,
social, emotional or physical
Acts a resource individual
Makes job referral

REFERENCES:
Position Name Address Contact No.
Barangay Captain _____________________________________ _____________________________________________________ _____________________
Parish Priest/Minister _____________________________________ _____________________________________________________ _____________________
School Personnel _____________________________________ _____________________________________________________ _____________________
Health Personnel _____________________________________ _____________________________________________________ _____________________

I hereby certify that the statements in this application are true and correct to the best of my knowledge and that I have
accomplished this form in my desire to serve as a Volunteer Parole and Probation Assistant in the Parole and Probation
Administration.

Res. Cert. No. ___________________________ _________________________________________

Issued At: ____________________________ Signature of Applicant
Date Issued: ____________________________

Assessed By: Recommended By:

Johnny T. Lisondra _______________________________________

Supervising Probation and Parole Office/OIC Regional Director

Recruited by: SrPPO M. BORCES___________________ Thumbmark