Republic of the Philippines

Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen
EVALUATION TOOL
DepEd Order No. 66 Series 2007

INITIAL ASSESSMENT OF APPLICANTS (PHASE I)

ADMINISTRATIVE OFFICER II
Date: November 14, 2023
Name of Applicant LEONA MIE C. CUBOS
Address / School POBLACION, ANDA, PANGASINAN / ANDA INTEGRATED SCHOOL
District DISTRICT OF ANDA
Present Position

Position Applied ADMINISTRATIVE OFFICER II

Item No.

School Where the Vacancy Exists

District Where the Vacancy Exists

POSITION'S BASIC QUALIFICATION STANDARD
Level ELEMENTARY SECONDARY

Education Bachelor's Degree Bachelor's Degree

Experience None Required None Required

Training None Required None Required

Eligibility CS Professional CS Professional

APPLICANT'S QUALIFICATION STANDARD

VALIDATED BY:
To be filled-out by the Applicant
PASSED FAILED Signature and Date

Education

Experience

Training

Eligibility

QUALIFIED DISQUALIFIED

Attested By:
 NELIA C. SANTOS
bit.ly/sdo1-PSBforms Administrative Officer IV (Personnel)
NOTE: DOWNLOAD FILE FIRST

<- SELECT FROM DROPDOWN LIST

 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen
EVALUATION TOOL

ELEMENTARY / JHS / SHS

POSITION APPLIED < Select POSITION

NAME
ADDRESS / SCHOOL
DISTRICT
PRESENT POSITION
HIGHEST EDUC'L ATTAINMENT / COURSE
DATE OF LAST PROMOTION DATE EVALUATED March 16, 2024
A. PERFORMANCE RATING ( points) SCORE
School Year (last 3 rating period) Rating Points EARNED POINTS
SY
SY
2022 - 2023
2021 - 2022 0.00 0.00 0.00
SY 2020 - 2021
B. EXPERIENCE ( points) SCORE
Example: 1yr. & 3mos. 15/12 - 1.25 points
Inclusive dates
from:
to:
0yrs, 0mos, 0days
0.00 0.00
No. of years Points No. of months Points EARNED POINTS
0 0 0 0.00 0.00
C. OUTSTANDING ACCOMPLISHMENTS (0 points) 0.00 0 SCORE
a. Outstanding Employee Award Points EARNED POINTS
Awardee in the School
Nomination in the Division / Awardee in the District/Cluster
Nomination in the Region / Awardee in the Division
Nomination in the Department / Awardee in the Region
National Awardee
b. Innovations Points EARNED POINTS
Title of the Workplan / IM / INNOVATION

Conceptualized
Started the implementation
Fully Implemented in the school
Adopted in the district
Adopted in the division
c. Research and Development Projects Points EARNED POINTS
Title of Action Research

Action Research conducted in School 0.00

Action Research conducted in the District
Action Research conducted in the Division
d. Publication / Authorship Points EARNED POINTS
Title /s of Article/s

Articles published in a journal / newspaper / magazine of wide circulation (1 point

per article but not to exceed max points)

Co-Authorship of a book (shall be divided by the number of authors)

Sole Authorship of a book
e. Consultants / Resource Speaker in Trainings /
Seminars, Workshop / Symposia Points EARNED POINTS
District Level

Division Level

Regional Level

National Level
International Level
D. EDUCATION AND TRAINING (0 points) 0.00 0 SCORE
a. Education ( points) Points EARNED POINTS
Complete Academic Requirements for Master's Degree
Master's Degree
Complete Academic Requirements for Doctoral Degree
Doctoral Degree / JD / LLB

b. Training ( points) 0.00 0.00

Participant in a specialized training, e.g., Scholarship Programs, Short Courses, Study Grants
(1 point for every month of attendance but not to exceed points)
Participant in (3) or more training activities in each level conducted for at least (3) days not credited during the last promotion.

District / Cluster Level Trainings Points EARNED POINTS

3
Division Level Trainings Points EARNED POINTS

3 0.00
Regional Level Trainings Points EARNED POINTS

3
Participant in (1) training conducted for at least (3) days not credited during the last promotion

National Level Trainings Points EARNED POINTS

1
International Level Trainings Points EARNED POINTS

Chair / Co-Chair in a Technical / Planning Committee Points EARNED POINTS

District Level
Division Level
Regional Level
National Level
International Level

TOTAL A+B+C+D (Result of the Initial Evaluation)

E. POTENTIAL ( points)
F. PSYCHOSOCIAL ATTRIBUTES AND PERSONALITY TRAITS ( points)
Reviewed and Evaluated by the HRMPSB : Signature TOTAL SCORE
Chairperson: MA. CRISELDA G. OCANG, CESE
bit.ly/sdo1-PSBforms

