ANNEX A
R&R Form 1 (Nomination Form)
DISTRICT SEARCH Passport size
Photo
Individual Category : _____________ (Teacher, School Head, Non-Teaching Level 1 and 2)
Nominee (First Name, Middle Name, Last Name): Signature:
Position ( per Service Records): Gender: Age:
Status of Appointment ( per Service Records): Date of Birth
Telephone/Cellphone Nos (Active Contact Details): Place of Birth:
Residence Address:
Level of Position:
Group
1 Level 2
st nd
Level 3 Level (SDS/ASDS)
rd
Category:_____________________
Teaching Related Non-Teaching Teaching Nominee (Name of School/ Name of SDO):
Email Address: Size (small,medium, large):
SCHOOL HEAD
Name: Position:
Office/Office Address:
Telephone/Cellphone Nos. (Active Contact Details): Email Address:
DISTRICT
Name: Position:
Office/Office Address:
Telephone/Cellphone Nos. (Active Contact Details): Email Address:
NOMINATOR
Name: Position:
Office: Telephone/Cellphone Nos.:
Office Address: Email Address:
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 Category): (Group 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
HRMO
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, 2019. 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
_______________________, 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
