Department of Transportation

PAMBANSANG PUNONGHIMPILAN TANOD BAYBAYIN NG PILIPINAS

(NATIONAL HEADQUARTERS PHILIPPINE COAST GUARD)
139 25th Street, Port Area
1018 Manila

INVITATION TO U.S. COAST GUARD ACADEMY CLASS OF 2025 INTERNATIONAL

CADET PROGRAM

The U.S. Coast Guard Academy (USCGA) is inviting the Philippine Coast Guard (PCG)
to send a nomination to the International Cadet Program of USCG Academy Class of
2025 to start on June 2021 until 2025 at the U.S. Coast Guard Academy in Connecticut,
USA. This program is open to qualified civilian applicants. Successful applicants will
be provided with free tuition, monthly pay and allowances, free board and lodging,
transportation expenses and other government benefits. Successful applicants will
be admitted as a regular cadet at the USCG Academy and are subject to applicable
USCG Academy regulations covering class attendance, discipline, resignation, and
graduation requirements. Upon graduation, Filipino Cadets will be commissioned in
the PCG as regular Coast Guard Officer with a rank of Ensign. They will render a
minimum of eight (8) continuous years of PCG service/

BACKGROUND

The USCGA is one of the five federal service academies in the US. It offers an
outstanding four-year program with an intensive undergraduate curriculum leading
to a Bachelor of Science degree. Its curriculum is weighted heavily toward
mathematics, science and engineering courses. Following are its nine majors:

A. Civil Engineering
B. Cyber-Systems
C. Electrical Engineering
D. Government
E. Management
F. Marine and Environmental Sciences
G. Mechanical Engineering
H. Naval Architecture and Marine Engineering
I. Operations Research

The program also consists of formal classroom training in subjects such as

navigation and law enforcement supplemented by summer programs that include
general shipboard and aviation training, seagoing experience aboard the USCG
training ship Barque Eagle, military training, and other operational experience.

An integral part of the USCGA program is a rigorous physical education and physical
fitness program which demands that candidates arrive in good physical condition,
able to run, swim, and perform calisthenics.
For more information about the USCGA, you may visit its official website:
https://www.uscga.edu/aboutcga/

QUALIFICATIONS

Interested applicants should meet the following requirements:

1. Natural born Filipino Citizen;

2. Must have reached seventeen (17) years old but not morethan twenty-three
(23) by 28 June 2021;
3. Must be medically and physically fit and able to swim;
4. Must pass the Standard Physical Fitness Evaluation (PFE) prescribed under
USCGA Physical Fitness Exam (PFE) Manual;
5. Single and with no legal dependents;
6. Must have no derogatory records or legal impediments;
7. Must have an excellent command of English language and communication
skills;
8. Must be proficient in English and Mathematics subjects;
9. Must be at least High School Graduate by 01 June 2021;
10. Must have GWA of ninety percent (90%) and above and must have no grades
lower than eight-five percent (85%);
11. Must take either the Scholastic Aptitude Test (SAT) or American College Test
(ACT) and achieved the prescribed scores as follows:
1) SAT: Math – 600; Reading – 600
2) ACT: Math – 26; English – 27
12. Must pass the American Language Course Placement Test (ALCPT) to be
administered at Camp Aguinaldo after passing the SAT/ACT;
13. Must take the Test of English as a Foreign Language (TOEFL) or English
Comprehension Level (ECL) and meet the following score:

TOEFL: 560 on the ITP (paper-based test) or 90 iBT (computer-based test)

ECL: 80

In taking SAT or ACT Exams, visit the websites below and be mindful of the deadline
of registration:

Scholastic Aptitude Test (SAT)

Official website:https://collegereadiness.collegeboard.org/sat/register/international
USCGA Code:5807

American College Testing (ACT)

Official website: https://www.act.org/content/act/en/products-and-services/the-
act-non-us.html
USCGA Code: 0600

Deadline of submission of ACT/SAT Results will be not later than 28 December 2020.
The deadline should be strictly observed so as not to interfere with the timeline of
the selection process. The electronic copy of the test result must be sent at
[email protected] on the given deadline. Only those who
passed the prescribed ACT/SAT scores will be accommodated to the next selection
process:

Additional information about the selection process, physical fitness exam, and
medical requirements can be found at https://www.uscga.edu/international-cadets/
and https://www.uscga.edu/apply/:

IMPORTANT NOTES:

1. To receive an International Cadet appointment, all applicants MUST be nominated

by the PCG and MUST agree to render a minimum of eight (8) years of government
service in the PCG. The USCG Academy cannot and will not accept individuals
applying without a nomination from the PCG, even if those individuals are willing
to pay all fees and expenses.

