30 Submission of Nominees the 2 ... sion Search for Outstanding Government Workers.pdf. Div Memorandum No. 30 Submission
Repu bl ic of the Philippin es Department of Education-Nation al Capital Region SCHOOLS DIVISION OFFICE Nueva Ecija St., Sago Bantay Quezon City, Metro Manila
Februa ry 17, 2017 DIVISION MEMORANDUM No.~
,2017
SUBMISSION OF NOMINEES FOR THE 2017 CIVIL SERVICE COMMISSION SEARCH FOR OUTSTANDING GOVERNMENT WORKERS To:
Asst. Schools Division Superintenden ts Chiefs, SGOD/CID Education Program Supervisors Public Schools District Supervisors Elementary Schools Principals Secondary Schools Principals All Concerned
1. In response to the Civil Service Commission Search for 2017 Outstanding Government Workers, this Division invites employees who wish to join the said search. 2. Attached are the Honor Awards Program (HAP) Forms for Nominee/s. 3. The nominees shall be endorsed by tne Oifice of the Schools Division Superintendent not later that February 28,2017 . 4. Complete requirements shall be submitted to SGOD-HRD c/o Mrs. Ludevina R. Bruan, SEP1 not later than March 15, 2017. 5. For nomination procedures please contact the Honor Awards Program Secretariat at telephone numbers (02)9317993 and (02)9320381 . 6. Immediate and wide dissemination of this memorandum is desired.
lncls.: As stated. sgod/hrd/gina
HAP Form 1
PASTE
SEARCH FOR OUTSTAN DING GOVERNMENT WORKERS
1 Jli"
X
2"
(passport size) Photo here
(Presidential Lingkod Bayan and Civi l Service Commission Pagasa Award) For Outstanding Work Petiormance
Individual Category
D Presidential Liugkod Bayan
0
Civil Service Commission Pa,gasa
Name:
Signature:
Position:
Date of Birth:
:
Residence Address:
Place of Birth:
i !
Telephone/Cellphone Nos: Agency /Region: Agency Address:
Level of Position:
Telephone/Cellphone Nos:
Email address:
0
1st
Level
0 2"d Level {Executive Managerial) 0 2"d Level 0 3'd Level 0 Military 0 El~ctive
OFFICE I REGIONAL HEAD Name: Position: Telephone
'
I
i I
f
Cellphone Nos.:
Email address:
SECRETARY OF DEPARTMENT I AGENCY HEAD Name:
\
Position: Agency Address: Telephone/Cellphone Nos.: Email address:
NOMINATOR Name:
Position:
Agency:
Tel ephone/Cellphone Nos.:
Agency Address: Email add: Additional Information about the Nominee: Yes
0
No
What year: __ What Award Category: __
Were you a previous HAP Semi-finalist?
0
Yes
0
No What year: __ What Award Category: _ _
Were you a previous HAP Awardee?
0
Yes
0
No
Were you a previous HAP Nominee?
0
What year:__
What Award Category: _ _
~-
Nomination Write-up: (Maximum of 10 pages, A4 size bond paper, Aria / #12 font, including executive summary)
Name of Nominee:
Agency:
Division/Unit:
Position: Length of Service in the Position:
I.
In Government:
Executive Summary
Click here to enter text. ~-------------------------------------------------------------------------------------------------------------------------------------
II.
Significant Accomplish ment/s within the Last Three Years
(Description of the Project/Work Accomplished, Strategies/Activities Done and Problems Encountered)
The nomination of heads of offices and agencies including that of ihe Local Chief Executives should reflect their individual accomplishments)
Click here to en ter text .
Ill.
Impact of 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 conside red exemplary or extraordinary) For Presidential Lingkod Bayan Category : What was the impact of the extraordinary contribution to national public interest? For CSC Pagasa Category: What was th e impact of the Outstanding contribution to more than one department of the government?
Cli ck here t o ente r t ext.
IV.
Other Information (Major Awards/Citations Received/Membership in the Organization)
Click here to enter text.
CERTIFICATION We 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 actio n pursuant to applicable Civil Service laws and rules.
Printed Name and Signature:
Nomlnee
..
Nominator
. PRAISE Committee/Highest HRMO
Regional Office Head
\
.
HAP Form 2
·~
PASTE
SEARCH FOR OUTS 1ANDING GOVERNMENT WORKERS
1 :Yl"
X
2"
(passport size) Photo here
(Presidential Lingkod Bayan and Civil Service Commission Pagasa Award)
....
For Outstanding W ork Performance
Group Category
0
Presidential Lingkod Bayan
0
Civil Service Commission Pagasa
-
Name of Group:
Name of Team leader: Position : Email address:
Telephone/Cellphone Nos: Agency/Region: Agency Address:
level of Position:
0 l 5t level D 2"d Level D 3rd level D 2"d Level (Executive Managerial) D Military D Elective i
Telephone/Cellphone Nos: Team Members (Name- Position title in Service Record} 1.
; !
6. 7. 8. 9. 10 .
2. 3. 4. 5.
'
! ! !
OFFICE I REGIONAL HEAD Name: Position: Telephone I Cellphone Nos.: Email address:
SECRETARY OF DEPARTMENT I AGENCY HEAD Name: Position: Agency Address:
-- -- - --
Telephone/Cellphone Nos.: Email address:
NOMINATOR Name:
Pusition:
Agency:
Telephone/Cellphone Nos.:
Agency Address: Email add: \dditionallnformation about the Nominee: /ere you a previous HAP Nominee? D Yes 0 No
What year: __ What Award Category: __
Jere you a previous HAP Semi-finalist? D Yes 0 No Jere you a previous HAP Awardee?
