Republic of the Philippines

Department of Education
REGION VII – CENTRAL VISAYAS
ANNEX A: Rewards and Recognition Form 1 (Nomination Form)

RO 7 PASIDUNGOG SEARCH

NOMINATION FORM Passport size

Photo

INDIVIDUAL CATEGORY

Category: _________________________________________________________

Nominee (First Name, Middle Initial, Last Name) :

Signature:
ELIEZAR BELEYA PAYUSAN

Position (per Service Record): TEACHER 1 Gender: MALE Age: 26

Status of Appointment(per Service Record):

Date of Birth: JUNE 03, 1997
REGULAR PERMANENT

Place of Birth:
Telephone/Cellphone Nos(Active Contact Details):
BAYABAS CANSUJE, ARGAO,
09218129381
CEBU

Residence Address:
BAYABAS CANSUJE, ARGAO CEBU

Level of Position:
☐ 1st Level ☐ 2nd Level. ☐ 3rd Level (SDS/ASDS)

☐ Teaching Related ☐ Non-teaching ☐ Teaching

Email address:

SCHOOL HEAD

Name: IMELDA SARA SARDIDO

Position: HEAD TEACHER 3

Office/Office Address: LINUT-OD ELEMENTARY SCHOOL /LINUT-OD ARGAO

CEBU

Telephone/Cellphone Nos. (Active Contact Details): 09612412858

Email Address: imelda.sardido@deped.gov.ph

DIVISION/AGENCY HEAD

Name: Position:

Address: Doña M. Gaisano St., Sudlon, Lahug, Cebu City

Telephone Nos.: (032) 231-1433; (032) 414-7399
Email Address: region7@deped.gov.ph Doc. Ref. Code RO-HRDD-F036 Rev 00
Effectivity 05.22.2023 Page 1 of 3
Website: https://region7.deped.gov.ph
 Republic of the Philippines
Department of Education
REGION VII – CENTRAL VISAYAS
Office/Office Address:

Telephone/Cellphone Nos. (Active Contact Details): Email Address:

NOMINATOR

Name: Position:

Office: Telephone/Cellphone Nos.:

Office Address: Email Address:

RO 7 PASIDUNGOG SEARCH
Passport size
NOMINATION FORM Photo

GROUP CATEGORY
Category/Program: _________________________________________________________

Nominee/Focal: (First Name, Middle Initial, Last Name) : Signature:

Position (per Service Record): Gender: Age:

Status of Appointment: (Per Service Record) Date of Birth:

Telephone/Cellphone Nos:(Active Contact Details) Place of Birth:

Residence Address:

Level of Position:
Category:_
☐ 1st Level ☐ 2nd Level. ☐ 3rd Level (SDS/ASDS) (Division/District/School)

☐ Teaching Related ☐ Non-teaching ☐ Teaching

Email address: Size: (small, medium, large)

SCHOOL/OFFICE/HEAD

Name: Position:

Office/Office Address:

Telephone/Cellphone Nos: (Active Contact Details) Email Address:

DIVISION HEAD

Name: Position:

Office/Office Address:

Address: Doña M. Gaisano St., Sudlon, Lahug, Cebu City

Telephone Nos.: (032) 231-1433; (032) 414-7399
Email Address: region7@deped.gov.ph Doc. Ref. Code RO-HRDD-F036 Rev 00
Effectivity 05.22.2023 Page 2 of 3
Website: https://region7.deped.gov.ph
 Republic of the Philippines
Department of Education
REGION VII – CENTRAL VISAYAS
Telephone/Cellphone Nos. (Active Contact Details): Email Address:

NOMINATOR

Name: Position:

Office: Telephone/Cellphone Nos.:

Office Address: Email Address:

Additional Information about the Nominee:

Were you a previous PASIDUNGOG Nominee? ☐ Yes ☐ No What year: _____

What Award Category: _____

Were you a previous PASIDUNGOG Semi-finalist? ☐ Yes ☐ No What year: _____

What Award Category: _____

Were you a previous PASIDUNGOG Awardee? ☐ Yes ☐ No What year: _____

What Award Category: _____

Address: Doña M. Gaisano St., Sudlon, Lahug, Cebu City

Telephone Nos.: (032) 231-1433; (032) 414-7399
Email Address: region7@deped.gov.ph Doc. Ref. Code RO-HRDD-F036 Rev 00
Effectivity 05.22.2023 Page 3 of 3
Website: https://region7.deped.gov.ph