Republic of the Philippines

CSC FORM I
POSITION DESCRIPTION FORM

1. Name of ARQUERO JOZOILA SALAZAR

Employee
(Family Name) (First Name) (Middle Name)
2. Department/Corporation of Agency: 3. Bureau of Office:

Department of Education Bureau of SECONDARY Education

4. Branch/Division: 5. Work Station/Place:

Division of Ifugao LAGAWE NATIONAL HIGH SCHOOL

6. a) Pres. Approp., Previous Approp.: 7. Salary/annum 8. Other Compensation

P 222, 588.00 /annum P24,000.00

9. Official Designation: 10. Working/Proposed Title:

Teacher I Teacher II

11. WAPCO Classification of this Position 12. Occupational Group Title (Leave Blank)

Salary Grade 11
13. Statement of Duties and Responsibilities (Under General Supervision)
(Please attach additional sheet if necessary)

TOTAL 100 PERCENT WORKING TIME

85% 1 Teaches in the secondary grades such subject as English, Filipino, Math, Makabayan, Values
Education, etc.
2% 2 Enrolls students in the Secondary School.
2% 3 Evaluate students, progress and provides various experience for continues development.
2% 4 Works with other school personnel, parents and community for the total dev’t. of the children.
2% 5 Keeps students and schools, records and prepares required reports.
2% 6 Supervises curricular and co-curricular projects and activities of the children.
1% 7 Participates in the socio-economic development projects in the community.
2% 8 Provides guidance services to pupils.
1% 9 Coordinates and cooperates with other development projects in the community.
1% 10 Does other related works.
14. Position Title of Immediate Supervisor: 15. Position Title of Next Higher Superior:

Secondary School Principal I Assistant Schools Division Superintendent

16. Names, Titles and Items of those whom you directly supervise.

STUDENTS
17. Machines, Equipments, Tools, etc., used regularly in the performance of work.

Computers, Chalk, Eraser, Lesson Plan, Black Board, Manila Paper, Textbooks, Visual Aids, Others

18. Contracts: 19. Working Conditions:

Occasional Frequent Normal Working x
General x Field Working
Other Agencies x Field Trip
Supervisors x Exposed to Weather x
Management x Other Specify

20. I CERTIFY that the above answers are accurate and complete.

___________________ _____________________
Date (Signature of Employee)

21. Describe briefly the general function of the position.

TO PROVIDE QUALITY EDUCATION

22. Describe briefly the general function of the position.

CLASSROOM TEACHING

23. a) Indicate the required qualifications by years and kind of education considered in filling up a vacancy for the
position. (Keep the position in mind rather than the qualification of the incumbent) This item should be filled for all
positions other than teaching.

EDUCATION: __Bachelor in Secondary Education (BSEd) with 27 Professional units in graduate studies major in
Educational Planning.

EXPERIENCE: none required

24. b) License or Certificate required to the work.

Teachers’ License

25. I HEREBY CERTIFY that the above answers are accurate and complete.

_____________________________ MARIA D. DOMOGDOG,Ph.D

(Date) School Head

_____________________________ SALLY B. ULLALIM, CESO V

(Date) Schools Division Superintendent

(Form 1)
1994
SWORN STATEMENT OF ASSETS, LIABILITIES AND NETWORTH
DISCLOSURE OF BUSINESS INTERESTS AND FINANCIAL CONNECTIONS
AND IDENTIFICIATION OF RELATIVES IN THE GOVERNMENT SERVICE
As of December 31, 2016
 (Required by R.A. No. 6713)

Surname First Name M.I. Position/Income:

PAGADUT NOVELYN C. Teacher II

Address: Office:

POBLACION SOUTH, LAGAWE, IFUGAO Department of Education

Office Address: Lagawe

Spouse Name:
Surname First Name M.I. Position:

PAGADUT HUBERT B. ANIMAL KEEPER

Office Address:
LGU-LAGAWE
Unmarried Children Below 18 Years Old
Name of Children: Date of Birth:
ASHLEY KAY C. PAGADUT JULY 13, 2001
AUBREY ALLYANA C. PAGADUT MARCH 9, 2006
ALBY BREY CHANLEY C. PAGADUT AUGUST 29, 2015
A. ASSETS AND LIABILITIES AND NETWORTH
1. ASSETS
a) Real Properties
Year Mode of Nature of Property Assessed Current Per Acquisition Cost
Kind Location Acquired Acquisition (Paraphernal, Value Market Value
Conjugal,
Community)
Residential lot Bahawit Pob. 2000 Inherited 100,000.00
South, Lagawe
House Bahawit, 2010 constructed 100,000.00

