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Republic of the Philippines Department of Education Region III Central Luzon Schools Division of Tarlac Province

OMNIBUS SWORN CERTIFICATION Republic of the Philippines ) Division of Tarlac Province ) Moncada National High School) Moncada, Tarlac A F F I D AV I T

I, ___________________________, of legal age, (married/single)______________ Filipino, and residing at _________________________________________________, after having been duly sworn in accordance with law, do hereby depose and state that: 1. I am qualified Teacher I applicant at Moncada National High School. 2. I am executing this omnibus sworn certification to assure authenticity and veracity of all documents submitted; 3. I assure full responsibility and accountability on the validity and authenticity of the documents submitted and I understand that any violation will automatically disqualify me from the selection process. IN WITNESS WHEREOF, I have hereunto set my hand this _____ day of ____________, 2012 at Moncada, Tarlac, Philippines.

_________________________________ Printed Name and Signature of Applicant

SUBSCRIBED AND SWORN TO before me this ______ day of __________________, 2012. Affiant exhibiting to me his/her Community Tax Certificate No. _____________________ issued on _________________, at _____________________________, Philippines.

_________________________________

Republic of the Philippines Department of Education Region III Central Luzon Schools Division of Tarlac Province Moncada National High School Moncada, Tarlac

ACKNOWLEDGEMENT RECEIPT

This is to acknowledge receipt of the following documents for Teacher I position submitted by Ms./Mr./Mrs. ________________________________________, an applicant of Moncada National High School, Moncada, Tarlac.

_____ CSC Form 212 (Revised 2005) in two copies with latest 2x2 ID picture. _____ Certified photocopy of PRC Certificate of Registration/License. _____ Certified photocopy of rating obtained in the Licensure Examination for Teachers/ Professional Board Examination for Teachers. _____ Certified true copy of Transcript of Record for Baccalaureate. _____ Copies of Service Record, Performance Ratings and School Clearance for those with teaching experience _____ Certificates of specialized trainings, if any _____ Certified copy of Voters ID _____ NBI Clearance _____ Omnibus Certification of Authenticity and Veracity of all documents submitted

Issued this ______ day of ______________, 2012 at Moncada National High School, Moncada, Tarlac.

___________________________________________ Chairman/Member of the School Selection Committee