Republic of the Philippines

DEPARTMENT OF EDUCATION
Region V
Schools Division OFFICE of Camarines Sur

May 27,
2022
GRACE D. ESTRELLA
(Name of Applicant)
Zone 5B, Impig, Sipocot, Camarines Sur
(Address of Applicant)

Sir/Madam:

This is to certify receipt of the following, documents relative to your application for transfer to
another school in SDO Camarines Sur.

Document Remarks
1. Letter of Intent to Transfer addresses to the Schools division /
Superintendent
2. CSC Form 212 (Revised 2017) Personal Data Sheet completely filled out /
with latest 2x2 ID picture.
3. Service record X to follow
4. Voter’s ID or Certification of Residency in the Barangay. /
5. Marriage Contract (if applicable) /
6. Certification of Employment of Spouse (if applicable) NA
7. Birth Certificate of the Child (if Nursing Mother) /
8. Solo Parent ID (if applicable) NA
9. Assessment Result on the exceptionality of the child (if parent of a child NA
with special need)
10. Police/ Barangay Blotter, Incident Report/ Certification from the NA
MDRRMO (if armed conflict is the reason)
11. Medical Certificate signed by a government doctor (if applicable) NA
12. Certification of Performance rating (for the last rating period) X to follow
Remarks:
 / (check) if document is submitted
 X if document is not submitted
 NA if document is not applicable

Certified by School Head:

(Name) MODESTO B. MONTAÑEZ

JR.
(designation) ESHT-1
(School) Del Carmen Elementary School
(Date) _________________________

Conforme: Teacher Transfer Applicant

(Printed Name) GRACE D. ESTRELLA

(Designation) T-1
(School) Del Carmen Elementary School
(District) Lupi District
(Signature) _________________________
Republic of the Philippines
 DEPARTMENT OF EDUCATION
Region V
Schools Division OFFICE of Camarines Sur

TRANSFER APPLICANT’S INDIVIDUAL SCORE SHEET

Name Designation: T-1
(Surname, First Name, Middle Name) School: Del Carmen Elementary School
ESTRELLA, GRACE DEUNA District: Lupi
Address (Residential): Zone 5B, Impig, Sipocot, Camarines Sur Contact Number: 09989340874
Address (Permanent): Zone 5B, Impig, Sipocot, Camarines Sur
EVALUATION CRITERIA
CRITERIA Weight Points Remarks/
Earned Documents
Presented
a. Teacher is declared excess by School Head, expertise is needed in 25 points
another school/district
(Ref. Certification signed by the PSDS)
b. Teacher has served more than 5 years outside his/her 10 points
barangay/municipality/province
10 years up=10 Pts., 5 to 10 years =5 Pts.
c. The teacher is a bonafide resident of the barangay, municipality, 10 points
province where the school intended to transfer is located.
Barangay=10 Pts.; Municipality=7 pts.; Province=5 Pts
d. The teacher is joining his/her husband/wife in the same school. 10 points
(R.A. 4670)
(Ref. Marriage Contract; Cert. of Employment of Spouse)
e. Teacher is a nursing mother 10 points
Child is below 10 y/o = 10 pts.
Child is 2 years old and up =5 pts.
(Ref. Birth Certificate of the Child)
f. Teacher is a solo parents/parent of a child with exceptionality 5 points
Below 18 y/o =5 pts. With social needs= 5 pts.
Above 18 y/o= 0 pts.
(Ref. Solo Parents ID, Assessment Result on the exceptionality of
the child)
g. Teacher’s life in danger 10 points
(Ref. Police Blotter, Cert. from MDRRMO on the current state of the
area.
h. Teacher has very poor health condition 10 points
(Ref. Medical Certificate/ Records)
i. Performance rating for the previous School Year 10 points
4.5 to 5= 10 points; 3.5 to 4.4=9 points; 2.5 to 3.4= 5 points;
Below 2.5=3 points
TOTAL 100 pts.
Certified Correct (Signature over printed Name/ Date Signed)
SCHOOL SCREENING COMMITTEE REVIEWED BY:
Chairman 1: PSDS:
MODESTO B. MONTAÑEZ JR. ANA N. CALISURA
Member 1: HR STAFF:
VILMA S. MIRA
Member 2: HRMO:
EMMA G. BORROMEO

Member 3:
ROSEMARIE P. OCMER