Republic of the Philippines Department of Education Region III – Central Luzon Schools Division of Tarlac Province

OMNIBUS SWORN CERTIFICATION Republic of the Philippines ) Division of Tarlac Province ) Moncada National High School) Moncada, Tarlac A F F I D AV I T

I, ___________________________, of legal age, (married/single)______________ Filipino, and residing at _________________________________________________, after having been duly sworn in accordance with law, do hereby depose and state that: 1. I am qualified Teacher I applicant at Moncada National High School. 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 _____ day of ____________, 2012 at Moncada, Tarlac, Philippines.

_________________________________ Printed Name and Signature of Applicant

SUBSCRIBED AND SWORN TO before me this ______ day of __________________, 2012. Affiant exhibiting to me his/her Community Tax Certificate No. _____________________ issued on _________________, at _____________________________, Philippines.

_________________________________

2012 at Moncada National High School. ___________________________________________ Chairman/Member of the School Selection Committee . ________________________________________. Moncada. Moncada. Tarlac. an applicant of Moncada National High School./Mr. Tarlac. _____ Certified photocopy of rating obtained in the Licensure Examination for Teachers/ Professional Board Examination for Teachers. Tarlac ACKNOWLEDGEMENT RECEIPT This is to acknowledge receipt of the following documents for Teacher I position submitted by Ms. _____ Certified photocopy of PRC Certificate of Registration/License.Republic of the Philippines Department of Education Region III – Central Luzon Schools Division of Tarlac Province Moncada National High School Moncada. Performance Ratings and School Clearance for those with teaching experience _____ Certificates of specialized trainings./Mrs. if any _____ Certified copy of Voter’s ID _____ NBI Clearance _____ Omnibus Certification of Authenticity and Veracity of all documents submitted Issued this ______ day of ______________. _____ Copies of Service Record. _____ Certified true copy of Transcript of Record for Baccalaureate. _____ CSC Form 212 (Revised 2005) in two copies with latest 2x2 ID picture.

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