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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 _________________________________,

Position School

Address of School

2. I have submitted the following documents:

2.1 CSC Form 212 (Revised 2017) in two copies with the latest Passport Size
ID picture
2.2 Certified Photocopy of PRC Professional Identification Card
2.3 Certified Photocopy of Ratings obtained in the Licensure Examination for
Teachers/Professional Board Examination for Teachers
2.4 Certified Copy of Transcript of Records
2.5 Copies of Service Record/Certificate of Employment, Performance
Rating, and School Clearance for those with teaching experience
2.6 Certificates of Specialized Training, if any
2.7 Certified Copy of Voter’s ID and/or any proof of residency as deemed
acceptable by the School Screening Committee
2.8 NBI Clearance

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 Laguna through the School Principal, to verify
the authenticity of the abovementioned documents.

Signature over printed name


SUBSCRIBED AND SWORN to before me in City/Municipality ________________ this _____ day of

__________, 2018, affiant exhibiting to me his/her Community Tax Certificate No. ________ issued on
______________ at ______________________________________, Philippines.

Notary Public