Omnibus Certification of Authenticity and

Verification of Documents Submitted

The School Screening Committee

The Division Selection Committee

Sir/Madam:

Pursuant to DepEd Order No. 3, s. 2016 entitled "Hiring Guidelines for Senior High School
Teachers (SHS) Teaching Positions Effective School Year 2016-2017", the undersigned applicant
hereby respectfully submits his/her written application indicating the subject group he/she intends
to teach supported by the following documents:

1. CSC Form 212 (Revised 2017) in two copies with the latest 2 x 2 ID pictures
2. Certified photocopy of certificates of relevant specialized trainings, if any
3. Certified copy of the Voter's ID or any proof of residency as deemed acceptable by the School
Screening Committee
4. NBI Clearance
5. Certified copy of Transcript of Records with at least 15 units of specialization in relevant
strand/specialized subject with Genaral Weighted Average (GWA) and Diploma
6. Certified photocopy of ratings obtained in the Licensure Examination for Teachers or
Professional Board examination for Teachers
7. TESDA National Certificate (for TVL teacher-applicants)
8. Certified photocopy of Trainers Methodology Certificate (TMC), if available (for TVL teacher-
applicants)
9. Certified photocopy of Certification Of Proficiency/Recognition from recognized and
respectable relevant associations/organizations/guild (for Arts & Design and Sports teacher-
applicants)
10. Copies of service record, performance rating and school clearance for those with
teaching experience only.

The undersigned applicant assumes full responsibility and accountability on the validity
and authenticity of the foregoing documents submitted and commits that any violation will
automatically disqualify the undersigned applicant from the selection process.

Very truly yours.

MARK KEVIN DG. MENDOZA

(Signature over printed name)

SUBSCRIBED AND SWORN to before me this day of 2018 at by the affiant who
showed to me to me his/her ______________________________________ as competent
proof of his/her identity.

Notary Public

Doc. No. _______

Page No. _______
Book No.________