Pob. South

Total = Php 200,000.00

b) Personal and other Properties
Kind Year Acquired Acquisition Cost
Personal Apparel 2009 4,000.00
Cellphone 2014 5,000.00
oven 1995 12,000.00

Total = Php21,000.00
2. LIABILITIES (Loans, Mortgage, etc) Name of Creditors Amount
Loan LMDC 100,000.00
Loan MTMAS 100,000.00

Total = 200,000.00

NETWORTH (Total Assets (1.a + 1.b) Less Total Liabilities (2) = P21,000.00
(Note: Please use additional forms/sheets if necessary)

BUSINESS INTEREST AND FINANCIAL CONNECTIONS

Do you have any business and other financial connections including those of your spouse and unmarried children
below 18 years of age living with you in your household?

[ x ] No [ ] Yes If Yes, give particulars.

 Name of Firm Nature of Business
Name Company Address Interest & Financial Date of Acquisition
Connection
N/A

C. IDENTIFICATION OF RELATIES IN THE GOVERNMENT SERVICE

To the best your knowledge, are you related within the fourth degree of consanguinity or affinity to anyone working in
the Government?

[ X ] No ( ) Yes If Yes, give particulars.

Name Position Relationship Name/Address of Office

Edelgrace P. Kimayong EPS Sister in -Law Division-Ifugao

I HEREBY CERTIFY to the best of my knowledge and information, that these are true statement of my
assets, liabilities, networth, business interest and financial connections, including those of my spouse and unmarried
children below 18 years of age and my relatives in the government as of December 31, 2006 as required by and in
accordance with Republic Act 6713.

I hereby authorize the ombudsman of his duly authorized representative to obtain and secure from all
appropriate government agencies, including the Bureau of Internal Revenue such documents that may show my
assets, liabilities, networth, business interest and financial connections, to include those of my spouse and
unmarried children below 18 years of age living with me in my household covering previous years to include the year
I first assumed office in the government.

Date: March 25, 2016

_________________________ ______________________
(Signature of Spouse) (Signature)

Tin Number: _____ ____________ Tin Number :298-593-185

Community Tax Cert. No. Community Tax Cert. No . : 08383131

Issued at : Issued at : Lagawe, Ifugao

Issued On: Issued On : Feb. 26, 2016

Subscribed and Sworn to before me this 25th day of March, 2016.

Affiant exhibiting to me his/her Community Tax Certificate as indicated above.

CHRISTOPHER B. PAGADUT
Barangay Captain

Republika ng Pilipinas
KOMISYON NG SERBISYO SIBIL
Probinsya ng Ifugao
Lagawe, Ifugao
 PANUNUMPA SA KATUNGKULAN

Ako si JOZOILA S. ARQUERO ng MABATO-BATO, LAMUT, Probinsya ng IFUGAO,

na hinirang/itinalaga sa katungkulan bilang _ TEACHER 11 __ ay taimtim na nanunumpa ng
aking buong kakayahan, pagkaraan nito’y gagampanan ko sa Republika ng Pilipinas, na tunay na
mananalig at tatalima ako rito, susundin ko ang mga batas, mga kautusang legal, at mga dekretong
pinaiiral ng mga sadyang itinakda ng may kapangyarihan ng Republika ng Pilipinas, at kusa kong
babalikatin ang pananagutang ito ng walang ano mang pasubali o hangaring umiwas.

Kasihan nawa ako ng Diyos.

JOZOILA S. ARQUERO
Pangalan at Lagda

Sedula Bilang : 25503430___________

Kinuha sa : Lamut, Ifugao_______
Petsa : January 27, 2016____

Nilagdaan at Pinanumpa sa harap ngayong ika __________________________________

ng _____________________ sa Lagawe, Ifugao.