2. Interested applicants shall bear all related expenses in taking SAT or ACT/TOEFL
exam including registration fee, meals, accommodation and transportation
expenses to the Testing Center. SAT or ACT and TOEFL are administered at
various testing centers throughout the country. ALCPT and ECL has no
registration fees and will be taken at the Camp Aguinaldo, Quezon City and will
be arranged and scheduled by the Office of CG-12.

SUBMISSION OF APPLICATION REQUIREMENTS

Interested applicants may

submit the following requirements at:
[email protected] on or before 18 October 2020.

1. Accomplished Application Form

2. Personal History Sheet (PHS)
3. High School Report Card or College Transcript of Records (Translated in
English)
4. PSA Birth Certificate
5. Essay stating reasons for joining the program and how do you think your 4-
year experience in the USCG Academy can help the PCG.

POINT OF CONTACT (POC), MAILING ADDRESS AND CONTACT DETAILS

LTJG RAQUEL M COLARINA PCG

Program Coordinator
CP # 09771071185
National Headquarters Philippine Coast Guard
Office of the Deputy Chief of Coast Guard Staff for Education and Training, CG-12
139 25th Street, Port Area, 1018 Manila
Email Address: [email protected]
Telephone Number: 02 527 8481 local 6431
Operations Number: Smart – 0998-589-3984
Globe – 0917-842-5158
 Department of Transportation and Communications
PAMBANSANG PUNONG HIMPILAN TANOD BAYBAYIN NG PILIPINAS
(National Headquarters Philippine Coast Guard)
Office of the Deputy Chief of Coast Guard Staff for Education and Training, CG-12
139 25th Street, Port Area
1018 Manila

PCG APPLICATION FORM

(FOR USCG ACADEMY INTERNATIONAL CADETSHIP PROGRAM CLASS OF 2025))

(Write all entries in ALL CAPS legibly and accurately. Use BLUE BALLPEN only. Tick appropriate boxes □ and indicate N/A if not applicable. DO NOT ABBREVIATE)

PERSONAL DATA
LAST NAME ADLAWON
FIRST NAME JERWIN NAME EXT. N/A Jr., III, IV, etc

MIDDLE NAME OLIVA

GENDER ☐ MALE ☐ FEMALE CURRENT AGE 21 RELIGION ROMAN CATHOLIC

MARITAL STATUS
SINGLE CITIZENSHIP
FILIPINO
BIRTH DATE 17-NOVEMBER-1998
day-month-year HEIGHT (in feet) 5'4 WEIGHT (in kgs) 51
BIRTH PLACE BARANGAY MAYPATAG, BAYBAY LEYTE

UPPER LAGUERTA UPPER LAGUERTA

House/Block/Lot No Street House/Block/Lot No Street

SITIO TARCOM BUSAY SITIO TARCOM BUSAY

Subdivision/Village/Sitio Barangay Subdivision/Village/Sitio Barangay
PRESENT
HOME ADDRESS CEBU CEBU ADDRESS CEBU CEBU
City/Municipality Province City/Municipality Province

7 6000 7 6000
Regio
Region Zip code n Zip code

☐ Living with Parents ☐ Living with Relative / Guardian ☐ Home Address☐ Living with Relative / Guardian
☐ Renting ☐ Others(Specifiy ___________) ☐ Renting ☐ Others(Specifiy ___________)
FAMILY
BACKGROUND
LAST NAME LAST NAME OLIVA
FIRST NAME FIRST
JOEL SR FELICIDAD
MOTHER (Maidn

NAME EXT. NAME

FATHER

MIDDLE MIDDLE
LAMAN MANGAYAAY
Name)

NAME NAME
OCCUPATI OCCUPATI
ON N/A ON N/A
CURRENT CURRENT BIRTH
AGE 55 BIRTH DATE 07-03-1965
dd-mm-yyyy
AGE 53 DATE 20-02-1967
dd-mm-yyyy

NO. OF
BROTHERS 5 NO. OF SISTERS 5
BIRTH
ORDER
☐ 1ST ☐ 2ND ☐ 3RD ☐4TH ☐ (Specify_________)7TH ARE YOU A BREADWINNER ☐ YES ☐ NO

LAST NAME N/A LAST NAME N/A

RELATIVE
NEAREST RELATIVE

FIRST NAME Jr., III, FIRST NAME Jr., III,

NAME N/A EXT. etc NAME N/A EXT. etc
SERVICE (ACTIVE)

MIDDLE MIDDLE
INSERVICE(RETIRED)

NAME N/A NAME N/A

RELATIONS RELATIONS
N/A N/A
NEAREST

HIP HIP
BRANCH BRANCH
IN

OF RANK OF RANK
SERVICE N/A N/A l 6k SERVICE N/A N/A
PAGE 1 OF 2

SIGNATURE DATE 29-09-2020

dd-mm-yyyy
EDUCATIONAL BACKGROUND
PERIOD OF HIGHEST LEVEL
BASIC EDUCATION / YEAR ACADEMIC
LEVEL DEGREE / COURSE NAME OF SCHOOL ATTENDANCE / UNITS GRADUA HONORS
FROM EARNED
(Write in Full) TO TED RECEIVED
(if not graduated)
ACCOUNTANCY, BUSINESS UNIVERSITY OF SOUTHERN WITH
SECONDARY AND MANAGEMENT PHILIPPINES FOUNDATION 2017 2019 128 UNITS 2019 HONORS
COLLEGE BACHELOR OF SCIENCE IN UNIVERSITY OF SOUTHERN N/A
MANAGEMENT ACCOUNTING PHILIPPINES FOUNDATION 2019 2020 39.5 UNITS N/A
GRADUATE STUDIES N/A N/A N/A N/A N/A N/A N/A
VOCATIONAL / TRADE
N/A N/A N/A N/A N/A N/A N/A
TESDA
N/A N/A N/A N/A N/A N/A N/A
RATING
☐ PRC ☐ CSE – PROFESSIONAL ☐ CSE – SUB PROFESSIONAL ☐ OTHERS (SPECIFY:
ELIGIBILITY (for
___________________ )
CSE):
OTHER INFORMATION
BODY BUILT SKIN COLOR BROWN
SLIM
COLOR OF HAIR COLOR OF EYE
BLACK BLACK
BLOOD TYPE IDENTIFYING MARKS
N/A N/A
FOOD RESTRICTIONS ALLERGIES
N/A N/A
SPORTS HOBBIES
BASKETBALL AND CHESS SINGING AND READING
ORGANIZATION
JOINED VOICE OF CEBU CHORAL
SKILLS
(Give at least THREE
(3)) SINGING TECHNIQUES, COMPUTER SKILLS AND LISTENING SKILLS
MID #
PHILHEALTH #
(PAG-IBIG) 1212-1107-0605 12-025667099-8
TIN GSIS #
342-312-945-000 N/A
MOBILE # 1 MOBILE # 2
09653196346
CONTACT
PERSON IN CASE OF EMERGENCY:
NAME
FELICIDAD O. ADLAWON
RELATIONSHIP CONTACT NUMBER:
MOTHER 09975122843
ADDRESS SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY
PLEASE ANSWER THE FOLLOWING TRUTHFULLY:

1. Have you been involved in any case / investigation pending against you? ☐ YES ☐ NO If yes, what is its nature and status?
_______________________________________________________________________________________________________________
2. Have you ever been charged in any Administrative / Criminal case ? ☐ YES ☐ NO If yes, what is its nature and status?
_______________________________________________________________________________________________________________
3. Do you have any history of drug abuse? ☐ YES ☐ NO If yes, where and when did you undergo rehabilitation?
_______________________________________________________________________________________________________________

THIS IS TO CERTIFY that all entries above are true and correct and that
I support all information contained herein with original or authenticated
documentary proofs. Any false information/statement or failure to enclose
any material fact may cause the filing of administrative / criminal case/s
against me.

THUMB MARKS

2 X 2 Picture
(Taken within 3 months with name
tag and white background)

RIGHT
LEFT

JERWIN O. ADLAWON
__________________________________________________ 09-29-2020
___________________
Signature over Printed Name Date

PAGE 2 OF 2

Viber/Messenger Account:________________________________
JERWIN OLIVA ADLAWON
 PERSONAL HISTORY STATEMENT
INSTRUCTIONS

1. Answer all the questions completely; if the question is not applicable,

write “NA.” Write “UNKNOWN” only if you do not know the answer and cannot
obtain the answer from personal records. Use the blanks pages at the back of this
form for extra details on any question for which you do not have sufficient space.

2. Type, print or write carefully, illegible or incomplete forms will not receive
consideration.

WARNING

1. The c o r r e c t n e s s o f a l l s t a t e m e n t s o f e n t r i e s m a d e h e r e i n
w i l l b e investigated.

