OMNIBUS SWORN STATEMENT

REPUBLIC OF THE PHILIPPINES

PROVINCE OF SOUTHERN LEYTE
MUNICIPALITY OF SAN FRANCISCO

I, LHESLY B. BINONGO of legal age, married and resident of Barangay Habay, San Francisco, Southern
Leyte, after having been having duly sworn in accordance with the law, do hereby depose and say:

1. I am the owner of the following documents submitted to the School Screening Committee:

a. CSC Form 212 (Personal Data Sheet) in with the latest passport size ID pictures;
b. Certified true copies of Transcript of Records;
c. PRC License (not expired);
d. Certificate of Completion/Certificate of Recognition in Conference/Training
Programs/Seminar/Workshop of Scholarship Enjoyed/Awards Received;
e. Complete Service Records; and
f. Latest Performance Ratings (3 Rating Periods)
2. Each of the documents submitted is in satisfaction and compliance with the requirements for
application teacher 2 position set by the Department of Education, Division of Southern Leyte.
3. Each document is an authentic copy of the original, complete, and all data/information
therein are true and correct to the best of my knowledge and belief;
4. I assume responsibility and accountability on the validity and authenticity of the documents
submitted.

IN WITNESS WHEREOF, I have hereunto set my hands this 18th day March, 2019 in Liloan, Southern Leyte
Philippines.

__________________________
Signature of Applicant

SUBSCRIBE AND SWORN TO before me this 18th day of March, 2019, affiant exhibiting to me his/her
Community Tax Certificate No. ______________ issued on _______________________ in
______________________ Philippines.

Doc. No. ____________

Page No. ____________
Book No. ____________
Series No. ___________