Republic of the Philippines

Department of Education
Region III
SCHOOLS DIVISION OF SAN JOSE DEL MONTE CITY

APPLICANT'S RATING FORM FOR TEACHING (Natural Vacancy)

Rating: ______________
Name: ________________________________________ Designation: __________________________
School: _______________________________________
District: _________________________Mobile Number: ____________________
DIRECTIONS: Due to health emergency situation, this office shall apply online submission of documents to be submitted or or before the
deadline st by the Division Personnel Selection Board (PSB). All main documents should be scanned and required for submission.This form
should be scanned and submitted as well after your self-assessment. Please submit all your on the link to be provided for.

Note: All documents in bold with asterisk (*) are required for submission
PERTINENT PAPERS
☐Letter of Intent * ☐Transcript of Records/Diploma * ☐Trainings Attended *
☐Latest Appointment * ☐Performance Rating for the last 3 Years * ☐Certification on Authenticity Veracity of Documents *
☐Service Record * ☐Eligibility/PRC License *

QUALIFICATION STANDARDS
Note: Please see Schools Division Memorandum and DepED Order

I. CRITERIA Points Documents Presented SCORE

A. Performance Rating 35
Average for the last three Ratings: ☐Performance Rating (page showing the SCORE/POINTS) *
years multiplied by '0.35 SY _____________ = _______ ☐Very Satisfactory for the Last Three Years
SY _____________ = _______ ☐Performance Rating/RPMS
SY _____________ = _______ ☐Certification of Computation with average and weight Initial of PSB Member:
Total =_______ i.e. 4.5+4.5+4.5 = Ave. 4.5 x 2 = 9 x 3.0 = 27 points
Average =_______ Note: If lack of three years, the average rating is still divided by 3
B. Experience 5
☐Relevant to the duties and functions of the ☐Certificate of Employment (COE) or Service Record * if any
position to be filled up. (1 point per year) ☐Latest Appointment ☐Revocation
i.e. 2 years and 6 months = 2.5 points ☐Designation duly signed by the SDS
☐Certification on the computation of all experiences Initial of PSB Member:
C. Outstanding Accomplishments 20
1.1. Outstanding Employee Award (4 pts.) ☐Certificate or Medal or Plaque of Recognition *
☐Awardee in the School 0.5 pt. ☐Memorandum of the Search
☐Nomination in the division/awardee in the district 1 pt. ☐Invitation/Program of the Awarding Ceremony
☐Nomination in the district/awardee in the division 2 pts. ☐Picture of the Awarding Ceremony Initial of PSB Member:
☐Nomination in the department/awardee in the region 3 pts. ☐Letter/Memo or Bulletin of Invitation from the Award Giving Body
☐National Awardee 4 pts. ☐If Certificate is not available, certification of the award received
GSP Award BSP Award
☐National Level Award 2.0 pt. Service Award for Unit Leaders Merit/Usa/Tamaraw Award ☐Certificate of Recognition *
☐Regional Level Award 1.75 pt. ☐Bronze 0.25 pt. ☐Bronze 0.25 pt. ☐Memorandum of the Search
☐Service Award (Gold) 1.25 pt. ☐Silver 0.50 pt. ☐Silver 0.50 pt. ☐Invitation/Program
☐Service Award (Silver) 0.75 pt. ☐Gold 0.75 pt. ☐Gold 1.00 pt. ☐Picture of the Ceremony
☐Service Award (Bronze) 0.50 pt. ☐Cou 0.50 ☐Reg'l 0.75 ☐Nat'l 1.25 ☐Plaque, Medal or Trophy
Both for BSp and GSP ☐Council 0.50 ☐Regional 0.75 ☐National 1.25 ☐Publication or Bulletin
0.25 Points for GSP Jade, Coral, Ruby and other GEMS Award ☐If certificate is not available,
Reference: DECS Order No. 99, s. 1999 Certification of the award
C.2 Innovations (4 pts.)
(Type of Innovations: Innovative Workplan or Continous Improvements, Curriculum or Instructional materials,
Inventions or Breakthrogh, Proven Effective Teaching Techniques or Strategies and Tested Mechanism to simplify work)
☐Conceptualized 0.5 pt. ☐Innovative work plan properly documented, approved by SDS *
☐Started the implementation 1 pt. ☐Approved work plan Initial of PSB Member:
☐Fully implemented in the school 2 pts. ☐Certification that it is being started/fully implemented/and or adopted
☐Adopted in the district 3 pts. ☐Pictures of Project implementation
☐Adopted in the division 4 pts. ☐Attendance/Documents of Utilization
 ☐Accomplishment Report/Narrative Report or Write-Up
C.3 Research and Development Projects (4 pts.)
☐School Level 2 pts. ☐Approved Final Manuscript signed by SDO
☐District Level 3 pts. Innovation Committee, if any*
☐Division Level 4 pts. ☐Approved Proposal duly signed by SDO Innovation Committee
☐Documents showing the conduct of research Initial of PSB Member:
☐Pictures, Inivitation or Programs, Memo of research
C.4 Publication/Authorship (4 pts.) ☐Photocopy of Publication (page showing the Nameplate of journal,

