ANNEX A
R&R Form 1 (Nomination Form)
DIVISION TAPOC SEARCH Passport size
Photo
Individual Category: Teacher (Teacher, School Head, Non-Teaching Level 1 and 2)
Nominee (First Name, Middle Name, Last Name): Signature:
Stephanie F. Alob
Position ( per Service Records): Teacher III Gender: Female
Age: 30
Status of Appointment( per Service Records): Permanent Date of Birth August 30,
1994
Telephone/Cellphone Nos (Active Contact Details): 09171405695
Place of Birth: Caloocan City, Metro Manila
Level of Position:
Group
1st Level 2nd Level 3rdLevel (SDS/ASDS) Category:___________________
_
Teaching Related Non-Teaching Teaching Nominee(Name of School/ Name of
SDO):
San Jose Provincial High School
Email Address: [Link]@[Link] Size (small, medium, large):
Large
SCHOOL HEAD
Name: Esther M. Villarin Position: Principal II
Office/Office Address: San Jose, Poblacion, Negros Oriental
Telephone/Cellphone Nos. (Active Contact Details): 09276455321 Email
Address: esther.villarin001@[Link]
DISTRICT/AGENCY HEAD
Name: Nida L. Bersabal, EdD
Position: District Supervisor
Office/Office Address: San Jose/ Poblacion, San Jose, Negros Oriental
Telephone/Cellphone Nos. (Active Contact Details): 0917180327 Email Address:
[Link]@[Link]
NOMINATOR
Name: Esther M. Villarin Position: Principal II
Office: Poblacion, San Jose, Negros Oriental
Telephone/Cellphone Nos.: 09276455321
Office Address: Poblacion, San Jose, Negros Oriental
Email Address:esther.villarin001@[Link]
Additional Information of Nominee:
Were you a previous PASIDUNGOG/TAPOC Nominee? Yes No
What year: ______
What Award Category?
Were you a previous PASIDUNGOG/ TAPOC Semi-finalist? Yes No
What year:_____
What Award Category?
Were you a previous PASIDUNGOG/ TAPOC Awardee? Yes No
What year: _____
What Award Category?
ANNEX B
R & R Form 2 (Nomination Write-up for all Categories)
Nomination Write-up
(Minimum of 250 words and Maximum of 500 words, A4 size bond paper, Arial# 12 font,
including executive summary)
Name of Nominee: (including (Group Category):
Category):
Position: Name of School/District
Length of Service in the Position: Head of Office:
in Government:
I. Executive Summary
II. Exemplary Behavior/ Conduct Displayed within the last 3 years
III. Impact Accomplishments (indicate problems addressed, savings
generated, people/ office benefited and transactions facilitated. Indicate
whether or not the accomplishments are part of the nominee’s regular
functions/ mandated or the product of his/her/their own initiative. If part of
nominee’s regular duties or mandated, justify why the accomplishments are
considered exemplary or extraordinary.
Other Information (Major Awards/Citations Received/ Membership in the
Organization)
CERTIFICATION
We/ I attest to all facts contained herein and authorize the use of these information for
publication. We understand that the Committee on Awards will validate the accuracy of the
information contained in this form and grant our consent to the conduct of a background
investigation. Any misrepresentation made by the signatories shall be a ground for disciplinary
action pursuant to applicable Civil Service laws and rules and DepEd RO VII/Division Rewards &
Recognition Policy.
Printed Name and Signature:
Nominee Nominator PRAISE Division Office
Committee/Highest Head
HRM
ANNEX C
R & R Form 3 (Omnibus Certification for Individual & Group Categories)
OMNIBUS CERTIFICATION OF AUTHENTICITY
AND VERACITY OF DOCUMENTS
I, ___________________________________, Filipino, of legal age, with permanent address at
___________________________________________, after being sworn in accordance with law, hereby
depose and state that:
1. I am applying for ______________________________________________________ at
Name of Category
_______________________________________________________________________;
Name of School/Division , Address of School/Division
2. I have submitted the following documents:
1. Fully Accomplished Rewards and Recognition Forms
1.1 Nomination Form (Form 1)
1.2 Nominee’s Write-ups on the Highlight of Accomplishments
(Form 2)
2. Updated PDS with passport size (1 ½” x 2) photo with name tag taken within the
last six (6) months prior to the nomination.
3. Endorsement letter from the Schools Division Superintendent/ Chairperson of the
Division PRAISE Committee or its equivalent, that the nomination has undergone
deliberation by the Committee.
4. Certification of No Unliquidated Cash Advances signed under oath by the agency’s
Financial Officer/ Accountant and Certification of No Disallowances issued by the
COA Resident Auditor for previous accountabilities as of December 31, 20_____. In
case of existing unliquidated cash advance and disallowance, a certificate of the
status of such financial obligation shall be issued by the COA Resident Auditor.
5. Certificate of no pending administrative/civil/criminal case;
6. Updated service record duly certified by the agency’s Human Resource
Management Officer (HRMO).
7. Performance Rating for the last three (3) performance rating periods prior to the
nomination.
3. I am executing this Certification as to attest to the authenticity and veracity of all
documents submitted.
4. By executing this Omnibus Certification of Authenticity and Veracity of
Documents, I hereby authorize the Department of Education, Division of Negros
Oriental, to verify the authenticity of the above mentioned documents.
__________________________
Signature Over Printed Name
_____________________
Date
SUBSCRIBED AND SWORN to before me in City/Municipality _________________________ this _____
day of ________________, 20____, affiant exhibiting to me his /her Community Tax Certificate No.
__________________ issued on _____________________ at _________________, Philippines.
________________________________
Notary Public