Republic of the Philippines

DEPARTMENT OF EDUCATION
National Capital Region
SCHOOLS DIVISION OFFICE OF PASIG CITY

OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF

DOCUMENTS

I, CINDY FECUNDA VICENCIO, Filipino, of legal age, single, residing at 11131 Talisay St., Nagpayong,
Pinagbuhatan, Pasig City, after being sworn in accordance with law, hereby depose and state that:

1. I am applying for a Teacher I position at Buting Senior High School.

2. I have submitted the following documents:

a) CSC Form 212 (Revised 2005) in two copies with the latest 2x2 ID picture

b) Certified photocopy of PRC Professional Identification card

c) Certified photocopy of ratings obtained in the Licensure Examination for Teachers / Professional Board
Examination for Teachers

d) Certified copy of transcript of records

e) Copies of service record, performance rating, and school clearance for those with teaching experience

f) Certificates of specialized training, if any

g) Certified copy of the Voters ID and/or any proof of residency as deemed acceptable by the School
Screening Committee

h) NBI clearance

3. I am executing this Certification to attest to the authenticity and veracity of all documents submitted.

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

5. By executing this Omnibus Certification of Authenticity and Veracity of Documents, I hereby authorize the
Department of Education, Schools Division Office Of Pasig City through the School Head, to verify the authenticity of
the above mentioned documents.

__________________________________

Signature over printed name

____________________

Date

SUBSCRIBED AND SWORN TO before me this _____ day of __________, 2016, affiant exhibiting to me his/her
Community Tax Certificate No. ________ issued on ______________ at ________________, Philippines.

____________________

Notary Public