JOHN N. GAHID
Administrative Officer V

Documentary Stamp

CSC form 211

MEDICAL CERTIFICATE
(For employment) PHILIPPINES CIVIL SERVICE
INSTRUCTION

1. This Medical Certificate should be accomplished by a Government Physician.

2. Attached this Certificate to appointments that are initial, original or reinstatement appointment.

FOR THE PROPOSED APPOINTEE

NAME: (If married woman, write maiden name) AGENCY:

Last Name First Name M. I.

PAGADUT NOVELYN C. Department of Education

ADDRESS: Proposed Position:

BAHAWIT, POB.SOUTH, LAGAWE, IFUGAO Teacher III

AGE: SEX: CIVIL STATUS:

39 y/o [ ] male [ X ] female MARRIED

Pre – Employment Medical Latest

1. Blood Test
2. Urinalysis
3. Chest X-Ray
4. Drug Test
5. Neuro Psychiatric Examination (if necessary)

Note: All results of examination must be attached to this form.

For the Physician:

I hereby certify that I personally examined the above mentioned Documentary Stamp
individual and found him/her to be physically and mentally fit/unfit for
employment.

Signature of Physician: Certificate. No. Other Information about the Appointee:

Official Designation HEIGHT(bare Foot) Weight (Kilos)

Teacher II 154cm 68 KGS

Agency: Date Examined:

Lagawe National High School-Main

Republic of the Philippines

 Department of Education
Cordillera Administrative Region
DIVISION OF IFUGAO
Lagawe
______August 26, 2011______
(Date)

The Schools Division Superintendent

DepEd, Division of Ifugao
Lagawe, Ifugao

Madam:

Pursuant to DepEd Order No. 04, s. 2007 dated January 29, 2007 entitled GUIDELINES

ON RECRUITMENT, EVALUATION, SELECTION AND APPOINTMENT OR

TEACHERS IN PUBLIC SCHOOLS, the School Selection Committee of

_______CudogElementarySchool_______________Lagawe________________, Ifugao

(Name of School/Cluster) (Municipality)

based on the DIVISION REGISTRY OF APPLICANTS, recommends the following for appointment:

Name School Total Rank Remarks, If any

Points
1. Junelyn B. Gad-icon Cudog Elem. School
2. Diana Buyaco Cudog Elem. School
3. Magdalena Bandao Cudog Elem. School
4. Mergierita Tugunen Cudog Elem. School
THE SCHOOL SELECTION COMMITTEE:
1 Taught at Cudog ES as
SEF teacher for one year
2 Teaching at Quezon, Nueva
Vizcaya
4 Kindergarten Teacher at
Cudog ES
3 Cannot be contacted

__CORAZON L. PABLO_______ ___GLORY T. HABBILING_________

MT-II, Teacher Member T-III, Teacher Member

___AGNES T. MAGYANO_____ _____________________________

T-III, Teacher Member Teacher Member

______OLIVER D. TOBIAGON______
 Chairman

Republic of the Philippines Div./Station No. :_ 109 /011____

Department of Education Employee No. :__0263544___
Cordillera Administrative Region GSIS Policy No. :__6300289___
Division of Ifugao
Lagawe, Ifugao To be filled up by RPSU:
Old Rate :_____________
New Rate :_____________

NOTICE OF STEP INCREMENT

December 8, 2009
Date
MRS. CORAZON L. PABLO
Master Teacher II
Cudog Elementary School
Lagawe District

Madam:

Pursuant to Joint Civil Service Commission (CSC) and Department of Budget and Management
(DBM) Circular No. I, s. 1990 Implementing Section 13 of R.A. No. 6758, your salary as Master Teacher
II, [S.G. 19, Step 3 ] is hereby adjusted effective December 2, 2009 as shown below:

Basic Salary as of December 1, 2009 ------- PhP 24, 177.00

Salary Adjustment:
Length of Service: 3 Years/ 1 Step ---- 484.00

Total Salary Adjustment ---------------------- PhP 24, 661.00

The Step Increment is subject to review and post audit by the Department of Budget and
Management and subject to readjustment of fund if found not in order.

Very truly yours,

I certify that the salary adjustment/s indicated
on this page have been verified and found to be in
accordance with the provisions of Joint CSC-DBM
Circular No. 1, s. 1990 a s amended. Those that are
not in accord with said Circular and DECS Regional ESTELA L. CARIÑO
Office records have been corrected and initialed. Schools Division Superintendent

JONATHAN C. ANGIWAN
Administrative Aide IV