GUIDELINES IN ACCOMPLISHING THE PLV CAT 2023 APPLICATION FORM

1. FILL OUT THE PLV CAT 2023 APPLICATION FORM USING MS EXCEL APPLICATION
(HANDWRITTEN APPLICATION FORM WILL NOT BE ACCEPTED)

2. PRINT THE PLV CAT 2023 APPLICATION FORM IN A 8.5 X 13" (LONG) BOND PAPER.
PRINT THE FORM IN A BACK TO BACK SET UP.
(FORMS PRINTED IN 8.5 X 11" (SHORT) BOND PAPER WILL NOT BE ACCEPTED)

3. ATTACH ONE (1) PASSPORT SIZE ID PICTURE ON THE DESIGNATED AREA

4. CHECK THE COMPLETENESS AND CORRECTNESS OF THE INFORMATION/DATA ON THE

PLV CAT 2023 APPLICATION FORM

5. TYPE YOUR NAME AND SIGN THE APPLICATION FORM AND INDICATED THE PREPARATION
DATE WHEN YOU HAVE ACCOMPLISHED THE FORM

6. ARRANGE THE APPLICATION FORM AND THE REQUIRED DOCUMENTARY REQUIREMENTS

IN ORDER BASED ON THE APPLICATION POSTING
 PAMANTASAN NG LUNGSOD NG VALENZUELA PLV CAT APPLICATION NO.
COLLEGE ADMISSION TEST
SCHOOL YEAR 2023-2024

INSTRUCTIONS: READ THE APPLICATION QUALIFICATIONS. DO NOT APPLY IF NOT QUALIFIED. Fill in all the required information. DO NOT leave an item blank. If an item is
not applicable, indicate “N/A”. Only fully accomplished form will be accepted. Credentials filed in support of this application will become the property ofthis institution and will not be
returned to the applicant.

A. NAME OF APPLICANT (AS IT APPEARS ON THE BIRTH CERTIFICATE)

1 LAST NAME Ganir
FIRST NAME MC Jemuel NAME EXTENSION N/A
MIDDLE NAME Oronica

B. FACTS OF BIRTH
2 DATE OF BIRTH (MM/DD/YYY) 3 PLACE OF BIRTH (CITY/MUN./PROVINCE) 4 GENDER 5 CITIZENSHIP 6 AGE

11 9 2004 Caloocan MALE FILIPINO 18

7 BLOOD TYPE 8 CIVIL STATUS 9 RELIGION 10 BIRTH ORDER 11 NO. OF SIBLINGS

UNKNOWN SINGLE Jehovah Witnesses 2 1

C. ADDRESS & CONTACT DETAILS
12 CURRENT ADDRESS HOUSE/ROOM/FLOOR/BLOCK /LOT/PHASE/STREET/SUBD. BARANGAY CITY/MUNICIPALITY DISTRICT ZIP CODE

Block 3 Lot 27 Phase 3 Assumption Ville LINGUNAN Valenzuela City II 1446

13 PERMANENT ADDRES HOUSE/ROOM/FLOOR/BLOCK /LOT/PHASE/STREET/SUBD. BARANGAY CITY/MUNICIPALITY DISTRICT ZIP CODE

Block 3 Lot 27 Phase 3 Assumption Ville LINGUNAN Valenzuela City II 1446

14 ACTIVE EMAIL ADDRESS 15 SOCIAL MEDIA (FACEBOOK URL ADDRESS/ID) 16 ACTIVE MOBILE NUMBER 17 TELEPHONE NUMBER
[email protected] https://www.facebook.com/mcjemuelganir.me 9399531069 N/A
D. FAMILY DATA
FIRST NAME MIDDLE NAME LAST NAME NAME EXTENSION PHYSICAL EXISTENCE
18 FATHER'S INFORMATION
Cesar Raquel Ganir N/a ALIVE
AGE HIGHEST EDUCATIONAL ATTAINMENT CURRENT OCCUPATION AVERAGE INCOME PER MONTH MOBILE NUMBER TELEPHONE NUMBER

