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I, MARLON B. CUSTODIO, Filipino, of legal age, with permanent address

at 16 P. Sandoval St., Burgos, Rodriguez, Rizal, after being sworn in
accordance with law, hereby depose and state that:

1. I am applying for SHS Teacher at Burgos National High School

Position School

Daang Bakal St., Burgos, Rodriguez, Rizal;

Address of School

2. I have submitted the following documents:

2.1 Letter of Intent

2.2 CSC Form 212, Revised 2005 (Personal Data Sheet) in two (2)
copies with the latest 2x2 ID picture
2.3 Certified photocopy of certificates of relevant specialized
2.4 Certified copy of Voters ID and/or any proof of residency
2.5 National Bureau of Investigation (NBI) clearance
2.6 Certified photocopy of Diploma on Bachelors Degree
2.7 Certified photocopy of Transcript of Records with at least 15
units of specialization in relevant strand/specialized subject
2.8 Certified photocopy of Professional Regulation Commission
(PRC) professional ID card/certificate of registration /license
2.9 Certified photocopy of ratings obtained in the Licensure
Examination for teachers (LET)/Professional Board
Examination for Teachers (PBET)
2.10 Technical Education and Skills Development Authority
(TESDA) National Certificate (NC)
2.11 Certified photocopy of Trainers Methodology Certificate (TMC)
2.12 Certified photocopy of Certification of Proficiency/Recognition
from recognized and respectable relevant
2.13 Certified photocopy of Certification of Status of
Employment/Service Record from HEI/TVI

3. I am executing this Certification 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 Rizal
through the School Principal, to verify the authenticity of the abovementioned

Signature over printed name