OMNIBUS SWORN CERTIFICATION

Republic of the Philippines

Province of Quezon )

A F F I D AVI T
I, JENSEN RYAN T. LIM, of legal age, MARRIED, Filipino, and residing at 1278
QUEZON ST BRGY BACLARAN CALAUAG, QUEZON, after having been duly sworn in
accordance with law, do hereby depose and state that:
1. I am qualified Senior High School teacher applicant;
2. I am executing this omnibus sworn certification to assure authenticity and veracity of
all documents submitted;
3. I assure full responsibility and accountability on the validity and authenticity of the
documents submitted and I understand that any violation will automatically disqualify
me from the selection process.
IN WITNESS WHEREOF, I have hereunto set my hand this 16th day of October, 2015 at
Calauag, Quezon Philippines.

JENSEN RYAN T. LIM

Printed Name and Signature of Applicant

SUBSCRIBED AND SWORN TO before me this 16TH day of October, 2015. Affiant
exhibiting to me his/her Community Tax Certificate No. 26172345, issued on
JANUARY 7, 2015, at Calauag, Quezon, Philippines.

_________________________________
Notary Public

ACKNOWLEDGEMENT RECEIPT

This is to acknowledge receipt of the following documents for Senior High School
Teaching Position submitted by MR. JENSEN RYAN T. LIM:
_____ CSC Form 212 (Revised 2005) in two copies with latest 2x2 ID picture.
_____ Certified photocopy of PRC Certificate of Registration/License.
_____ Certified photocopy of rating obtained in the Licensure Examination for Teachers/
Professional Board Examination for Teachers.
_____ Certified true copy of Transcript of Record for Baccalaureate.
_____ Copies of Service Record, Performance Ratings and School Clearance for those
with teaching experience
_____ Certificates of specialized trainings,
_____ Certified copy of Voters ID
_____ NBI Clearance
_____ Omnibus Certification of Authenticity and Veracity of all documents submitted
Issued this ______ day of ______________, 2015 at Talipan Pagbilao.
___________________________________________
Chairman/Member of the Division Selection Committee