Highschool Machine Operator 12000 9283458269 N/A

FIRST NAME MAIDEN MIDDLE NAME MAIDEN LAST NAME NAME EXTENSION PHYSICAL EXISTENCE
19 MOTHER'S INFORMATION
Marites Oronica Ganir N/A ALIVE
AGE HIGHEST EDUCATIONAL ATTAINMENT CURRENT OCCUPATION AVERAGE INCOME PER MONTH MOBILE NUMBER TELEPHONE NUMBER

Highschool Housewife N/A 9213286912 N/A

20 MARITAL STATUS OF PARENTS 21 APPLICANT'S LIVING STATUS 22 HOME OWNERSHIP STATUS 23 TOTAL NO. OF HOUSEHOLD MEMBER

MARRIED LIVING WITH BOTH PARENTSOWNED BY PARENTS 4

24 TOTAL NO. OF HOUSEHOLD MEMBER WITH WORK 25 GROSS MONTHLY FAMILY INCOME 26 TOTAL MONTHLY EXPENSES

1 10001-15000 5001-10000
27 GUARDIAN'S DETAIL FIRST NAME MIDDLE NAME LAST NAME NAME EXT. RELATIONSHIP MOBILE NUMBER

Marites Oronica Ganir N/A N/A 9213286912

E. EDUCATIONAL BACKGROUND
28 ARE YOU CURRENTLY ENROLLED? YES 29 IF "YES" WHAT PROGRAM IS IT? Senior High School Program (GRADE 12)
30 NAME OF SCHOOL LAST ATTENDED (DO NOT ABBREVIATE) STI COLLEGE CALOOCAN

31 SCHOOL'S MAILING ADDRESS (NOT THE EMAIL ADDRESS) N/A

32 TRACK/STRAND/PROGRAM/COURSE/MAJOR LAST TAKEN (OR YOU ARE CURRENTLY ENROLLED) Arts and Design Track
33 LEARNER REFERENCE NO. 34 ESC NO. (IF APPLICABLE) 35 DATE OF GRADUATION 36 NO. OF SEMESTER COMPLETED (IF APPLICABLE)

136795100189 N/A N/A 1

37 ENROLLMENT HISTORY NAME OF SCHOOL SCHOOL'S MAILING ADDRESS PERIOD OF ATTENDACE (FROM - TO)
COLLEGE/VOCATIONAL N/A N/A N/A

GRADE 12 STI COLLEGE CALOOCAN N /A 2022-2023

GRADE 11 STI COLLEGE CALOOCAN N /A 2021-2022

GRADE 10 LINGUNAN NATIONAL HIGHSCHOOL N/A 2020-2021

GRADE 9 LINGUNAN NATIONAL HIGHSCHOOL N/A 2019-2020

GRADE 8 LINGUNAN NATIONAL HIGHSCHOOL N/A 2018-2019

GRADE 7 LINGUNAN NATIONAL HIGHSCHOOL N/A 2017-2018

F. INTENDED COURSE OF STUDY (UNDERGRADUATE PROGRAM)

38FIRST CHOICE (COURSE/MAJOR) Bachelor of Science in Information Technology (BSIT)

39SECOND CHOICE (COURSE/MAJOR) Bachelor of Science in Business Administration Major in Financial Management (BSBA FM)

WHY DO YOU CHOOSE THE FOLLOWING COURSE?

N/A
N/A

N/A
N/A

MC Jemuel O. Ganir 19-Mar-23

Printed Name of Applicant Signature of the Applicant Date

 PAMANTASAN NG LUNGSOD NG VALENZUELA
COLLEGE ADMISSION TEST
SCHOOL YEAR 2023-2024

G. ORGANIZATIONAL AFFILIATION
40A NAME OF ORGANIZATION 40B NAME OF ORGANIZATION

TYPE OF ORGANIZATION TYPE OF ORGANIZATION

POSITION ON THE ORGANIZATION POSITION ON THE ORGANIZATION

40C NAME OF ORGANIZATION 40D NAME OF ORGANIZATION

TYPE OF ORGANIZATION TYPE OF ORGANIZATION

POSITION ON THE ORGANIZATION POSITION ON THE ORGANIZATION

H. OTHER INFORMATION
ARE YOU A PERSON WITH DISABILITY? NO
41 IF "YES", PLEASE SPECIFY THE TYPE OF DISABILITY

PLEASE PROVIDE THE PWD ID NO.

