Republic of the Philippines

Department of Education
Region III
SCHOOLS DIVISION OF NUEVA ECIJA
Old Capitol Compound, Burgos Avenue, Cabanatuan City, 3100

CERTIFICATION
(Certificate of Authenticity and Veracity of All Documents Submitted)

I, __________________________________, of legal age, single/married/separated,

Filipino, and residing at _________________________________________ [Address of
Applicant], after having been duly sworn in accordance with law, do hereby depose and
state that:

1. I have submitted the following documents:

Pertinent Papers (to be submitted on the date set by the District)
a. Intent Letter e. Service Record
b. Latest Appointment f. Civil Service Eligibility
c. Transcript of Records/Diploma g. Certification of Authenticity and Veracity of All
d. Performance Rating for the last 2 years Documents Submitted

Papers for Ranking (to be accomplished, presented and submitted on the date set by the
Division and District Ranking Committee)
With None
a. Innovation _____ _____
b. Subject Coordinatorship or Grade Level Chairmanship _____ _____
c. Chairmanship in Special Committee _____ _____
d. Educational Research _____ _____
e. Community Coordinatorship _____ _____
f. In-Service Trainings _____ _____
g. Coach/Trainor/Coordinator _____ _____
h. Authorship _____ _____

2. All the documents submitted in satisfaction of the requirements for Ranking of Master
Teacher position is an authentic copy of the original, complete, and all statements and
information provided therein are true and correct;

3. I am authorizing the District Selection Committee and Division Personnel Selection

Board or its duly authorized representative(s) to verify all the documents submitted;

4. I understand that any violation will automatically disqualify me from the selection
process: and

5. Acknowledge and understand all conditions in the Guidelines stated in MECS Order No.
10, s. 1979 on Master Teacher position;

IN WITNESS WHEREOF, I have hereunto set my hand this ____ day of ______________
at ________________________, Philippines.

_____________________________________
Signature Over Printed Name of the Applicant

SWORN AND SUBSCRIBED before me this _______ day of ______________, affiant

exhibiting to me his her Community Tax Certificate No. ____________ issued on
________________ issued at _______________________, Philippines.

excellence is our choice

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