Member: ANGELINE S. CASIPIT, Ed.D

Member: MARISOL M. MAMARADLO, M.D.
Member: RAFAEL IRWIN G. NICOLAS, EdD, JD 0.00
Member: NELIA C. SANTOS
Member:
Member:
space for computation of multiple experience TOTAL

0.00

FALSE

FALSE

FALSE

FALSE

FALSE
FALSE

FALSE
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen
EVALUATION TOOL
Decs Order No. 57 Series 1997
For MASTER TEACHER I and II
ELEMENTARY / JHS / SHS

POSITION APPLIED MASTER TEACHER I < Select here DATE EVALUATED March 16, 2024
NAME PRESENT POSITION
PRESENT SCHOOL HIGHEST EDUC'L ATTAINMENT
PERFORMANCE
DISTRICT RATING DATE OF LAST PROMOTION

INTRODUCED ANY OF THE FOLLOWING WHICH HAS BEEN ADOPTED OR USED

A. BY THE SCHOOL. 20 Points for any of the Item.
Highest Possible
No. of Points = 20

1. CURRICULUM OR INSTRUCTIONAL MATERIAL

Required Documents 0
* Certification by the District Supervisor / Principal (Elementary) department head of the School
(Secondary) as to the authencity, functionality and utilization in the School for MT I and District for MT II.

* Certification of evaluation by the Education Supervisors in charge in the subject area,

recommending approval by ASDS and approved by the SDS.

* Certification / Testimonies of teachers who adopted / used the curriculum instructional materials.

TITLE

2. EFFECTIVE TEACHING TECHNIQUES OR STRATEGIES

Required Documents
* Proper endorsement by the District Supervisor / Principal, and Head Teacher of the Department,
evaluation by Education Supervisor in charge of the subject area, approval recommended by ASDS.

* Certification / Testimonies of Teachers who adopted / used the Teaching Techniques or

Strategies.

* At least two (2) copies of Lesson plan using the techniques or strategies.

TITLE

3. SIMPLIFICATION OF WORK AS IN REPORTING SYSTEM, RECORD KEEPING, ETC. OR

PROCEDURES THAT RESULTED IN COST REDUCTION.
Required Documents
* Proper endorsement by the Principal and Head Teacher of the Department, evaluation by
Education Supervisor in charge of the subject area, approval recommended by ASDS and
approved by the SDS.

* Implementation of the Simplified work by proponent.

* Certification of the Head Teacher and Principal on the Effectiveness (Cost Reduction) of the
work and / or procedures.

TITLE

4. WORTHWILE INCOME-GENERATING PROJECT BENEFITING STUDENT / OSY's AND

RESULTS AND GIVEN RECOGNITION / CERTIFICATION BY HIGHER OFFICIALS IN THE
DIVISION.
Required Documents
* Feasibility study duly signed by the initiator of the project and endorsed / certified by the District
and Division Official.

* Checked by the NFE Education, Research Supervisor and / or ASDS in charge of the Non Formal
Education.

* Certification by the District and Division Level evaluation committee as to the feasibility,
viability and economic profitability of the project.

TITLE
* SERVED AS SUBJECT AREA COORDINATOR OR CURRICULUM YEAR LEVEL
B. CHAIRMAN FOR AT LEAST ONE YEAR
Highest Possible
No. of Points = 12

Required Documents (any 2 or 3 of the following) 0

* approved designation by proper authorities
* action plan
* accomplishment report
* pictorial (optional)
REMARKS

* SERVED AS ADVISER OF SCHOOL PAPER, SCHOOL ORGANIZATION OR INTEREST

CLUBS AND DISCHARGED DUTIES SATISFACTORILY FOR AT LEAST TWO YEARS
AND NOT CONSIDERED PART OF THE REGULAR TEACHING LOAD
Required Documents
 * certification by proper authorities as to role or function
* list of activities / project / accomplishment report
REMARKS
 SERVED AS CHAIRMAN OF A SPECIAL COMMITTEE, SUCH AS CURRICULUM
STUDY COMMITTEE, COMMITTEE TO PREPARE INSTRUCTIONAL MATERIALS,
C. COMMITTEE TO CHAIR / SPEARHEAD / INITIATE SCHOOL PROGRAM /
PROJECTS / THRUST AND DISCHARGE THE WORK EFFICIENTLY.
Highest Possible
No. of Points = 12

Required Documents
* approved designation; assignment by proper authorities
* list of members of said committee
* accomplishment report / sample outputs
REMARKS
INITIATED OR HEADED AN EDUCATIONAL RESEARCH ACTIVITY OR
INVESTIGATORY PROJECT DULY APPROVED BY EDUCATIONAL AUTHORITIES,
D. EITHER FOR IMPROVEMENT OF INSTRUCTION, FOR TEACHER WELFARE OR
FOR COMMUNITY DEVELOPMENT
Highest Possible
No. of Points = 12

Required Documents / Evidences

* permit to conduct action research / investigatory project duly signed by
division authorities. (Attach to the permit in the research proposal or outline)
* defense of the action research
* certificate of completion of the research and certified correct by the
division authorities concerned
* copy of the research
REMARKS
COORDINATOR OF A COMMUNITY PROJECT OR ACTIVITY OR PROGRAMS OF
E. ANOTHER AGENCY OR RURAL IMPROVEMENT ACTIVITY FOR AT LEAST 2 YEARS
Highest Possible
No. of Points = 12

Required Documents / Evidences

* certification as to designation by the barangay captain and noted by
the school head
* action plan
* program of activities
* accomplishment report certified correct by the barangay captain
and school head
REMARKS
ORGANIZED / MANAGED A IN-SERVICE TRAINING ACTIVITY OR OTHER SIMILAR
F. ACTIVITIES AT LEAST ON SCHOOL LEVEL FOR MT-I; DISTRICT LEVEL FOR MT-II
Highest Possible
No. of Points = 12

Required Documents / Evidences

* training design / program of activities by proper authorities
* list of participants / certificate of participation
* output of the in-service training
REMARKS
CREDITED WITH MERITORIOUS ACHIEVEMENTS SUCH AS:
G. Note: (Total number of points allowed for items should not exceed 10) Highest Possible
No. of Points = 10

* TRAINORS / COACH to contestants who received prizes, COMMENDATIONS

or any form of RECOGNITION
* ATHLETIC COACH of athletes who won prizes
* COORDINATOR of BOY SCOUTS / GIRL SCOUTS 0

National Winners : 1st Place = 10 points 4th Place = 7 points

Regional Winners :
Division Winners :
District Winners :
School Winners :
Service Merit Awards from BSP / GSP will be credited :
(of the candidate himself)
2nd Place = 9 points 5th - 10th = 6 points
3rd Place = 8 points
1st Place = 5 points 4th Place = 2 points
2nd Place = 4 points 5th Place = 1 point
3rd Place = 3 points
1st Place = 3 points
2nd Place = 2.75 points
3rd Place = 2.5 points
1st Place = 2 points
2nd Place = 1.75 points
3rd Place = 1.5 points
1st Place = 1 point
2nd Place = .75 point
3rd Place = .50 point
Jade = 1 point
 Gold = .75 points
Silver = .5 points
Bronze = .25 points
 AUTHORSHIP : Book with Approval from DECS
H. (Sole Authorship = 10 points, Co-Authorship = 5 points) Highest Possible
No. of Points = 10

Required Documents / Evidences

* books and article must be critical with relevance to education
* articles are published in the school paper, community paper, professional
magazine or publication of national circulation
(articles should not exceed 3 points)

I. DEMO TEACHING
Highest Possible
No. of Points = 10
Required Documents / Evidences
* certification
* lesson plan approved by principal or higher authorities
* pictures if any

SCHOOL DISTRICT DIVISION REGIONAL NATIONAL

MT-I 0 10 10 10 10 t
MT-II 0 0 10 10 10 t

Reviewed and Evaluated by the HRMPSB : Signature

Chairperson: MA. CRISELDA G. OCANG, CESE

bit.ly/sdo1-PSBforms

Member: ANGELINE S. CASIPIT, Ed.D

Member: RAFAEL IRWIN G. NICOLAS, Ed.D
Member: NELIA C. SANTOS
Member:
Member:
Member:
6, 2024

POINTS EARNED

POINTS EARNED

0
POINTS EARNED

POINTS EARNED

POINTS EARNED

POINTS EARNED

POINTS EARNED

0
POINTS EARNED

POINTS EARNED

TOTAL SCORE

0
 Republic of the Philippines
Department of Education
Region I
SCHOOLS DIVISION OFFICE I PANGASINAN
Lingayen
EVALUATION TOOL

ELEMENTARY / JHS / SHS

POSITION APPLIED for RECLASS

NAME
ADDRESS / SCHOOL
DISTRICT
PRESENT POSITION
HIGHEST EDUC'L ATTAINMENT / COURSE
DATE OF LAST PROMOTION DATE EVALUATED March 16, 2024
A. PERFORMANCE RATING (20 points) 20 SCORE
School Year (last 3 rating period) Rating Points EARNED POINTS
SY
SY
2022 - 2023
2021 - 2022 0.00 0.00 0.00
SY 2020 - 2021
B. EXPERIENCE ( points) SCORE
Example: 1yr. & 3mos. 15/12 - 1.25 points
Inclusive dates
from:
to:
0yrs, 0mos, 0days
0.00 0.00
No. of years Points No. of months Points EARNED POINTS
0 0 0 0.00 0.00
C. OUTSTANDING ACCOMPLISHMENTS (0 points) 0.00 0 SCORE
a. Outstanding Employee Award Points EARNED POINTS
Awardee in the School
Nomination in the Division / Awardee in the District/Cluster
Nomination in the Region / Awardee in the Division
Nomination in the Department / Awardee in the Region
National Awardee
b. Innovations Points EARNED POINTS
Title of the Workplan / IM / INNOVATION

Conceptualized
Started the implementation
Fully Implemented in the school
Adopted in the district
Adopted in the division
c. Research and Development Projects Points EARNED POINTS
Title of Action Research

Action Research conducted in School 0.00

Action Research conducted in the District
Action Research conducted in the Division
d. Publication / Authorship Points EARNED POINTS
Title /s of Article/s

Articles published in a journal / newspaper / magazine of wide circulation (1 point

per article but not to exceed max points)

Co-Authorship of a book (shall be divided by the number of authors)

Sole Authorship of a book
e. Consultants / Resource Speaker in Trainings /
Seminars, Workshop / Symposia Points EARNED POINTS
District Level

Division Level

Regional Level

National Level
International Level
D. EDUCATION AND TRAINING (5 points) 0.00 5 SCORE
a. Education ( points) Points EARNED POINTS
Complete Academic Requirements for Master's Degree
Master's Degree
Complete Academic Requirements for Doctoral Degree
Doctoral Degree / JD / LLB

b. Training (5 points) 5 0.00 0.00

Participant in a specialized training, e.g., Scholarship Programs, Short Courses, Study Grants
(1 point for every month of attendance but not to exceed 5 points)
Participant in (3) or more training activities in each level conducted for at least (3) days not credited during the last promotion.

District / Cluster Level Trainings Points EARNED POINTS

2 1
3
Division Level Trainings Points EARNED POINTS

2 2
3 0.00
Regional Level Trainings Points EARNED POINTS

2 3
3
Participant in (1) training conducted for at least (3) days not credited during the last promotion

National Level Trainings Points EARNED POINTS

1 4
International Level Trainings Points EARNED POINTS

1 5

Chair / Co-Chair in a Technical / Planning Committee Points EARNED POINTS

District Level 1
Division Level 2
Regional Level 3
National Level 4
International Level 5
TOTAL A+B+C+D (Result of the Initial Evaluation)
E. POTENTIAL (10 points) 10
F. PSYCHOSOCIAL ATTRIBUTES AND PERSONALITY TRAITS (15 points) 15
Reviewed and Evaluated by the HRMPSB : Signature TOTAL SCORE
Chairperson: MA. CRISELDA G. OCANG, CESE
bit.ly/sdo1-PSBforms

Member: ANGELINE S. CASIPIT, Ed.D

Member: MARISOL M. MAMARADLO, M.D.
Member: RAFAEL IRWIN G. NICOLAS, EdD, JD 0.00
Member: NELIA C. SANTOS
Member:
Member:
space for computation of multiple experience TOTAL

0.00

FALSE

FALSE

FALSE

FALSE

FALSE
FALSE

FALSE
 0 POTENTIAL ( points) PSYCHO-SOCIAL ( points)
NAME RATEE 1 RATEE 2 RATEE 3 AVERAGE RATEE 1 RATEE 2 RATEE 3 AVERAGE
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
 Republic of the Philippines
Department of Education
Region 1
SCHOOLS DIVISION OFFICE 1 PANGASINAN
Lingayen

RATING SHEET FOR INTERVIEW (Non-Teaching Positions, Level 1)

School: ________________________ Position: _________________________

Communica
Ability to Potential (20 points)
Leadership
Psychosocial
Human
Attributes
Stress
(15 points)
Present Alertness Judgement TOTAL Decisivenes TOTAL
NAME SCHOOL ADDRESS tion Skills
Ideas (4 (4 pts) (4 pts)
Ability (4
(20 pts)
Relations
s (5 pts)
Tolerance
(15 pts)
(4 pts) pts) (6 pts) (4 pts)
pts)

__________________________________
Signature of HRMPSB member
Non-Teaching Level 1