TEACHER APPLICANT DATA FORM (SY 2022-2023)

INSTRUCTION: Write ligibly and avoid erasures. All entries should be in CAPITAL LETTER. Follow the formats of dates and names indicated. For NEW TEACHER APPLICANTS, provide all required data.
I. PERSONAL INFORMATION:
SURNAME GIVEN NAME MIDDLE NAME

SEX: DATE OF BIRTH (MM/DD/YYYY): AGE

CIVIL STATUS: FOR MARRIED WOMAN, PLEASE WRITE YOUR MAIDEN NAME (SURANAME, FIRST NAME, MIDDLE NAME)

Is the Applicant a person with Disability? If applicant is a PWD, type a description of disability.
REGISTERED ADDRESS (Based from your voters ID or any proof of recidency:
MOBILE NUMBER: EMAIL ADDRESS: House No./Street/Purok
A Barangay:
B Municipality:
C Province:

II. APPLICATION INFORMATION

WHAT ARE YOU APPLYING FOR? (SPED,
KINDERGARTEN, ELEMENTARY, JUNIOR HIGH
SCHOOL, SENIOR HIGH SCHOOL):
DISTRICT(e.g. ALICIA SOUTH DISTRICT): FOR SHS APPLICANTS, SUBJECT CORE GROUPS APPLIED FOR(Refer to from the Groups below):
SCHOOL APPLIED FOR(WRITE THE COMPLETE NAME OF SCHOOL):
Group I-A : Oral Communication, Reading and Writing, English for Academic and Professional Purposes, Practical
Research
Group I-B : Komunikasyon at pananaliksik sa Wika at Kulturang Pilipino, Pagbasa at Pagsusuri ng Ibat ibang
LEGISLATIVE DISTRICT: Teksto sa Pananaliksik, Pagsulat sa Filipino sa Piling Larangan
Group I-C : 21st Century Literature from the Philippines and the World; Contemporary Philippine Arts from the
Region; Understanding Culture, Sociaty and Politics; Introduction to Philosophy of the Human Person and related
MUNICIPALITY: specialized HUMSS subjects
Group I-D : Media and Information Literacy; Empowerment Technologies
Undergraduate Course(Type in full): Group II : ABM and Entrepreneurship, Research and Work Immersion
Group III-A : General Mathematics, Statistics and Probability and related specialized STEM subjects
MAJOR/SPECIALIZATION: Group III-B : Earth Science, Earth and Life Science, Physical Science and related specialized STEM subjects
Group IV-A : Specialized TVL/Agri-Fisheries
Did you apply for a teaching position in SDO Isabela last (YES or NO): Group IV-B : Specialized TVl/Industrial Arts
SY 2019-2020 Group IV-C : Specialized TVL ICT
SY 2020-2021 Group IV-D : Specialized TVL/Home Economics
SY 2021-2022 Group V : Sports - Physical Education and Health, Personal Development and related specialized Sports Subjects
Group VI : Arts and Design

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 If your answer in "SY 2021-2022" if "Yes", would you like to retain your previous points?("NO", "YES - SOME CRITERIA", "YES ALL CRITERIA")
If your answer above is "NO", proceed answering Part III. EDUCATIONAL ATTAINMENT portion until the end of the template.
If your answer above is "YES-SOME CRITERIA" or "YES ALL CRITERIA", provide the data asked below: (Submit a copy of your Certificate of Rating for SY 2021-2022)
IMPORTANT: If you opted to retain some/all your points during the previous assessment (SY 2021-2022), please enter the data asked below. WRITE IN CAPITAL LETTERS your name that you used last SY. DO NOT PUT period
"." in the middle name or extension name. If there are period, space or dash "-" in the name, please include ( e.g. MA(period)(space) CRISTINA = MA. CRISTINA, MARIA(space)CATALINA = MARIA CATALINA, JAY(dash)AR
= JAY-AR). If you have no Middle name or no extension name, leave the spaces blank.
Name of applicant when he/she joined the assessment last SY 2021-2022
Surname Given Name Middle Initial Extension Name

Applicant Information last SY 2021-2022:

1 What Category was you application? (SPED, KINDERGARTEN, ELEMENTARY, JUNIOR HIGH SCHOOL, SENIOR HIGH SCHOOL):
2 School(for Secondary) or District(for Elementary) where you applied:

3 Enumerate the Criteria stated in your Certificate of rating last SY2021-2022 and the points you earned: Write "RETAIN" if you want it to be REMEMBER:
retained, and "UPDATE" if you want to 1. If you want to update your points in a criteria, submit ALL REQUIRED
CRITERIA PTS update. DOCUMENTS for that criteria.
A
B 2. Write the data required on the PART of this template where you want to
C update. Example, you want to update your Trainings, then you should write
D ALL the applicable data in Part VI. TRAININGS of this template.
E
F 3. Only the Criteria you opted to Update needs document submission and data
G writing. If you will not update the other criteria, leave the Part for that criteria
in this template blank.
TOTAL

GWA(include GWA of earning units. Copy

If you did not graduate,
III. EDUCATIONAL BACKGROUND: the GWA from the GWA encoding sheet indicate the number of units
COLLEGE: (Name of School) COURSE: (Include earning units if there is/are) YEAR GRADUATED: for accuracy): finished bellow:
A
B
C
If you did not graduate, indicate
GWA(include GWA of unfinished the number of units finished
MASTERAL:(Name of School) COURSE: YEAR GRADUATED(do not fill up if units earned only): MA/MS/MB ETC.): bellow:
A
B
C
If you did not graduate, indicate
the number of units finished
DOCTORAL: (Name of School) COURSE: YEAR GRADUATED(do not fill up if units earned only): GWA: bellow:
A
B
C

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 For SPED Teacher Applicants:
Did you complete units of
specialized subject AFTER
Number of Units in SPED either in the Bachalaureat Degree (e.g.
Bachelors Degree or Masteral or Doctoral you are applying for SHS
STEM Math, did you acquire
units aligned with Math after Number of Units (Copy from the
Total Number of Months of experience of college graduation?)YES OR
actual teaching in SPED Performance Rating as SPED Teacher NO?
list on the right which ever is
applicable):
NONE
15 units specialized subject
18 units specialized subject
Master complete Acad
Masters degree
Doctorate Acad Requirements
Doctorate

IV. LET/PBET and OTHER ELIGIBILITY

LET, PBET or NOT ELIGIBLE? LET/PBET Rating (leave blank if not eligible): Year LET/BPET was taken:

Place Taken (City/Municipality, Province)

Indicate other Eligibility below(e.g. Civil Service, PRC, Marina, etc.): Rating: Place Taken (City/Municipality, Province)

V. TEACHING/RELATED WORK EXPERIENCE

A. If the your are CURRENTLY Teaching, the Number of Months (Column B) should be counted until the end of the school year (July 31, 2022 for Public Schools) unless otherwise the end of his/her contract is stated in the Service
Record/Certificate of Employement.
B. If you are CURRENTLY Teaching in a PUBLIC SCHOOL (wether as PTA, Volunteer, LSB,PSB) the Number of Months (Column B) should be counted until the end of the school year (July 31, 2022 for Public Schools) unless otherwise the
end of his/her contract is stated in the Service Record/Certificate of Employement.
A B C D

Number of Months (Based Is/Was the applicant an/a Local

School/Agency/Company/Corporation/Business Establishment on Service Record/Cert. of School Board/Provincial School Number of MONTHS as LSB or
Category etc: Employment) Board? PSB:
A Teacher in the Kindergarten:
B Teacher in the Elementary:

C Teacher in the Secondary (JHS or SHS):

D Teacher in the Tertiary:
E Teacher in Post Grad School:
F Teacher in Special Education (SPED):
Teacher in Alternative Learning System
G (ALS):
Teacher in Indigenous Peoples Education
H (IPED):
Industry or other related work
experience/s, please type below the
I nature of your work: Company/Corporation/Business Establishment etc: Number of Months: Remarks:
I.1
I.2
I.3
I.4
I.5
I.8

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 Did you perform duties and functions higher than his/her position? (Example: Teacher who has served as a Nature of duties and function (Example: Teacher who has served as a
Department Head, a mechanic who has performed supervicosry functions, an artist who is the president of a Department Head, a mechanic who has performed supervicosry functions, an Number of MONTHS in the
guild, etc.) YES or NO artist who is the president of a guild, etc.): higher position:

VI. TRAININGS:

Title of the training/seminar/workshop/symposium attended by the applicant. (Include only those that were
attended AFTER GRADUATION from Bachelors Degree).For SPED/KINDER/ELEMENTARY/JHS Applicants,
include in this column your National Certificate (NC) and Trainors Methodology Certificate (TMC). For SHS Year training was
applicants, NC and TMC shall be writted in a separate table below. attended Training Provider Number of Days of attendance:
1
2
3
4
5
6
7
8
9
10

For SPED, Kindergarten, Elementary, and Junior High School Teacher Applicants, indicate the skills
demonstrated during assessment.

For SHS Arts and Design Applicants, please write in the box in each column if the applicant received and submitted any of the certifications bellow, if none, leave it blank:
Certification from any respectable and highly
regarded national and/or international art-related
professional organizations (e.g. Kasibulan, Agos
Kulay, Portrait Artist Guild of the Philippines, Art
Participation in art exhibitions or performances whether group, solo, held in the country Association of the Philippines, Society of Pohilippine
Certification of felloships abroad Participation in local arts congress (sponsored by NCCA or CCP) or abroad. Sculptors, etc.)
A

B
C
D
E

For SHS Sports Applicants, please write in the box in each column if the you received and submitted any of the certifications bellow, if none, leave it blank:
Certification from any respectable and highly regarded and international Physical Education, Health, Fitness,
Certified by Red Cross in Standard First Aid
Sports, Recreation, and Dance associations or organization (e.g. the National Sports Association, Americal College
and Basic Life Support-Cardiopulmonary
Certified Instructor in group or individual training (yoga, suspension training) by a of Sports Medicine, National Strength and COnditioning Association, National Association for Sports Medicine, or
Resuscitation (BLS-CPR)
reputable organization the Americal Council on Exercise)
A
B
C
D
E

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 For SHS TVL Applicants, please write the title of the NATIONAL CERTIFICATES(NC) and indicate the date of validity as seen in the certificate, if none, leave it blank:
Date of Validity
National Cerificate (NC) course completed (include only the certificates with the highest NC Level if the same Level: (Level 1, Level 2, Level
course and which are still valid until today): 3, Level 4) From (MM/DD/YYYY) To(MM/DD/YYYY)
A
B
C
D
E

Date of Validity
Trainor Methodology Certificate (TMC) completed(if any): Level (1 or 2): From(MM/DD/YYYY) To(MM/DD/YYYY)
A
B
C
D
E

VII. ENGLISH PROFICIENCY TEST(EPT)

Did you took the English Prociciency Test last 2020 or 2021 conducted by SDO Isabela or other SDOs?
Yes or No
if YES, Month EPT was taken (if you cant remember, leave it blank ):
Year Taken:
Place Taken:

Name of Applicant when he/she took the test(TYPE IN CAPITAL LETTER):

Given Name Middle Name Surname Extension Name

VIII. PORTFOLIO/OUTSTANDING ACHIEVEMENTS

(This includes but are not limited to: Published work, Recognized innovations and accomplishments in research and development, Prizes, awards, recognitions, letter of commendations for theses or major academic paper, exemplary
performance, work and/or academic projects. Practitioners/experts may also submit Government-issued business permit (if self-employed), Certificate or proof of proficiency issued by duly recognized body including guilds and
sports organizations, Certificated of recognition from duly recognized body including guilds and sports organizations, Certificated of accreditation from a duly recognized body including guilds and sports organizations.) Valid or
Title of Citation/Recognition Received, Level: Award Giving Body: Date Awarded(MM/DD/YY): Invalid
1 Published works:
2
3
4
5
6
7
8
9

Prepared by:

Signature over printed name of Applicant

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