OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF

DOCUMENTS

I, __MERALD A. GAYOSA__, Filipino, of legal age, with permanent address at _PUROK 1-B
BALET BABAK ISLAND GARDEN CITY OF SAMAL___, after being sworn in accordance with law,
hereby depose and state that:

1. I am applying for _____TEACHER ____ at _BALET NATIONAL HIGH SCHOOL___,

Position Name of School

BRGY. BALET BABAK ISLAND GARDEN CITY OF SAMAL;

Address of School

2. I have submitted the following documents:

2.1 CSC Form 212 (revised 2005) in two copies with the latest 2x2 ID picture
2.2 Certified photocopy of PRC professional identification card
2.3 Certified photocopy of ratings obtained in the Professional Board
Examination for Teachers
2.4 Certified copy of transcript of records
2.5 Copies of service record / certificate of employment
2.6 Certificates of specialized trainings
2.7 Certified copy of Voter’s ID and /or any proof of residency
2.8 NBI Clearance

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

4. By executing this Omnibus Certification of Authenticity and Veracity of Documents, I

hereby authorize the Department of Education, Division of _____________, to verify the
authenticity of the abovementioned documents.

__________________________
Signature over printed name

__________________________
Date

SUBSCRIBED AND SWORN to before me in City / Municipality ________________ this _____ day of
__________, 2017, affiant exhibiting to me his/her Community Tax Certificate No. ________ issued on
______________ at ________________, Philippines.

__________________________
Notary Public