r$' gryisl0li 0rftff $r.{ni}fl.

uy0it0
Btc0fiffistcfl(}il
Bepubtrc ol tlre pril$pints
B
Dcprrrtrncnt o[ €!utrrtiorr BY:
NATIONAT CAPITAL RECION
SCHOOIS D|VIS|ON OrFtCt - MANDALTTYONG Ctfi OAT lt4L :a0
OIfice of tlre Schools Division
Superintendent
Lpill28,2023

?yIffiiT,,?H
RTCRUITMEITT, HIRIIIIG, AXD SELECTIOT OF ELEMEITTARY TO SEIIIIOR
HIGH SCHOOL TEACHER.APPLICATTS F'OR SCHOOL YT,AR 20123.2024

To: Chief Education Supervisors, CID and SGOD

Offrcials, OSDS, CID and SGOD
School Heads, Public Elementary and Secondary Schools
All Others Concerned

1. The field is hereby informed of the Recrz{ttnr,rtt, Hitlng, o,nd Selcdlon oJ

Elenrntory to Selrrlor Hlgh School Teachct-Appllcants to" School Year 2023-
2O24, for the information and guidance of all concerned.

2, School Principals are encouraged to post this memorandum in conspicuous

places of the school to encourage application from interested applicants which will
run until Uay 12, 2(D2. Announcements / information must contain tl.e required
documents to be submitted and the recruitment period.

3. It is the policy of the Department of Education to strictly adhere to t-Ile

principles of merit, competence, fitness, equal opportunity, transparency, and
accountability. Consistent with this policy, SDO-Mandaluyong City applies non-
discrimination principle that allows anyone to apply for a position, irrespective of
age, sexual orientation and gender identity, civil status, disability, retgion, ethnicity,
oi political beliefs. During the recruitment, screening, selection and appointment
process, utilization of atrxiliary aid services is highly encouraged.

4. ALL appltcdtons should be first stbmltted ln tbe school tttlthln tlp

dhttslor} Likewise, applicants are advised to submit one (1) application only. There
is no necessity for applicants to submit multiple application as there will only be one
Comparative Assessment Result - Registry of Qualified Applicants.

5. shall onlg acept teocl,r]ragpllcants ttttth anea of

ElEt /4lnto/ry schools
speclallzathon in prc'school and elrlnentary. ApplTcatlons Jor secondary leoel
ipctaltzattons mrr* * sl.drmtlted to elthcr Integrded or *condary schools'
i" p", guldellnes, teachcr'appltcanrts sltottld onlg applg 7n thr.lt rcspcthn
fields or arca oJ qteclo,llzatlon.
6. All interested applicants shall submit the following documentary documents
to the school sub-cotlmlttce aot later then f,av 12. 20113, to b€ fastened in a
long white folder with earrnarks, arranged as listed below:

a.ChecklistofRequirementsandomnibusSwomStat€mentonthe
certification on the Authenticity and veracity (cAV) of tl.e documents

Addr6s: calbayog 5t., Brgy. Highway Hills, Mandaluyont CitY

Phon.: OSDS 79555921 . AO 79561263 . CID 79552557
' S6OD 85349810
Emall: sdo.mandaluyonS@deped,8ov.ph
Webclte: www.depedmandaluyont.or8
 submitted and Data kivacy Consent Form pursuant to RA No. 10173 /Dota
PriuocE Act of 2O12), notaized, by authorized olficial; (see Enclosure No. 2);
b. ktter of intent addressed to the Head of OI[ce;
c. Duly accomplished Personal Data Sheet (CSC Form 212, Revised 2017) with
passport size ID picture ald Work Experience Sheet;
d. Photocopy of autheatlcated, valid and updated PRC License/ID/ proof of
renewal/proof of authenticated copy for release, if applicable;
e. Photocopy of authoatlceted LEf ILEYI /PBET Rating or proof of
authenticated copy for release, if applicable;
f. Photocopy of duly signed scholastic/ academic record such as but not limited
to Transcript of Records (TOR) with computed weighted average rating and
Diploma, including completion of graduate and post-graduate units/
degrees, if available;
g. Photocopy of Certificate/ s of Training, if applicable;
h. Photocopy of duly signed Certificat€ of Employment, Contract of Service, or
duty signed Service Record, whichever is/ are applicable;
i. Photocopy of School Clearance for those with teaching experience;
j. Photocopy of latest appointment, if applicable;
k. Photocopy of the Performance Rating in the last rating period(s) covering one
(1) year performance in the current/ latest position prior to the deadline of
submission/obtained from the relevant work experience, if applicable;
l. Photocopy of Voter's ID and/or proof of residency; and
m. Photocopy of NBI Clearance

7. The appllcaut a33u8let ftrll terpooslb[lty an.t accouatablllt5r for the

authenticlt5r and veraclty of the docrrmonts rubmltted, al evldenced by the
Omnlbus Swora Stetement, duly rtgacd by the appllcaat. Any hlse aad
frauduleot document submltted lhall be groundr for dlrquallflcatloa. l[o
addltlond docunc[t! rlll be accepted beyoad the deedllae.
8. The School Sub-Committee shaU submit the soft copy of the following forms
at hrmo.mandaluyong? deped.gov.ph , following the hard copy of the pertinent
documents to the Schools Division Office Human Resource Management Offrcer
(HRMO), through the SDo-Records section to be stamped "Received" not latet than
Msv 26.2(23: S:(Xlp.m'
a. Application letter together with the complete documents;
b. Accomplished Initial Evaluation Result (IER);
c. Accomplished Individual Evaluation sheet (IES) of Teacher-Apptcants using
DepEd Order No. 7, s. 2023;
d. Aciomplished COT-RSP Inter-Observer Agreement Form with Summary and
Average of score/ s and;
e. Summary of Initial Assessment of Teacher-Applicants using DepBd Order
No. 07, s. 2023.

9 lhe School Sub-Committee shall consist of the following:

. Chairperson School Head

o Members:
Desigrrated PubUc School District Supervisor
Education Program SuPervisor
Assistant Schooi Principal/Assistant to the Principal (for SHS)
Grade /Year level ChairPerson
Department Head of subject area (if JHS or SHS)
Master Teachers
Head Teachers
Administrative Officer (if no Administrative Officer,
designated Guidance Teacher)
President of School Teachers' Association
10. For schools with no existing department heads, the school head shall
designate the members of the committee from s-ong the faculty based on
qualihcation and demonstrated creditable competence.

11. The School HRMPSB in coordination with the EPSs and PSDS in-charge shall
be responsible for monitoring and facilitating tlle paper pre-assessment, classroom
observation/demo-teaching, and other recruitment related activities in their
respective schools.

12. Furthermore, the School HRMPSB shall ensure the timely submission of duly
sigrred and accomplished reports and forms as stated in Item No. 7 of this
Memorandum.

13. A secretariat/ School HRMPSB Focal Person shall be assigned to facilitate t}te
documentation, minutes of the meeting, and consolidation of papers.

14. The Divldon Hurnan Rerource Ucrlt ProEotloa and Selectloa Boatd
(IIRUPSB| shall be composed of the following:

Chalrperron: Mr. Rex A. Ado, Chief ES - SGOD, HRMPSB Chairperson

Uemborr:
Dr. Alyn G. Mendoza, Chief ES - CID
Mr. Ceasar A. Nachor, Education Program Supervisor
Dr. Josefino C. Pogoy Jr., Education Program Supervisor
Mr. Edgar O. Beknonte, Public Schools District Supervisor
Dr. Efren S. Consemino, School Principal IV
Mr. Henry A. Sabidong, School Principal IV
Mr. Johnlord S. Mendoza, SEPS-HRD
Ms. Miriam M. Villa Ignacio, ACT Representative
Ms. Milarosa M. lanza, ACT Representative
Mr. Mark Sherwin G. Magsombol, Administrative Officer V
Ms. Ma. Qpsitia l. Tria, Administrative OIEcer V-Budget
Ms. Evelinda S. Balibat, Administrative Offrcer IV-HRMO

HRUPSB Secteterlgt:
Elemcntary: Ms. Faye L. Portuguez, Administrative Aide M
Mr. Jerwin C. Cinco, Administrative Assistant III
Jualor H8: Ms. Daisy'mie Kate A. Tulang, Administrative Assistant III
Ms. Gloria E. Pueyo, Clerk
Senlor H8: Ms. Josephine A. Cedo, Administrative Assistant III
Ms. Rheza E. Ronquillo, Administrative Assistant III

Note: An alternate HRMPSB member shall be designated if in case the principal

HRMPSB member is not available during detberation/ s.

15. Membership of the HRMPSB shall be considered a regular duty and shall be
treated with utmost PrioritY.

16. All HRMPSB meetings and deliberations shall always be presided by tJ e

Chairperson. A majority of the HRMPSB members shall constitute a quorum.

17. Sub-committee/s will be designated, as deemed practicable, to assist in the

conduct of comparative assessment.

18. Qualified applicants shall be assessed based on the criteria set forth in
DepEd Order lfo. O7, t. 2(fr23, 'Guldellnes ol Recrultmetrt, S€lectloa, end
ADpohtncnt ln the Departmeat of Educstlon," to wit:
 Crlterla Maxlmum Polatr
Poslble
a. Education l0
b. Training 10
c. Experience 10
d. PBET/ LETI LEPT Rating 10
e. PPfiT COIs (Classroom Observation/ Demo Teaching) 35
f. PPST NCOIs (Teacher Reflection) 25
Totql 100
19. As pmvided in Sec 26 (b) Paragraph 2 of RA 9293 entitled "An Act Amending
Certain Sections of Republic Act Numbered Seventy-eight Hundred and Thirty-six
(RA 7836), Otherwise Known as the Philippine Teachers Professionalization Act of
1994," teachers who have not practiced their profession for the past live (5) years
shall be required to trke at least twelve (12) units in education courses, consisting
of at least six (6) units of content courses.

20. Following pertinent rules and regulations ald guided by the CAR-RQA, in the
exercise of sound discretion, the undersigrr.ed as Appointing Authority, select, insofar
as practicable, the candidate deemed most qualified for appointment.

21. The CAR-RQA shall be valid for one (1) school year reckoning from issuance.
However, the Schools Division Offrce may call for another recruitment if all teachers
in the CAR-RQA are already exhausted.

22. Teacher-applicants shall undergo the pre-employment mental/ physical and

medica-l examinations required under tlle Magna Carta for Public School Teachers
only prior to the issuance of their appointment by the appointing authority and
before they perform their actual teaching assignments.

23. The following timetable shall be observed:

Dete Activlties Person/Commlttee

Rellronslble
Aprtl l9-2O,2O23 Re-Orientation of School Sub- SDO HRMO
Committees, School HRMPSB
Focal Person ald SDO HRMPSB
and Secretariat
April 28 - May 12, Filing of application letter with Qualified applicants
2023 complete supporting documents
to the School Sub-Committee
May 15-18, 2023 Delibe ration of School Sub- School Sub-Committee
Committee for the initial
evaluation ald pre-assessment
of papers.
May 19-25,2023 Cl,assroom Observation/ School Sub-Committee
Demonstration-Teaching
fSchool lrve!
May 26,2O23 School Sub-Committee submits School Sub-Committee
the papers to the SDO and
through email.
May 29-31,2023 SDO HRMO and Personnel Unit SDO HRMO and
checks the initial assessment, Personnel Unit
completenes s of documents and
 Applicant's qualification viz-a-
viz Quali fication Standards
June 1-2,2023 SDO HRMO submits the Initial SDO HRMO
Evaluation Results (IER) to the
HRMPSB, posting of IER and
informing of applicalts.
June 5-7 2O23 Orientation of Qualified SDO HRMPSB
Candidates
June 5 (Elementary)
June 6 (Junior HS)
June 7 (Senior HS)
June 8-13, 2023 SDO HRMPSB checks the initial SDO HRMPSB
assessment of papers thmugh
deliberation.
JrnLe l4-2O,2O23 Administration and evaluation SDO HRMPSB and
of Teacher Reflection Form for designated Sub-
Qualified Candidates Comrnittees
Jlune 2l-23,2O23 Consolidation and encoding of SDO HRMPSB
initial assessment, demo- Secretariat
teaching and TRF results
Julre 26, 2023 Conduct of Pinal Deliberation SDO HRMPSB
by t}te HRMPSB
Jurrc 27,2023 Submission to the Office of SDS SDO HRMPSB
t1:e Compa.rative Assessment
Results-Registry of Qualifi ed
Applicants (CAR-RQA)
June 28,2O23 Posting of tJle CAR and CAR- SDO HRMO
RQA
Conduct of Background SDO HRMO
Investigation as requested by
the Appointing Authority
To be announced Appointment of Successful Appointing Authority
Candidate

24. All participa.ting individuals to the above-mentioned activities are reminded to

strictly adhere to the minimum health and safety protocols as pr€scribed by the
Inter-Agency Task Force for the Management of Emerging Infectious Diseases.

25. All expenses relative to the conduct of these activities shall be charged against
local fundslMOOE subject to the usual accounting and auditing rules and
reguLations.

26. Immediate and wide dissemination of this Memorandu is desired.

, cEso vI.
AURELIO G.
Assistant Schools Di
Oflicer-In
tend ti
Offlce of the Schools Division perintendent

Encls:
Errlosure tlo. I- CSC Minimum Qualification Standards
Enchsure l.lo. 2 - Checldis of Requlternents urith Omnibus CertfiCauon and Woilfr ratw*raats*,,rt
Encl,osur€ tlo. 3 - Initial Evaluatidl Result (IER) 1ot*-roa r.dtt P)
Endosure tlo. 4 - Irdividual EvaluaUon Sheet (IES) @ b ed@ b, .lut had)
Encfosure No. 5 - Summary d hitial Assessment of Teacher-Applicants /br. ft,t'cFt'dbtstbtro@)
Errlosure No. 5.1- Summary COT-RSP of Teacher Apdicants @ b@,*td rt et@t Me)
 Enclosure llo. 6 - IncremenE Table and Rubnts
Enclosure No. 7 - COT-RSP Observation Notes Form ro a. .dqnr's.d ot cor a"N.)
Enclosure tl,o. 8 - COT-RSP Teacher Apdfant Rating Sheet tu bc @,8d b @robs)
Enclosure l,l,o. 9- COT-PSP Teacher Applicant RatirE Stle€t (for IPft apdicants) o a xow,a or cor*tt
Enclosure No. 10 - COT-RSP Inter{bserver Agreement Form @ b a@& b/@re')
Enclosure No. 11 - COT-RSP hterobserver Aoreement Form (for IPEd applicanb) o"^,*n,-,nt
Enclosure No. 12 - Teacher Reflection Fotm ORF) irbE@,ar.dr.*,,5,
Enclosure No. 13 - Teacher R€flection RitinQ Sh€€t &a"-uroaa DrtwEittu)
Enclosure No. 14 - Teacher R€flecton Inter-Evaluabr Agreement F()Im rb ,. &dr4kh6r' tr, itl. E .)
'Aat
Enclosure No. 15 - Personal DaE Sheet (CSC Fom 212 Rorlsed 2017) p o, *v,u.a t waat
Enclosure No. 16 - Work Experience Shesf. o a. a*aa ty**ac)

References:
DepEi Order No. 07, s. 2023 - Guidelines on Recruiunent, Selection, and Appoinunent in the Department
of trucation
DepEd Order I{o. 27, s.2015 - Qualification Stan@ds for Senlor High School (SHS)
Teaching Positions in the Department of ftucation
CSC Resolution M. 1500358 - Qualification Standards re: Teaching Posiuons for Senior High School,
Department of Education
CSC Resolution No 1701192 - Qualificaton Standards re: Amended QS of Senior High
School Teaching F\rsitions, Technical-Vocatbnal Uvelihood C[VL) Tract, Elepartment of Educatio.l
1995 DepEd (Formerly DECS) Qualification StaMards Manual for Unique Posi0ons

To be indicated in the perpctu.l Index

under the following subjects:
Hiring
Recruitment
Teacher

ESB/JTM/JSM Aprir 28, 2023

 Enclosure IlIo. 1

QUALIFICATION STANDARDS

For Eloaeotary sad Juaior Hirh School:

POSITION EDUCATIOIT EPERIEITCE TRATMG ELIGIBILITY

REOI'IREUEITTS REOI'IREUE TS REQIIIREUEITS RE,OUIREIEITT8
Teacher I Fo[ ELo.lt tyl None required None required RA 1080 (Teacher)
Bachelor of Elementary
Education (BEEd) or Bachelor's
Degree plus 18 profeesionaj
units in Education
For .runlor Hlgh School:
Bachclor of Secondary
Education (BSEd) or Bachelorb
Degree plus 18 profesaiona.l
units in Education s.ith
appropriate maior

For Sealor Hish School ISHS):

POSITION EDUCATIOIT E'(PERIEI{CE TRAII{IIIG ELIGIBILITY

REQIIIREUEIfTS REQI'IREUEI{TS RF€UIRTUEITTS REOI'IREXEI{TS
Teacher I Acedcmlc TncL: None required None reguired r Applicants for a
Bachelor's degree with a permanent
(sHS) major in t]le relevant appointEent: RA
strand/ subject; or any 1080 {Teacher); if
Bachelor's degree with at not RA 108O
least 15 units of eligible, they trust
specialization in relevant pass the LET within
strand/ subject five (5) years after
the date of fust
TVL Tnct: TVL fnclr ?VL fr.cll biring
Bachelor's degrce; or None required At least NC II
completion of techrticsl- 'Appropriate to the o Applicants for a
vocational courses (s) in the specialization corrtractual
area of specia.lization position: None
requted
Artr rad Dcdgn TncL: &tr lgd Dcdgn An! .ad DGtliE
Bachelor's degree with a Trrcl: frrct: . Practitioners (pait-
major in field (s) under the None requted. None required. time only): None
Track; or any Bachelor's required
degree plus at least 15 units
of specialization in t}le
relevant subject

gportr TncL: Sport3 Ar.ct: Sportr Trach:

Bachelor's degree with a None requhed. None required.
major in field (s) under the
Track; or any Bachelor's
degree plus 15 units of
specializ.ation in fields under
the Track
 POSITION EDUCATIOIV EXPERIEIICE TRAIITIITG ELIGIBILITY
REOI'IREUE]lTS REOI'IREUEIITS REQI'IREXEITTS REOI'IREUEITTS
Special For Sciegc€ a[d Ultt None Required None Required . Applicants for a
oaly: permaflerrt
Science Bachelor's degree in a appointment: RA
Teacher I specialized held in Science, 108O (Teacher); if
(sHS) Technolory, Engineering, not RA l08O
Matiematics, or ottrer eligible, they rDust
applied courses as identified pass t-lle LET within
and approved by DOST as Eve (5) years after
priority s &T courses, the date of first
hAins
 A.naex C
CHECXLIST OF REQUIREMETTA

Name of Applicart: Application Code:

Position Applied For
OIIice of the Position Applied For:
Contact Nutaber:
Religion:
Ethaiciry
Person with Disability: Yes ( ) No ( )
Solo Parent: Yes ( ) No ( )

Status of Vcrilication
Sub6ission lto be flled-a)t b! t E |lR olfie/ al,}.rnnn1tee)
Basic Documentarj. Requircment fo be ffAed-out bA Status of
Submission
che* if s1tbtuifted)
a, L€tter of trtcnt addressed to tlte Head of Oflice, or to the
highest human resource ofliccr designated by the Head of
O{tice
b Duly accooplished Personal Data Sheet (PDS)
(CS Fora No. 212, Reviscd 2017) with passport sizc ID
picture and Work Experienc. Sheet
Photocopy of authenticated, valid and updated PRC
License/lD, if applicable
d Photocopy of authcnticated LET/ LEPT/ PBET Report of
Rating, if applicable
Ptotocopy of scholastic/acaderaic record such as but not
limitcd to Transcript of Records (TOR) with computcd
weighted averagc rating ard DiploEa, including cordpletion of
graduate and post graduate units/degrees, if available
f Photocopy of Ce.tificate / s of Training, if applicable
g. Photocopy ol Certficate of Eaplolment, Contract of Servic'e,
or duly signed Service Record, whichever is/are applicable
h Photocopy of School Clearance for thos. with teaching
experience
1 Photocopv of latest appointment, if applicable
j. Photocopy of the Performancc Rating in the laat.ating
period(s) covering on. (1) yea, pcrforEance in the current/
latest position prior to the deadline of subEi$ion/obtained
from the relevant work cxperience, if applicable;
k Chccklist of Requbcoents and omnibus Certification/Waiver
{Annex C)
l. Photocopy ofVoter's lD and/or proof of residency
m Photocopy of NBI Clearalce

HuEan Rcsource (HR) Oflice / subcommittee

OMI{IBUS SWORI{ STATEMEI{T

CTRAIFTATIO OIf AUTIIETTICTTY AJID VERACITY

I hereby certiry that all information above are true and correct and ofmy personal knowledge and bclief, and ttre documents
submitted helewith are original and/or cettified true cooies thereof.
DATA PRIVACT COXAEI{T
I hereby grant the Departsent of Education the right to cotlect a,rd process my pcrsonal inforaation as stated above, for
purposcs relcvant to thc recruitmcnt, s€lection, and plac-ement of persomel oI tlte DepartEent and for purposes of
comoliancc with the laws. rules. arrd requlations beinc imotemented by the Civil Scwicc Commission.

Name an<IS@-ure ofApplicant

Sub*rib.d ald geE to bc6F rc thtu &y of yce

-,

tD @lermc wirn R.publi. Act r{o. a792 or thc "Elcchrqi: col,rllrft Ac1 of 2OOO', (c)lccttEt d(x:rEcnE srEI baE th. Egal .ft.1, Etdity o. c.focability a dy
orhct d@ll'l@r or Lgar mftiry md 4 (*)h@ th. law rcquiEs a de@dr ro bc in nitin& that lrquiEm.nt is n l by m cb.t Dnic d@uo6t if thc sid .L.rlodc
de@at miDtaiB its inearity &d clsbtrty md la b. auth.trtiaLd & a to bc uebb tor s )s.qu.nt EGEre.
 IIIITIAI. EV/IIUATIOX REAULA (IER}
Q!.llficrdo! atl!.l 'd. oa tI. Po.Itto!
S.la.y GEd. ed Monthly S61ary

PGtulrlllfor.Uo!

5
II
II
PEpsr.d ed ccnificd orn:ct bv:

Hul1@ R@urc. ManaBc@nt omer

I.t ..dlqtE dodLr6. AIIO!

4) Forrhc pu,,its of posttng ttc tsR, oa&4tu D b t .hal b @ ela h @'71d@ uth RA No tol63lDdra Prbdc! Ad) ta oau inJoriari.n @t shatbe na.1e Fbtb drt tta
bl ftha infodatbn .toa not appv ta th. applidtt, pta* Nt tt/^
 Annex G-l

INDIVIDUAL EVALUATION SHEET (IES)

Name ofApplicant: Application code

Position Applied Fon
Schools Division Omce
Contact Number
)ob Group/SG-Level

Applicant's Actual Quallff cations

Details of Applicant's
Weight
Criteria Qualifications Actual
Allocation ?.levora ilr.r rt. nrs lrr l,mr rt .i; Computatlon Score

Education 10
II
I
Training 10

Experience l0

PBET/LET/LEPT Rating 10

PPST Classroom Observable

Indicators
35
(De mo nlEr a tio n Teq c h in g
usins coT-RSP)
PPST Non-Classtoom
Observable lndicators 25
(Teacher Rellection)
TOTAI, too

I hereby attest to the conduct of the application and assessment process ill accordance with the applicable
guidelines; and acknowledge, upon discussion with the Human Resource Merit Promotion and Selection
Board (HRMPSB), the results of the comparative assessment and the points given to me based on my
qualifications and submitted documentary requirements for the [insert posttlon] uoder llnsert ofncrE
where the vacancy exlstsl.

Furthermore, I hereby amx my sig[ature in this Form to attest to t]e obiective and iudicious conduct of
the HRMPSB evaluation through Open Ranking System.

Name and SiSnature of APPlicant

Date:

Attested:

H RMPSB Chair
Enclosure No. 5

scHooLs t Msro oFFtcE

CiV ol Ma.daluyong

NTTAL ASSESSTIEiIT OF TEACHER APPLICANTS

sY 2023 - 2o2a
DepEd Ordq 7, s. 2023

Sp.ctalilltlo.r
(Xlnd.rg.rt€,l
I
f e.chlng Relaled Tr.inihs Teaching Erperience

rctf
I

REMARKS COT Re0hg TOTAL

Name Educ.tion, by REMARKS REMARKS (poinls
Subl.ct Are. il nany wars oblained in
Equlvalenl
Equivalent Equivrl.nt Equlvalent
ot leaching and/ot Ratng
Points Polnts
by Tr.ck il Obsetwr
sHs) otc ) tainingl Agrcen,,nt
as teachar)

IIIIIIIIIIIII
--.{!lFt--fl!f!tEt-Il-lt!tilE
II -
(l ltI r-6t aFl-rt/.finl
o.oo

0.oo

IIIIIIIIIIIII
2

3 o.oo

SCHOOL SCREENING COMMITTEE

School Prirrcipal

Member
Enclosure No. 5.1

scHooLs DrvrsroN oFFrcE

City of Mandaluyong
School:

Summary of COT-RSP (lnter-Observer Agreement Form)

sY 2023 - 2024
DepEd Order 7, s. 2023

Area of Sp€ciali.ation
(Kindergarten or Rating for
Total No. of
ceneral Education, lndicator I lndicator 2 lndicator 3 lndicatoll lndicator 5 Points
COT.RSP
No. Name of Applicant Application code (total score/ 30'35)
by Subiect Area if Obtained
secondary and by
Track if SHS)

1
0

2 0

SCHOOL SCREENING COMMITTEE

School Principal

Observer 1 Observer 2 Observer 3

Ivlember Member

Member Member
 Table 2.a. Ircrerents Table - Ed.ucs.tion

Level Range
tr.ro!o To
I Can R.ad and wnte ElcDcntary Lcvcl Education

2 EbrD.ntary Cradu.tc Junbr Hith School Iarcl Mucation E ro l2)

HiIh School l^.vel lold curriculum)
3 CoIlFt d Junior HiEh schoot lx to l2l Senior HiSh School Lv€l Education (K to 121

S€nior Sigh School Craduat E b r2) Lct! thaa 2 yca$ of Collcgc

IIiEI School Graduate [Old currkulu.h)
CoEtp€t€d 2 yeara in Co[e8c
6 Bachclor'! DegEc
6 Unita cem€d tor,ard! ilc clEpiction of
7
f.!s than a Bachcb/s Dcgrc. but ioorc thln 2 ylrra
in CoI.r.
L.. thar 6 Unit! caIncd towerda thc comrledon
of. M.at r'' DcsEc
t€ss than 9 Unit! crrncd tovards thc clripLtion

8
a Mastcr's DrgrEe
9 Unit. .arn d toeard. th! coEplcti,od of L..
of a MaBt6r's Dcrrlc
than 12 Unit! cerncd lo!.,ard. ttrc compLtiou of a
l
a Mastcrh Desce Ma.trrb Dcgrrc
I 12 Units eahrd tovard. dl. c@plcdoi of k$a tnm r5 Units !sF.d tosard8 tie conpletiion of a
a MarLrb Delrec Mastcr's IlcgEc
r0 15 Unit! carncd to*ards tb. complction of lr!. than l8 Unita earned t nards thc complction of 6
a lrsstcr's De8re€ Ma.tcrL Dc*rac
11 l8 Udt! carned torvards th. coinplction oI L!! thln 2l Uri6 elrn€d taar& the codplctidr of e
a Ml3ter'! Dc!!!a Mslhfl'. DcEr.c
72 2 I UDits carnEd toeards lh. complction ot Las drrE 24 Uai6 €lrncd tot ards tlE complction of!
r MaEalrl D.tF.
24 Uait earncd to*arda tlrc coDplctron of
--L L..a rhln 27 UEta lraltcrb Dqr€c
carncd tosrrd! thc coDplction of a
a Martarb D!l,!a L&.t rb D.gre.
14 27 Unit! €srn€d towards th6 coErpLtion of lr.a tbra 30 Ulha cardcd towardr thc coagletjor of a
a Marer"r Dla,lc Ma6!ar'a Degr€c
15 30 Units eemed tocrards th. coEpl6tion of Lca3 then 33 Unit! camad toraerd! thc coEplctidr of a
a Mast /s D.cra6 Mattcrl Dercree
16 33 Units eamed toq,ard3 rhe cmplction of L€s than 36 Units ramcd loq,ards th. coEplcton of.
a Maltcr's DcgrEc Malter'a Dclre!
11 36 Lhitt carn d berrds th. compl.tion of LcB! than 39 Units larncd tosard! th6 @mplction of a
a laader! D€8tt Mlatcl'a Dcgcr
l8 39 UniB clrncd to$rrdr thc corrpbhon of lrss than 42 Unitr .ara.{ toq,ards the coEpLtion of a
a Ma61E! Dcgrce xa.t6t Dcrr..
l9 42 Units carn.d tortrds the corDplclon of Lcss tl|an CrmpLte AcadeEa R€quiruacits coroplcild
a MaEter's D€gre€ to,ards dr! cornpLtion of r Ma.tc/. Dcg!.
20 codplctc A.adcnic RcquicEcnta co@plct d Lss than an awardcd Masterh Degrec
rovards r Maalcls Degrer
2t I,last€r's D.gr.e Lss then 3 Unitr clmcd toward! tlc coETleooa of a 1
Doctorate
3 Units eemcd t sarda th€ coapletion of [.ss thaa 6 Units €amcd towards thc comCction of a
r Doctolrll
-- 6 Ullit Em.d t *"rds th" c@pbtion of Ia6 than 9 Utrits camad towards dra collplctotr of a
a Dodorata Doctorale
9 Unita eatucd tox/ard! the coopletion of L!s dlan 12 Unit! aarncd to*ards th. compLtidr of i
a Doctoratc Doct ratc
25 t, UoiE.rmcd tosadt lh! cotrtplction o, L€la tbaa lS Unit! .arnod towatds thr complctim of a
e Doctdatc M.oratt
26 1S Unitr c.mcd tolxsld! th. conrplctioD of t rs than l8Unit ..m.d t.irards tbr corrdctirt ofa
a Doctfrrtc koratc
27 18 UDit3 aamcd bwads tlt complcuotr of lrrt tbllr 2 I UDit! .trtld towa.rds the completion of a
a Doetorata Docloratc
2a 2l UDits !6rrcd towards tllG compl.tion of Laas tbad 24 Uiita crrircd torrsrds the coEpleddt of a
e Doctoratc Doctoratc
29 24 U[its eam.d towards thc compLtion I..ss than CoDipletc AcadEEic RcquiE t€!t!
towards the cdrplction of a Doctorate
30 C4mplct Aca&mic R.quircocfi8 coBplct d las! thrn an a*!rd.d Doctoatc
towards a Doctorat€
3I

Page 2 of 12
 Tablc 2.b. InctG[rents Tablc - Trahtng Teblc 2.c. IlcremeBta Tablc - Erpcrl,etrqe

Level Raage Lcvel Raage

trro!1 To Froo To
1 0 houra L€ss than I hours 1 None Less than 6 months

) 8 hour6 Less than 16 houra 2 6 monthj L.3 t]laD I year

3 Lcss tha. 24 houc 3 1 y.ar kra than I year 6 Eonthg

L- L.33 than 2 )'earg
24 hours lr6s tban 32 hour3 4 1 ,,Eat
6 month3
S 32 hour8 Le8s tian 40 holrrs 5 2 ycara la63 tban 2 y€als

6 40 hours Ias th8n 4a houra 6 2 rcan Lcss than 3 )'!arr

6 months
7 48 hour8 Less than 56 hour3 7 3 year6 [.a3a tha, 3 y€arg
6 motrth3
8 s6 hours L.ss than a hour6 I 3 Ferg

9 t s than 72 hours 9 L$ tbafl 4 years

6 monrha
10 72 hourc L.ss thsn 80 hour3 10 4 }lars
11 80 hours Iaes than 88 hours 1l 5 y.arg Llrs than 5 yeert
6 monthg
88 hours L€ss tlEn 96 hour6 t2 5 y.arg Irss thr$ 6 ye3r!

hour9 L.ss than l(X hours i r3 I..lB thaE 6 yeirg

6 months
l4 104 hour€ t s6 rle. lt2 hourg l4 6 years L?s6 then ? yeer6

112 hours Less than t2O houra 15 Less than 7 yc6rs

6 Eonth!
16 t€si than 12a hours t6 Less than I ycar8
6 Eonth8
\7 128 hours Lc6s than 136 houra l7 8 y€ars t ss thall 8 ],!ars
6 rnonthr
18 136 hours kss than 144 hours la 8 years
6 montlg
l9 Lss than 152 houre I9 9J.cefs Ls! tlan 9 ,!arg
6 month8
20 I 52 hours L.ss tllan 160 houts 20 9 year6 L€rs the, l0 Jears

160 hours Lc6rs tllen 168 hours I

l0 year8 l,'e ahan lO yeari
6 Eotrths
22 I68 hours tas than 176 hours 22 l0 )€ars Lcas than 1l ye€rs

176 hours L&s than r84 hours I I ]ear8 L€3 than 11 ycarg
6 Eontha
I84 hours t sr th6n 192 hours 24 I I yeais Ls! than 12 yearg
6 rnonth8
I92 hours L.ss than 200 hou.s 12 years lrs8 than 12 yars
6 monthB
2o0 iourg l,€ss than 208 hours 26 l2 year8 L€.8 than 13 yearg
26
6 Eorths
27 208 hours Lss than 216 hour6 27 13 ycers L.ss than 13 ycar3
6 months
2A 216 hours IPia the. 224 hours l 2A l3 years lass lhan 14 year8
6 Eronth3
224 hours kss tha! 232 hour6 29 L6s tharl 14 years
6 montha
232 hours l.€ds tban 24O houre 30 ks5 r-hatr l5 yearg
30
6 months
240 hours 3I 15 year8

Page 3 of 12
ArUG 3. Rlbrlcr for Conprtettoo of FolDtr lior Educetlon, ttrhltr! r8d fD.rl.nc.
lducruon Trrlll{ ErD."Laa
l,r$t illlocrdoa bln-altr llo- blrtr lElDrtlha hd,!t icbtr
l0 6 !!dr lo l0 or tDorr
to
lo or rrtrr ID

E-9 rrKr"trEnrr 3 I
E hrutirl lopoors
Il,u,int ryt l0 poi^tt 6-7 urglrDcDtt c, 6.7 irq, r*atr 6 6 , rorrc@dr
F4aaw: lO prlrts -l
4-5 lrtctt D.ntt { {..i itrdlmaols .t 4 S lnarEE|cn!! .l I

lrsr*mt 2 2-3 in('rrrtcnlt 2 2-3 lrcJcdnl! 2

 COT.RSP

OBSERVATION NOTES FORM

OBSERVER: DATE:

TEACHER APPLICANT OBSERVED:

SUBJECT & GRADE LEVEL TAUGHT:

DIRECNONS FOR ITIE OBSERVERS:

Write your obsorvations oo the applicant's classroom pefomance on the space pfovid€d. Use additional sheots whanevor
necassary.

Signature over Printed Name of the Observer

Ihh ioolw,5 d.veloFd !hrcl{h th€ PhlllPpirc N.tbnalEeseanir

Cst..lo, I€ach€r aldhy (RCTO) wrh suppot from th€ Austtallan
Auatralbn
ald',Qr
Llle
@s6
 COT-RSP

TEACHER APPLICANT

RATING SHEET

OBSERVER: DATE
TEACHER APPLICANT OBSERVED:
SUBJECT & GRAOE LEVEL TAUGHT:

DIRECTIONS FOR THE OBSERVERS:

'1. Rate eacfi itetn on the checklist according to how well lhe teacher performed during the observation. Mark the
appropriate column with a ({symbol.
2. Each indicator is ass€ssed on an irdMdual basis, regardless of its rdationship to other indicators.
3. Attach your accomplished Ob6ervation Noles Form to lhe comploted Rating Sh€et.

INDICATORS 234s6NO.
'1. Apply knowledge

2.
of content within and across cuniculum teaching areas

Use a range of teaching strategies that enhance learner achievsment in

literacy and/or numeracy skills
IIIII
3. Apply a range of teac'hing stralegies to develop critical and creative
thinking, as well as olher higher-order skills
4. PIan, manage aM implemenl developmentally sequenced leaching and
leaming processes to meet cuniculum requirements and varied teaching

5.
@ntexls
Design, selecl, organize and use diagnostic, formalive and summalive
assessmenl strategies consistent wilh curriculum requirem€nts
OTHER COMMENTS:
IIIIII

Sagnature over Prinled Name of the Observer Signature over Printed Name ofthe Applicant

'NO stands for Not Obseraed which automatically gets a ratng of 2.