☐Articles published in a journal/newspaper 1 pt. article and the writer's name) if any *

magazine of wide circulation per article ☐Certificate of Approval/Uploading if any *

☐Co-Authorship of a Book ☐Book with ISBN No.
(shall be divided by the number of authors) Initial of PSB Member:
☐Sole Authorship of a Book 4 pts. ☐Finished Manual, Module, Book or Paper of the Research
☐Memo, Invitation or other issuance showing the name of the researcher
C.5 Consultant/Resource Speaker in Trainings/Seminars/Workshops/Symposia (4 pts.)
☐District Level 0.5 pt. ☐Certificate of Recognition, if any *
☐Division Level 1 pt. ☐Memorandum of the Training/Seminar/Workshop
☐Regional Level 2 pts. ☐Other supporting documents i.e, travel order, pictures
☐National Level 3 pts. ☐Invitation of the Agency Initial of PSB Member:

☐International Level 4 pts. ☐Picture while having the training as speaker/trainer

☐Training Matrix, Memo or Program showing the name of speakers
D. Education 25
☐Completed Academic Requirements for Master's Degree 10 pts. If completed academic requirements or MA graduate and above:
☐Master's Degree 15 pts. ☐Diploma with SO number or Board Resolutuion *
☐Completed Academic Requirements for Doctoral Degree 20 pts. ☐Transcript of Records ("Compre Passed" in the TOR) *
☐Doctoral Degree 25 pts. ☐Certificate of Completion from the Registrar with ProspectusInitial
* of PSB Member:
☐Certification, Authentication and Verification
(CAV) of TOR, Diploma from CHED endorsed by HEI
☐Permit to Study/Prospectus or Course Program/Enrollment Forms
E. Training 5
☐Participant in Specialized Training 5 pts. ☐Certificate of Participation
Scholarship programs, Short Courses, Study Grants shall be ☐Memorandum of the Training
given one (1) point for every nonth of attendance but ☐Other supporting documents i.e, travel order, pictures
not to exceed five (5) points. Initial of PSB Member:
☐Participant in three (3) or more training activities ☐Chair/Co-Chair in a technical/planning committee
in each level conducted for at least three (3) days not ☐District Level 1 pt.
credited during the last promotions: ☐Division Level 2 pts.
☐District Level 1 pt. ☐Regional Level 3 pts.
☐Division Level 2 pts. ☐National Level 4 pts.
☐Regional Level 3 pts. ☐International Level 5 pts.
☐Participant in one (1) trainingconducted for at least three (3) days
not credited during the last promotions:
☐National Level 4 pts.
☐International Level 5 pts.
E.Potential (5 points) 5 pts. (To be Scheduled)
(Result of the Panel Interview)

Initial of PSB Member:

F. Psychosocial Attributes and (To be Scheduled)
Personality Traits (5 points) 5 pts. (Result of the Test)

Initial of PSB Member:

Reference: DepED Order No. 66, s. 2007
DepED Order No. 02, s. 2009 TOTAL
CONFORME: CERTIFIED CORRECT:

__________________________________ __________________________________
Signature Over Printed Name of Applicant PSB Member, Evaluation Committee
Date: _________________
PSB Member:

PSB Member:

PSB Member: