Date:___________

Name of Applicant: _______________________ Please check: ___ Gen. Educ. ___ Pre School
School / District: ______________________ ___ New ___ Elem ___ JHS
___ Old ___ SPED ___ SHS (______)

*Refer to Rubrics: (DO 7 and 22 s. 2015) KINDERGARTEN, ELEMENTARY and JUNIOR HIGH
SCHOOL and (DO 3, s. 2016) SENIOR HIGH SCHOOL

Pointing System: 5pts- Exemplary (E), 3pts- Fully Acceptable, 1pt- Not Fully Acceptable (NFA)
INTERVIEW
Interviewer 1 Interviewer 2 Interviewer 3 Total Average
1. TEACHING ABILITY
(5pts)
2. CLASSROOM
MANAGEMENT
(5PTS)
3. SCHOOL FIT (5PTS)

TOTAL

Applicant’s Signature

Interviewer’s Signature

***Computation for Kindergarten to Junior High School ***Computation for Senior High School
Score = X .10 x 100 = Score = X .15 x 100 =
15 15