COT.RECRUITMENT, SELECTION
and PLACEMENT (RSP)
tool w.s debp€d througt the PhlllpPne .lbn.l
Itis
R6e.rct cent€rfor Tea.her aualty {RcrQ wnh suppon
from the A!stElaa n 6ov6mdtcnt.
Atrstralirn
aidt I4 o6
 COT.RSP
0PEd)

TEACHER APPLICANT

RATING SHEET

OBSERVER: DATE:

APPLICATION CODE OF THE APPLICANT OBSERVED:

SUBJECT & GRADE LEVEL TAUGHT:

DIRECTIONS FOR THE OBSERVERS:

1, Rate each item on the checklist according to how well the teacher performed during the observation. Mark the
appropriate column with a (/) symbol.
2.
--
Each indicator is assessed on an individual basis, regardless of ils relationship to other indicators.
3. Attach your accomplished Ob6ervation Notes Form to the comdeted Rating Sheet.

INDICATORS 23456NO
1 . Apply knowledge of content within and across curriculum teactling areas
I

2. Use a range of teaching strategies that enhance learnet achievemenl in

literacy and/or numeracy skills
3. Oisplay proficient use of Mother Tongue, Filipino, and English to facilitate
teaching and leaming
4. Adapt and use culturally appropriate teaching slrategies to address lhe
needs of learners from indigenous group6.

5. Design, select, organize and use diagnostic, formatiYe and summative

assessmenl strategies consislent wilh cuniculum requirements
OTHER COMMENTS:

Signature over Printed Name of the Observer Signalure over Printed Name ofthe Applicant

'NO stands for Not Obseryed which automatically gets a ratitu of 2

COT.RECRUITMENT, SELECTION
ANd PLACEMENT (RSP)
Ttistoolwas ddelop€d lhrouSh the Philippine Nataonal
R6o.rch centerfor Teci6r qu.litv {RCIQ with $ppon
from the Austra lia n Govemrenr.
At3trdbn
AH'.t E@ #6
 ,""'':'%

ffi
COT.RSP

TEACHER APPLICANT

INTER.OESERVER AGREEMENT FORM

OBSERVER 1: NAME OF THE APPLICANT OBSERVED:

OBSERVER 2:

OBSERVER 3: SUBJECT & GRADE LEVEL TAUGHT:

DATE:

DIRECTIONS FOR THE OBSERVERS:

Discuss with the other observ€rs your reason/s for rating in each indicator. ln case of different ratings, come up with a final
rating. The final rating is NOT an average; it is 8 rltlng bas€d on r rea3onod and consonsual Judgment. lndicate this
rating on the column "Final Rating". Add the final rating per indicator to get the total then compute for lhe Roting for
Clossrcom Observatio, using the formula below. (Note: Weight allocation for Classroom Observation is at 35 points.)

Note lhat if the applicant gets NO (Not Obsorved) in an indicator, write 2 as the final rating,

FINAL
INOICATORS
RATING

1. Apply knowledge ofcontent wilhin and across curriculum teaching areas

2. Use a range ofl6aching stratogies that enhance leamer achievement in literacy and/or
numeracy skilb
3. Apply a range of teaching strategies lo develop crilical and creative thinking, as well as olher
higher-order skills
4. Plan, manage and implement developmenlally sequenced teaching and lsaming processes to
meet cuniculum requiremenls and varied leaching contexts

5. Design, seloct, organize and use diagnostic, forrnative and summatve assessrnent strategies
consistent with cuniculum requirements

TOTAL NO. OF PoNIS OBfANED (h&f,est@srble se,b 30)

OTHER COMMENTS:
-130
Rrting fo? thG DGnrorGffilon T.achlng 1.c., (Totll 3{orr / 30) ' 35
ooints
Exomple: (m / 30) x 35 = 23.33 points

Signatur€ over Printed Nam€ Signature over Printed Name Signature over Printed Name
of Obssrver 1 of Observer 2 of Ob6erver 3

Signature over Printed Name of the Applicant

COT-RECRUITMENT, SELECTION
and PLACEMENT (RSP)
'nls tool w.s develop€d throuth th€ Philippine Nition.l
R€s.arrh c€nte. for T..drer Ou.lity lRcrQ wht suppon
ftom the Alstnli.n Gov€mment.
ftEtratar
^Ht E45 ffic
 iH:
COT.RSP
(rPEd)

TEACHER APPLICANT

INTER.OBSERVER AGREEMENT FORM

OBSERVER 1: APPLICATION CODE OF APPLICANT

OBSERVER 2:

OBSERVER 3: SUBJECT & GRADE LEVEL TAUGHT:

DATE:

DIRECTIONS FOR THE OBSERVERS:

Discuss with the other observers your reason/s for rating in each indicator. ln case of different ralings, come up with a final
rating. The ltnal rating i3 NOT !n ayerago; it is a ratlng barod on ! ro$onGd lnd consantual iudgment. lndicate this
rating on the column "Final Ralng". Add the final rating per indicator to get the total then comPute for lhe Roting fot
Clossroom Observotion usirE the formula below. (Note: Weight allocation for Classroom Observation is at 35 points.)

Note that ifthe applicanl gets No (Not Observed) in an indicator, write 2 as the final raling.
FINAL
INOICATORS
RATING

1. Applykno rledge of contsnt within and across curriculum teaching aroas

2. Use a range ot teaching strategies that enhance leamer achievemont in literacy and/or
numeracy skilb

3. Display proficient use of Mother Tongue, Filipino, and English to facilitate teaching and leaming

4. Adapt and use culturally approp,riate teaching strategies to addross the needs of learners
from indigsnous groups
5. Design, select, organize and use diagnoslic, formatave ard summalue assessment slrategios
consistont with curriculum requiremenls

ToTAI- NO. oF POIMIS oBIAINEO (hghes, poss,ible scora /b 30) 130

ER S:
-

R ting foi thG DGmotrtration Teaching I.... Ootal t(orc / 30) ' 35
points
Example: (20 / 30) x 35 = 23.33 Points

Signature over Printed Name Signature over Printed Name Signature over Printed Name
of Ob6erver 1 of observer 2 ot Observer 3

Signature over Printed Name of lhe Applicant

COT.RECRUITMENT, SELECTION
and PLACEMENT (RSP)
Tnis toolwas de,eloped throusn the PhiliPPine
n6e.r.h
f rom
center for Teacher auallty (RcrO with
the Alstralian Govmment.
Nation.l
support
Al|3tdan
lll
{
Llle
@@6
 TEACHER REFLEGTTON FORM (TRF)

NAME OF TEACHER APPLICANT: DATE:

Directions: Share how you were able to exhibit the objectives by writing specific situations from your experience/s as a teacher, as a practicum
student, or in any other related instances. Be guided by the questions/prompts provided. Limit your response to a maximum of 10 sentences.

Non-classroom
observable Narrative and Reflection
objective

OBJECTIVE 6
Maintain learning
environments that
are responsive to
community contexts.

Comments from the Evaluator:

Rating: E Exemplary (Spts) E Fully Acceptable (3pts) E Not Fully Acceptable (1pt)
Thjs tool was &vebped th.ough the Philippire National
icle.ch Ceiterf6r TEahe, Qu.lity (nrrQl with support
-fio.n the Australian @!€rnnE .
Arstralkm
Aidt E d* ffi6
"'d
Page | 1
 Non-classroo m
observable Narrative and Reflection
objective

OBJECTIVE 7
Review regularly
personal teaching
practice using
existing laws and
regulations that
apply to the
teaching profession
and the
responsibilities
specified in the
Code of Ethics for
Professional
Teachers.

