Republic of the Philippines

DEPARTMENT OF EDUCATION
Region XII
DIVISION OF XXXXXX

CERTIFICATION
TO WHOM IT MAY CONCERN:
This is to certify that __________________________ receives the following documents of
______________________ for ranking of Teacher 1 applicants on __________________

___1. CSC form 212 (Revised 2017) in two copies with latest 2x2 ID picture

___2. Certified photocopy of the PRC professional identification card

___3. Certified photocopy of ratings obtained in the Licensure Examination for Teacher/Professional Board
Examination for Teachers

___4. Certified copies of Transcript of Records

___5. Copies of Service Record, Performance Rating and School Clearance for those with teaching experience.
If unavailable, a justification citing the reason/s for unavailability

___6. Certificates of specialized training, if any

___7. Certified copy of the Voter’s ID and/or any proof of residency

State:____________________________

___8. NBI clearance

___9. Omnibus Certification of authenticity and veracity of all document submitted signed by the applicant

Given this _____ day of _________2018 at___________________ Division of XXXXX

_________________________
Signature over Printed name of the School Head
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region XII
SCHOOL DIVISION OFFICE OF XXXXXXXXX

OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, _______________________, Filipino, of legal age, with permanent address at ________________________,

after being sworn in accordance with the law, hereby depose and state that:

1. I am applying for Teacher 1 position at ___________________________,

School

_______________________________________________________________________________________

Address of School Municipality Province

That I understood well the DepEd Order (Hiring Guidelines for T1 position)

2. I have submitted the following documents:

a) CSC form 212 (Revised 2017) in two copies with latest 2x2 ID picture
b) Certified photocopy of the PRC professional identification card
c) Certified photocopy of ratings obtained in the Licensure Examination for Teacher/Professional Board
Examination for Teachers
d) Certified copies of Transcript of Records
e) Copies of Service Record, Performance Rating and School Clearance for those with teaching
experience. If unavailable, a justification citing the reason/s for unavailability
f) Certificates of specialized training, if any
g) Certified copy of the Voter’s 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, SDO XXXXXXXX through the School Head, to verify the authenticity of
the abovementioned documents.

_________________________
Signature over printed name

__________________
Date