2. Any deliberate omission or distortion of material facts may give sufficient

cause for denial of clearance.

3. The statement made herein is classified “CONFIDENTIAL.” Revelation

or use for purposes other than that authorized is prohibited by pertinent provisions
of AFPRG 200-052.

I. PERSONAL DETAILS

A. Name: ADLAWON _ JERWIN OLIVA

(Last) (First) (Middle)
B. Rank: N/A _ PCG/SN: N/A Br/Svc: N/A _

C. Present Job / Assignment: N/A _ ___

D. Business or Duty Address: N/A ___

E. Home Address (Include St. & Nr): _

SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY
_

F. Birth Date: NOVEMBER 17,1998 _ Place of Birth: __ BAYBAY _LEYTE

BARANGAY MAYPATAG,

G. Change in Name (If by Court Action give details): N/A __

H. Nicknames: TAGWE, TAGWIN OR WIN Nationality: FILIPINO _

I. TIN: PAGIBIG No: _ PhilHealth NO:

J. Religion: _ Blood Type: UNKNOWN _

K. Cellphone/ Telephone Number: 09668270352 _

Page 1 of 9
II. PERSONAL CHARACTERISTICS

A. Description: Sex: MALE_ Age: 21 _ Height: 5'4 _ (cms) Weight 51_ (kgs)
Build (heavy, Medium, Light): MEDIUM__ Complexion (Dark, Fair, Light): FAIR
Color of Eyes: BLACK Color of Hair: BLACK _

Scars or marks and other distinguishing features: LEFT EYE BROW SCAR __ _

B. Physical Condition/Present State of health (Excellent, Good, Poor) _

EXCELLENT _
Physical or Mental Defects: N/A __ Recent Serious Illness: N/A _

III. MARITAL HISTORY

A. Marital Status: SINGLE _

(Single, Married, Separated or Widow)
B. Name of Spouse: N/A _ __
(Full Name)
Date and Place of Marriage: N/A

Occupation and Place of Employment: N/A

C. Children:
Name Date of Birth Citizenship
N/A

N/A
N/A

IV. FAMILY HISTORY AND INFORMATION

A. Father’s Name: _JOEL L. ADLAWON SR

(Full name)
Date and Place of Birth: MARCH 07,1965 BARANGAY SAN JUAN, BAYBAY LEYTE

Address: SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY _

Occupation and Place of Employment: N/A _

FILIPINO
Citizenship: if naturalized, give date and place where
naturalized.

B. Mother’s Name: _FELICIDAD O. ADLAWON

(Full Name)
Date and Place of Birth: __
FEBRUARY 20,1967 MAYPATAG, BAYBAY LEYTE _

Address: SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY _

Occupation and Place of Employment: N/A

Citizenship: FILIPINO if naturalized, give date and place where
naturalized.

Page 2 of 9
 B. Brothers and Sisters
NAME AGE ADDRESS OCCUPATION
JENNEFER O. ADLAWON 31 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY
PROMODISER
JOEL L. ADLAWON JR 30 SAN JUAN, BAYBAY LEYTE CONSTRUCTION
JOANNE O. ADLAWON 29 CONSTRUCTION
SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY
JACKIELOU O. ADLAWON 27 SOONG LAPU-LAPU CITY, CEBU OFFICE STAFF, PARA PLANNER
JOSHUA O. ADLAWON 25 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY N/A
JEMARIE O. ADLAWON 24 SOONG LAPU-LAPU CITY, CEBU PRODUCT INSPECTOR
JOCELYN O. ADLAWON 20 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY N/A
JOLIUS O. ADLAWON 17 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY N/A
JONATHAN O. ADLAWON 15 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY N/A
JOSEPHINE O. ADLAWON 11 SITIO TARCOM, UPPER LAGUERTA BUSAY CEBU CITY N/A
D. Step-parent or Guardian: N/A _ _ _

Address N/A

Occupation and Place of Employment _ N/A

Citizenship _N/A _ if naturalized, give date and place where

naturalized

E. Father-in-Law N/A

Date and Place of Birth N/A __

Address N/A
(Street) (Bo/Brgy) (Town/City)
Tel Nr
N/A _
(Province)
Occupation and Place of Employment N/A _
Citizenship N/A _ If naturalized, give date and place where
naturalized

F. Mother-in-Law _N/A _

Date and Place of Birth N/A _ _

Address N/A
(Street) (Bo/Brgy) (Town/City)
N/A Tel Nr N/A _
(Province)
Occupation and Place of Employment N/A _
Citizenship N/A if naturalized, give date and place where
naturalized

Page 3 of 9
 V. EDUCATIONAL BACKGROUND

A. Elementary
School Location Date of Year Graduated
Attendance

B. High School
School Location Date of Year Graduated
Attendance

C. College
School Course Location Date of Year
Attendance Graduated

D. Post Graduate
School Course Location Date of Year
Attendance Graduated

E. Other Schools Attended and Date of Attendance

School Course Location Date of Year
Attendance Graduated

F. Civil Service Eligibility, if any, and others similar qualifications

G. Skills and other expertise

VI. MILITARY HISTORY

A. Date Enlisted in the PCG _

B. Date of Commissionship _ Source of Commission_ _

C. Important Unit Assignment since Enlistment/CAD:

Unit Assignment Designation Inclusive Dates

Page 4 of 9
D. Military Schools Attended
Name of Schools &Location Date of Attendance Nature of Rating
Training

E. Decorations and Awards or Commendations Received

Type of Award Authority

VII. PLACES OF RESIDENCE SINCE BIRTH

Inclusive Dates Places/Address

VIII. EMPLOYMENT

Inclusive Dates Type of Employment Name/Address of Reason of

Employment Leaving

Have you ever been dismissed or forced to resign from a position? Yes _ No
Ifyes, explain _

IX. FOREIGN COUNTRIES VISITED (In chronological order)

Date Country Visited Purpose of Visit

Page 5 of 9
 X. CREDIT REPUTATION

A. Are you entirely dependent on your salary? Yes _ No if no,

state other sources of income
_
B. Name and Address of Banks or other Credit/Institution with which your have
accounts/loans:

C. Have you filed a statement of your Assets and Liabilities with any
government agency
Yes No _ _ If so, what, agency? _ _
D. Have you filed your last income tax return?

E. Three (3) credit references in the Philippines:

Name Address

XI. ARREST RECORD AND CONDUCT

A. Have you ever investigated / arrested, indicted or convicted for any violation
of law? ? If so, state name of court, nature of offense and disposition of case.
_
C. Has any member of your family ever been investigated / arrested, indicated
or convicted for any violation of law? If so, state name of
court, nature of the case and disposition of case.

D. Have you, ever been charged in any Administrative Case?

E. Have you ever been arrested or detained pursuant to the provision of PD

1081 and its implementation order (GO, PO, LOI)? __ If so, state the
nature of the case and the place of your detention

F. Do you use intoxicating liquor or narcotics? If so, what

extent?
_ _

Page 6 of 9
XII. GENERAL REPUTATION
A. Give five (5) character references (not relatives) known three years or
longer, who are not your relatives:

Name Business Address/Residence

(Include Street & Number)

B. List down three (3) neighbors at your present residence:

Name Business Address/Residence

(Include Street & Number)

XIII. ORGANIZATION

List of organization or social groups which you have been a member:

Organization Address Date of Membership &

Position held

XIV. MISCELLANEOUS

A. Hobbies, sports and past times

B. Language and Dialect (indicate ability as fluent, fair or poor):

Language or Speak Read Write

Dialect
ENGLISH FLUENT FLUENT FLUENT
TAGALOG FLUENT FLUENT FLUENT
CEBUANO FLUENT FLUENT FLUENT

Page 7 of 9
 C. Are you willing to undergo periodic lie detection test?
Yes
D. Copy exactly the following paragraph in your own handwriting

As Luis E Rapazo III of 105th Xavier Ave guzzled his way trhough
three bottles of brandy, Josephine Z Quinsing, a partner in law firm of San
Diego and Ballesteros located at 2879 Valley Forge St., Quezon City
turned to Richard Ting Sr., a Chinese food expert from O.W. Kwantung
Company, Ltd., 346 HadjiJairul Hussein Blvd., and said, “I can’t speak for
my Government but I’m quite sure your country and mine better get
together for closer understanding.”

_
_
_
_
_ _
_
_
_
_
_
_

I certify that the foregoing answers are true and correct to the best of my
knowledge and belief and I agree that my misstatement or omission as to material
facts will constitute ground for denial of my application for clearance.

Signed at _ Date

(Signature of Applicant)

_ _
(Witness) (Witness)

Page 8 of 9
 THUMBMARKS

LEFT RIGHT

Subscribed and sworn to before me this _day of 20

Philippines, affiant exhibited to me his /her Community Certificate Nr _ _
Issued on _ at

_
(Administrative Officer/Notary Public)

_
(Rank and Designation)

_
(TIN)

Page 9 of 9