Comments from the Evaluator:

Rating: E Exemplary (Spts) E f utty Acceptable (3pts) E Not Fully A"ceptable (1pt)

Thls toolwas
i.grc h
&v€bped throqh the Phlllpplne tlatbnal
L-hcr Qorli+ly (Rcral srh ropporl
C.lnlr for
.lrom the Australhtr GovlrnnEm.
Australian
Ardt E4b ffig Page | 2
 Non-classroo m
observable Narrative and Reflection
objective

OBJECTIVE 8
Adopt practices that
uphold the dignity of
teaching as a
profession by
exhibiting qualities
such as caring
attitude, respect and
integrity.

Comments from the Evaluator:

Rating: E Exemplary (Spts) E rut ble 3 ) Not Ful ble (1pt))

Th{s toolwas ev€bp€d thro'rgh the Philippine Natbnal

Rere.rch Centerfor Te.eher Qu.lity {8cIQ) with iLrpporl
'fro m the Auskalhn GovernnEm.
Australbn
^rdt
LIlE
@ffi6 Page | 3
 Non-classroom
observable Narrative and Reflection
objective

OBJECTIVE 9
Participate in
professional
networks to share
knowledge and to
enhance practice.

Comments from the Evaluator:

Rating: E Exemplary (Spts) E futty Acceptable (3pts) D ltlot rulry Acceptable (1pt)

Applicant's Signature over Printed Name

-
Tllt tool w.r &v€b!€d throBh tlE Ptilhdna tLtblEl
n"i..r.h c.dt.r for Teh!. Qu.hy
lbfr rh. actnlbn 6oahmnr-
(nfiO.) wrh suppon
Arr3Haan
o;6Q @#6 PaSe | 4
 Annex O

TEACHER REFLECTION

TEACHER APPLICANT

RATING SHEET

APPLICANT OBSERVED: DATE:

POSITION APPLIED FOR: SUBJECT & GRADE LEVEL IAUGHT:

DIRECTIONS FOR THE EVATUATORS:

1. Rate each item on the checklist accordirE to how the teacher achiored the performance descriptions stipulated in the
Rubrics for Rating the TRF (Annex O). Mark the appropriate column whh a (/) symbol.
2. Each indicator is assessed on an individual basis, regardless
of lts relatiorEhip to other indicators.
3. Add the scor6 obtained per indicator ard write the totalon the space provided. Compute as wellthe final rating using
the formula indkated below. (Note: Weight allocation for NCOI TtF is at 25 points.)

INDICATORS 1 3 5

l. Maintain learning environments that are responsive to community contexts

2. Rwiew regularly personal teaching practica using exisling laws and regulations lhat apply
to the teaching profession and the responsibilities specified in the Cod€ of Ethics for

II
Professional Teach€rs.

3. Adopt practices lhat uphold the dignity ofteaching as a profession by oxhibiting qualiti€s
such as caring attilude, r6sp€cl, and integrity.

4. Parlicipated in profesional networks to share kno\ ,|€dge aM to enhance practice.

TOTAT NO. OF POINTS OETAINED: _120

OTHER COMMENTS:

Final rating for NCOI TRF i.e., (total no. of points obtained / highest pcsible score) x 25
points

Signature over Printed Name of the Evaluator

Tnis tool w.r d,6/ebF€d throi/ah th€ Phillppine .tbnal

R€.e.rch c.dcr for T*her Oialhy (RCIQ wth lltppon
ft om lhe Aunralaan Gov€mm.nt.
Austalbn
^rdQ 843 &c
 Annex P

TEACHER REFTECTION

TEACHER APPLICANT

INTER-EVALUATOR AGREEMENT FORM

APPLICATION CODE OF APPLICANT: DATE:

POSITION APPLIED FOR: SUBJECT & GRADE LEVEL TAUGHT:

DIRECTIONS FOR THE EVALUATORS:

Discuss with the other assessor/s your reason/s for rating in each indicator. ln case of different ratings, come up with a
final rating. The final ratlng ls NOT an averaBe; it is a ratlng based on a reasoned and consensual ludgment. tndicate this
rating on the coluffin "Finql Roting". Add the final rating per indicrtor to get the total then compute lot the Roting for
Portfolio Assessment using the formula below. (Note: Weight allocation for Portfolio Assessment is 25 points.)

INDICATORS FINAL RATING

1. Maintain leaming environmenls that are responsive to community contexts.

2. Review regulady personal leaching practice using existing laws and regulations that apply
to the teaching profession and lhe responsibilities specified in lhe Code of Ethics for
Professional Teachers.

3. Adopt practicos that uphold the dignity ofteaching as a profossion by exhibiting qualities
such as caring attitude, respect, and integrity.

4. Participated in profe6sional nelworks to share knowledge and to enhance practice.

TOTAL NO. OT POINTS OETAINED: 120

OTHCR COMMENTS:

Final rating tor NCOI TRF i.e., (total no. of points obtained / highGt possible score) x 25
txotnple. ( 20 / 20 ) x 25 - 25 points
_ points

Signature over Printed Name of the Evaluator

Aultrdlen
This tool wa5 dadop.d th rough the Ph illppine Nrtional
R6earch center for T..cher Qu.lity (RCIQ) whh epport
f rom the Aust.alian Golemment.
Aid'-Qr E4-1 @c
 PERSOI{AL DATA SHEET
WARN,IO: ADt ni/tnltr,p..t d@ md. /, tx t srdl O.,. Sh..l .i<l i. vq, ErE.rt'e Sr*t .tt c.tt . E flhe ol ..hhntn aiv"lc.inln l ...c. .g.td.r t { poaa
fHE AIIACHEO OUTDE fO F,rL,xlt OUf fHE PfRSO|IAL DATA Srrfr lPOS,l lrEiFORti C@a,PlrSr tO 7t EPErS
00 tioraa8Rfvt TE. I CS l0 t*o trEfEEEE
I, PERSONAL INF OR'I A1 IOII

z slrBuuE

FIRSTME

EruluE
-E@E
3 DAIE OF INI}I
16 OT?ENSHIP
E rif|l! E Dr.t cttd{rb
E t urC iy n r,6tadon

Ph indcC. cnfifry:

5 S€l El&& fl Fs.d.

Ll sltrc !T RESO€NTIII IDDRESS

O rrfio€d El s.e.ra.d
E et.rs
7 HEf*iIIn)

8 X'Elln {b)

9 ET,OOO mE

10 GS|S r0 r{o

1 ! P &rBrG t0 r€

12 PHITHEIITH I€ zrPcooE

13 SSS NO 19 'IEIEPIIONE NO

1' TIN NO T IrcELE IIO

E-I IL ADoRESS fl t'y)