DO YOU HAVE ILLNESS / MEDICAL CONDITION? NO

42 IF "YES", PLEASE SPECIFY THE DETAILS OF ILLNESS

MEDICAL CONDITION

ARE A MEMBER OF ANY INDIGENOUS GROUP? NO

43
IF "YES", PLEASE SPECIFY THE DETAILS

44 IS YOUR FAMILY A HOUSEHOLD BENEFICIARY OF 4PS? NO

45 ARE YOU RELATED BY CONSANGUINITY/AFFINITY TO ANY PLV EMPLOYEE? IF "YES", PLEASE SPECIFY THE DETAILS NO

45A NAME OF THE PLV EMPLOYEE 45B NAME OF THE PLV EMPLOYEE

DEPARTMENT OF THE EMPLOYEE DEPARTMENT OF THE EMPLOYEE

RELATIONSHIP TO THE EMPLOYEE RELATIONSHIP TO THE EMPLOYEE

45C NAME OF THE PLV EMPLOYEE 45D NAME OF THE PLV EMPLOYEE

DEPARTMENT OF THE EMPLOYEE DEPARTMENT OF THE EMPLOYEE

RELATIONSHIP TO THE EMPLOYEE RELATIONSHIP TO THE EMPLOYEE

46 ARE YOU RELATED BY CONSANGUINITY/AFFINITY TO ANY VALENZUELA CITY GOVERNMENT EMPLOYEE? IF "YES", PLEASE SPECIFY THE DETAILS

46A NAME OF THE VCG EMPLOYEE 46B NAME OF THE VCG EMPLOYEE

DEPARTMENT OF THE EMPLOYEE DEPARTMENT OF THE EMPLOYEE

RELATIONSHIP TO THE EMPLOYEE RELATIONSHIP TO THE EMPLOYEE

46C NAME OF THE VCG EMPLOYEE 46D NAME OF THE VCG EMPLOYEE

DEPARTMENT OF THE EMPLOYEE DEPARTMENT OF THE EMPLOYEE

RELATIONSHIP TO THE EMPLOYEE RELATIONSHIP TO THE EMPLOYEE

47
DO YOU HAVE ANY FAMILY MEMBER/S WITHIN THE 3RD DEGREE OF CONSANGUINITY WHO GRADUATED/STUDIED/OR CURRENTLY ENROLLED AT
PLV? IF "YES, PLEASE SPECIFY THE DETAILS

47A NAME OF THE STUDENT 47B NAME OF THE STUDENT

COURSE & MAJOR COURSE & MAJOR

YEAR GRADUATED / ATTENDANCE YEAR GRADUATED / ATTENDANCE

RELATIONSHIP TO THE STUDENT RELATIONSHIP TO THE STUDENT

47C NAME OF THE STUDENT 47D NAME OF THE STUDENT

COURSE & MAJOR COURSE & MAJOR

YEAR GRADUATED / ATTENDANCE YEAR GRADUATED / ATTENDANCE

RELATIONSHIP TO THE STUDENT RELATIONSHIP TO THE STUDENT

I. DECLARATION

I declare under oath that I personally accomplished this application form, and I hereby certify that all the information
given are true, correct, and complete statements. Further, I understand that the acceptance and approval of my
application for admission is based on the aforestated information.

I therefore agree that, in case of post-verification yields information contrary to what is declared, my application shall
be disapproved and I will be disqualified to apply.

Further, I hereby give my consent to the Pamantasan ng Lungsod ng Valenzuela that the abovementioned data may
form part of its database that can be used for relevant purposes but may not be limited to profiling and research, and
especially as a basis of data-driven decisions of the University.

MC Jemuel O. Ganir 19-Mar-23

Printed Name of Applicant Signature of the Applicant Date