'isc
~1\7,fsERVICE COMMISSION
0
Yes
0
'
No
What year: _ _
What Award Category: __
What year:__
What Award Category: __
Nomination Write-up: (Maximum af 10 pages, A4 size band paper, Aria/1112 font, including executive summary}
Agency:
Name of Nominee:
Division/Unit:
Position: In Government:
length of Service in the Position:
I.
Executive Summary
Click here to enter t ext.
II.
Significant Accomplishmentls within the Last Three Years
(Description of the ProjectNVork Accomplished, Strategies/Activities Done and Problems Encountered)
The r>nmination of heads of offices and agencies including that of the Local Chief Executives sh ould reflect their individual accomplishments)
Click here to
~nter
te xt.
I
Ill.
Impact of Accomplishments
(Indicate problems addressed , savings generated, people/office benefited and transactions facilitated. Indicate whether or not the accomplishments are part
of the nominee's regu lar 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) For Presidential Lingkod Sayan Category: What was the impact of the extraordinary contribution to national public interest? For CSC Pagasa Category: What was the impact of the Outstanding contribution to more than one department of the government?
J Click here to ent er text.
IV.
Other Information
(Major Awards/Citations Received/Membership in the Organization)
Click here to enter text.
CERTIFICATION
we 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. Printed Name and Signature:
Nominee
Nominator
PRAISE Comrnittee/H:ghest HRMO
Regio nal Office Head
For Group Nomination only
HAP Form No. 2-A INFORMATION ON TEAM/GROUP MEMBERS Contribution/s of each member
Reason for disqualification of the
(Including those of disqualified members)
Team Members, if any.
Position/Status of Appt./Agency
Name of Team Members
·--
Click here to enter text.
Click here to enter text.
Cli ck here to enter text.
Click here to enter text.
I
I I I I
I
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
-
CERTIFICATION
1 hereby attest to all the facts herei n, authorize the Committee on Awards to validate the accu racy of the information contained in this form and gra nt our consent to th e conduct of background inve sti gation . An y m isrep resentation made by the signatory shall be ground for disciplinary action pursuant t o ap plicable Civil Se rvice laws and rules .
-
•'
CHAIR, PRAISE Committee Signature over printed name
HAP FORM No. 3 PASTE
SEARCH FOR OUTSTANDING GOVERNMENT WORKERS
1 Yl" X 2"
(passport size) Photo here
(Outstanding Public Officials and Employees or
Oanga/ ng Bayan Award)
I
THE NOMINEE Name: Position: Residence Address:
Signature: Date of Birth: Place of Birth:
-
I I
Telephone/Cellphone Nos: Agency/Region:
5
level of Position: 0 l t level 0 2"d Level (Executive 1\'lanagerial) 0 2"d level 0 3'd lev~l
Agency Address:
- -- --
Telephone/Cellphone Nos:
0 Military 0
Electiv~ I
Email Add:
OFFICE I REGIONAL HEAD Name: Position: Telephone I Cellphone Nos.: Email address:
SECRETARY OF DEPARTMENT I AGENCY HEAD Name: Position:
I I
Agency Address: Telephone/Cellphone Nos.: Email address:
NOMINATOR Name: ' Agency:
Position : Teiephone/Cellphone Nos.:
-
I
Agency Address: Email add: -
·I
Additional Information about the Nominee: .Jere you a previous HAP Nominee?
0 Yes 0 No
_ What Award Category: _ _
Vere you a previous HAP Semi-finalist?
0
Vere you a previous HAP Awardee?
0 Yes 0 No What year:__
~
~/VInt::Cit1 COMMISSION
Yes
0
What year: _ No
W hat year:__ What Award Category: __ What Award Category: __
Nomination Write-up: (Maximum of 10 pages, A4 size bond paper, Aria/ 1112 font, inclu ding executive summary)
Agency:
Name of Nominee:
Oivision/U nit:
Position: J5 ;.. '·
hi Government:
lengi,h of Service in the Position:
l.
Executive Summary
Click here to enter text. ~---------------------------------------------------------------------------------------------------------------------------------- --
II.
Significant Accomplishment/s within the Last Three Years
(Description of the Project/Work Accomplished, Strategies/Activities Done and Problems Encountered)
The nomination of heads of offices and agencies including that of the Local Chief Executives should reflect their individual accomplishments)
Click here to e nter t ext.
f
Ill.
Impact of 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) For Presidential Lingkod Sayan Category : What was the impact of the extraordinary contribution to national public interest? For CSC Pagasa Category: What was the impact of the Outstanding contribution to more than one department of the government?
Click here to enter t ext.
IV.
Other Information
(Major Awards/Citations Received/Membership in the Organization)
Nomination Write-up : (Maximum of 10 pages, A4 size bond paper, Aria/1112 font, including executive summary)
Agency:
Name of Nominee:
Division/Unit:
Position: In Government:
Length of Service in the Position:
I.
Executive Summary
Cl ick here to enter text.
II.
Exemplary Behavi or/Conduct Displa yed with in the last 3 years
(Describe nominee's adherence to one or more of the following norms: Commitment to Public Interest,
Professionalism, Justne ~ s and Sincerity, Political Neutrality , Responsiveness to Public, Nationalism and Patriotism, Commitment to Democracy and Simple Living . Cite circumstances providing su ch norms , riskc involved and problems encountered.)
Click here to ent2r text
Ill.
Impact of Accomplishments
(Indicate problems addressed , savings generated , people/office benefited and transactions facilitated . Indicate whether or not the accomplishments are part
of the nomin ee'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)
Cl ick here to ente r te xt.
IV.
Other Information
Click here to enter text. '·
(Major Awards/Citations Received/Membership in the Organ ization)
CERTIFICATION We 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 .
Printed Name and Signature:
Nominee
Nominator
PRAISE Committee/Highest HRMO
Regio nal Office Head