II. FAIIILY BAq<AROUND

sPolrs€'s

Fnsr I
s.B{
lE
E N{lE o{ CHIoREN (Wrr.d nma}dHd)
@
mEEEiIMr,lt

btx.E ME

EMPIOYERTSU9 ESS NAME

BUgNESSADORESS

2a F rlcFsgro|f
E
FIRST

Ellltil&
MIE
I
rclralrrBrtE
gJi,llE
IIRSI I{AIE

DUI{TlE P rt.dtt*.ttt-arl..tty)
t. EDUCAIIO|IAL B ACKCROU D

26
LEVEL
BASE EDIJC TTOIi/DECiaEI@URSE
@ @@ffit
ffi ffiil ffit
lrl:t5i6:ttiiilti!!":

AESENITF!
III I
TRIOE CqJRSE

COILE6E
III I
GRADUTTE SIUOI'S

S'GI{AIURE
III DAIE
IV. CIVIL SERV'CE ELIGIBIUTY
2f ctxmsExvrcE R rm(uRo/uR) $oa oATE Of LrcExs€ fl #€&)
sPECr t urs/c€g c6€E q ril Trqr/ PLICE Of ELlll/tNATlOtl / @IFEFIENT
., {I

II
S MIGAY EJqAUTY/ OBVETs UCE SE @If,ERIE

II
I II
V. gr'ORX EXPER,ENtr
I I
lllr,t/d. !,iyaL andoytuar*. Sl l ftam wu rccznt flot/ll DesariDr'on ot drrrss stould b indicated in lhe rttched Wot* ExEdeica s,trll"
a IIE-I.6IVE DAIES
(mrtlrltty) POSITION IIT1E ocPAf,TrEXr /r6E S./ / OFFTCE / Cdf t{Y
SERIICE
0fi..taDord&rib) ovre n ftl,Do nd tB!.b)

II
II IIII
IIII
II
II IIII
IIII
II
II IIII
IIII
II
II IIII
IIII
II
II IIII
IIII
IIIT
IIII
II
II I
II III
II
II III
IIII
II
II IIII
IIII
II IIII
II IIII
IIII I
III
II
I
SIGNATURE DAfE
W VOLUNIARY WORK OR INWLVErefi N CIVC / NO$EOWRII,,,ENT / PEOPLE / VOLUNTARY ORGANTZANOMS

a l{Alf, g AooREss of oRG l{tz^TroN

(ffr.r,ir)
rE
lltauE vE D TES
H
I PO6II]ON / MTURE OF IYOfiX

III
iE

I II
II
w. LE RNfitG ArO DEWLOP,,fir (&q o
NIERWNqONSfiRA,,dNC PROGRArS
II
AffEttDED
I
rG-usavE I) rEs 0f
30 flIf OT IEAFI{I're rl0 DEVE.OTIEIII }IIEV9{NONETRT|II|IG PR(EflAF ITIE0 IC€ coiowlEvsPottsffi) 6Y
GVbn tr) (.r6yyr) rur. h u)

IIII
IIII
IIII
IIII
IIII
II II
IIII
-LII
IIII
IIII
II II II
II II
II II
II II
vl . ofuE( lNFoRNAftoN -III
rlolil C DELC !6III'EIU'S / RECGMIIOI{
3 EFERSffNASS@ TrOrl/OfiG r{Z Tlorl
3t SPEOI! SI(LIS aild HOABES 32
u.hu) f'fi&nlt,

S'GIVATURE DATE
3a Are you rElabd by consanguinity d afinily b tre appdnting a recoomondng autldity, or b tle
chief of hredl fr ofice q b tE Fso[ rtlo has hnslab sqErvision o\r€f yo( in t€ Offce,
BIrEu d oopatrolt uhqs you yiill be eohbd,
a. hin ote 0!i! d6gr€6?
EYE I r{o
b. wit n tle lorrh d8orE (h Local Go{€rrmdt l.lnit - C eq Elploye6s)? EYE ENo
lf YES, live debih:

36 a. Have you evef been tound guilty of any adninistsalive ofunse?

EYE E rio
lf YES, dve dehils:

b. lbve you b€en cfimimlly chaggd bet e arry cou{? EYES E r{o
lf YES, dve debils:
Dale Filed:
Shtus ot Casdsl

6 thv€ you ws beeo c.hlricbd of ary crire s vkMirn ol ary law, deoee, d*Erce d ngubliql
lYE nNo
by ary cout a tbomp
lf YES, give debils:

37 Have you a/ca been s€parabd tt,n 0!e ssvice in any of tl€ frrlo'iing rpdes: resiglalfun,
Elisnent dryed ftln tp rok, dsnissal, tdminalirn. sd of bm, f nish€d cont-act .r d6od
EYE nNo
lf YES, Oive debib:
oiJt (abdilirn) in tle Flrb o Fi'/"dle s€cb,

30 a. lla/e yoir 6.s b€€ll a canddab h a nalinal d localelocli,| held *hin tp hst yEr (e(cept
EYE ENo
B{angay eleclin)?
lf YES, give debib:

b. Have you rcsigned tcrn tle go\roflmeirt servbe dring tle dree (3]monh p€.iod boftre ore bst D YEs ENo
declion to trdnob/actively crrpai$ fq a naliorEl or local c€nddate? lf YES, {ive debib:

39 Have you acqrircd tle shfus of an irmi{Fnl oa p€rmanent rE6irent of anotEr counqn
EYE ENo
lf YES, live dehib (co{nty):

40 Pl'$ant to: (a) lrdgBnous People's A.l (RA 8371); (b) MagE Carla f6 obded P.rsoos EA
7274; ad (c) Solo Pareib t\/ella.o A.l of 2000 (RA &S72), please arFv€r he follo .irE ibr6l

a &e yor 6 msrbe. of any irdgeooos grow? EYE Ero

lf YES. d€6e speciry:
b Are you a person wtr drsability? EYB EI No
lf YES, plese gecify l0 No:
Are you a solo parei0 EYE E i|o
lf YES, pl€ase sp€city lD tlol

4' qEFERENCES

ADDRESS TET NO

wih lul dd ha.dMtb^

nm t4 ,id si9rtu6 M

12 I dscke unds oo0! tBt I hav€ p.{sorEfly accmdidted tis P€$onal Dab sh€et rhhh is a t!e, cqrect ard
cdrplete shEn€nt Frslant b 0E provisirs of p€.tnenl b$rs, rul€s dd reguhlixls of he Relblic of tle
Phili+ines. I autEdze 0le agE[ry h€adau$cized rErs6enhlive to v.rityrval&b tle corlblb siat d h.rdn.
I agree that any mi!.eFBsrhlio0 II6de in Uis doqrnst and ib atadInorb drall cause tle fliig ot
adnini#h/d.rihinai casds agalEt me.

lD G Pryt css, sss PRc, &ir. ti..-

Go/6rI!]€nl lssu€d *.)
ILEASE INDICAIE lD Nufib€, aN D,le oI lssuao@

sgn lue (sgn msds lhe box)

SUBSCRIBED AND SVYORN lo before me lhis , aftanl e$bilirE idller valicly 6sued go/enyrEnt lD as ftkated abo/e

Psson Adninislering Oatr

 Attachment to CS Form No. 212

WORK EXPERIE'VCE SHEEI

lnstructions: 1. lnclude only the work expeiences relevant to the position being applied to.

2. The duration should include start and ftnish dates, if known, month in abbreviated form,
if known, and year in full. For the cunent position, use the word Present, e.9., 199&
Present. Worl< expeience should be listed from most recent first.

. Duration:
. Position:
. Name of Office/Unit:
o lmmediate Supervisor:
o Name of Agency/Organization and Location:

List of Accomplishments and Contributions (if any)

o
o
o

a Summary of Actual Duties

o
o
o

o Duration
o Position:
o Name of Office/Unit:
o lmmediate Supervisor:
o Name of Agency/Organization and Location:

a List of Accomplishments and Contributions (if any)

o
o
o

Summary of Actual Duties

o
o
o

(Signature over Printed Name

of Employee/Applicant)

Date: