TEACHERS AND STAFFS CLEARANCE

F-SY2017

This is certify that ___________________________________________ of the _____________

Name MI Family Name Department
Is CLEARED from all obligations and accountabilities of this institution this 1 st / 2nd / Summer
Semester of S. Y. _______________. Signatories below will be affixed upon complying all the
requirements below:

All books borrowed are returned Librarian_______________ Date: ______________

OR Books In Charged

All Tools equipmnt checked Toolkeeper_______________ Date: ______________

(Students/Dept.Projects) Laboratory Technician______ Date: ______________

Evaluation Self Peer Guidance Counselor________ Date: ______________

E-Class Record and Class Cards Dept.Head________________ Date: ______________

Summary of D;W;F;INC.students Principal__________________ Date: _____________

Comprehensive Exam
Modules (Notebook) Grade Sheets School Registrar__________Date: _______________
Soft Copy/Xerox Copy of
E-Class Record / E Grades / Card/F137

Community Extension Project (ComEx) Executive VP______:Date: _______________

( By dept.and with Documentation)
Child Mapping / Brigada Eskwela

Weekly KRAs/D LL School President_________Date: _____________

Letter of Intent to continue Service
Written 3-5 year Plan; Continuing
Studies for Advancement

Fines? Penalties, Rentals, Canteen, VP for Finance__________Date: _____________

(Absences,non-submission of monthly
Modules Weeekly KRAs,grading sheeets)

I hereby acknowledge receipt of my salary this_______________________

Name and Signature of Teacher/Date

NOTE: Attached is the POINT SYSTEM RATING SHEET for request of CERTIFICATE OF
EMPLOYMENT
F-SY2017

SELF EVALUATION FOR TEACHERS

NAME: ____________________________________ DEPARTMENT: ___________ S.Y.:________

POSITION: Part-time / Full-Time RANK: Probationary / Permanent

INSTRUCTION: FILL UP THIS POINT SYSTEM RATING SHEET:

PARAMETERS POINTS
1. LENGTH OF TEACHING EXPERIENCE IN ICTIPC 20
a. 10 years* 20
b. 7 years 17
c. 5 years 14
d. 3 years 10
e. 2 years 7
f. 1 year 3
NOTE: NON-ISSUANCE OF CERTIFICATE OF EMPLOYMENT TOTAL:
BELOW 1 YEAR OF SERVICE
2. PERFORMANCE FOR THE PAST ___ MONTHS / ___ YEARS 50
a. Regularly submits weekly DLL 12.5
Monthly submission of DLL with penalty of 100p per 7
week
Semestral submission of DLL 5
Non submission of DLL every semester will be 0
penalized P500
b. Attends regular meetings called by Admin 10
Missed 1 meeting 7
Missed 2 meetings 5
Missed 3 meetings 3
c. Attends classes regularly (2 semesters) 12.5
Missed 5 classes (2 semesters) 7
Missed 10 classes (2 semesters) 5
Missed more than the number of classes above but 3
not below 80% of the total number of DepEd
required days
Below 80% of the total number of DepEd required 2
days
d. Attends all of the activities: 25
Brigada Eskwela – 1.5pt per day / Nutrition Month –
2pts
Filipino Month – 2pts / UN Month – 2pts / Com Ex –
3pts
English Month – 2pts/ Teachers Day – 2pts /
Foundation Days for 2 days – 3pts / Child Mapping –
3pts/
Enrolment Days – 1.5pts for each day present (max3
days)
TOTAL
3. MERIT POINTS: 30
Continuing studies (Masteral/Doc)/Publish Research–
5pts
Chairperson in the activities – 3pts
Emcee in school activities – 2pts
 Assist/Plans Schools Activities and Meetings – 4pts
Volunteers 10 days in Summer Workshop – 10pts
Attends Seminars and Workshops –2pts for each
certificate**
Recruits student – 2pts per student**
High Retention Rate of Advisory Class - 5pts
TOTAL
89-95pts EXCELLENT
82-88pts VERY
A Teacher who garnered such points will have its
SATISFACTORY
corresponding description in the TEACHER’S EFFICIENCY
75-81pts SATISFACTORY
RATING
74 UNSATISFACTORY
below
BONUS – *2 pts for additional years / ** - min. of 1 day / *** student has to finish the whole
year

NAME OF TEACHER AND SIGNATURE: _________________ VERIFIED BY: _____________

NOTE: Please submit this form together with the TEACHER’S CLEARANCE 3 days before payday. Thanks!