Republic of the Philippines

DEPARTMENT OF EDUCATION
Region 1
SCHOOL DIVISION OFFICE I PANGASINAN
Alvear St. East Capitol Complex Lingayen, Pangasinan
Tel.No./Fax No. (075) 522-2202 (OSDS);(075) 632-8385 (ASDS)
Email: pangasinan@deped.gov.ph;officeofthesdspangasinan@gmail.com

CHECKLIST FOR SCHOOL SELECYION COMMITTEE

Name of Applicant: ROSE ANGELA M. ULIGAN

Address: DULIG, LABRADOR, PANGASINAN

_________1. Written Application

_________2. CSC Form 212 (revised 2005) in two copies with the latest 2”x2” ID picture

_________3. Certified photocopy of PRC Certificate of Registration/License.

_________4. Certified photocopy of ratings obtained in the Licensure Examination for Teachers

_________5. Certified copies of Transcript of Records for Baccalaureate Course

_________6. Copies of Service Record, Performance Ratings, and school clearance for those with
teaching experience.

_________7. Certified of specialized training, if any.

_________8. Certified copy of voters ID and/ or any proof of residency as deemed acceptable by the
School Screening Committee

_________9. NBI Clearance

_________10. Omnibus certificate of authenticity and veracity of all documents submitted, signed by
the application

_________11. General Weighted Average Certificate (GWA)

Certified True & Correct:

MARIA LUISA R. MALONG EDILBERTO A. QUIAL

Member Member

NELEHANDRA G. NAZARENO, Ed. D MANUEL C. CUSTODIO

Member Member

JUANITO G. LADISLAO, Ed. D

Principal IV / Chairman

Note: Please arrange accordingly to the sequence in the checklist.

 If any these are not submitted, the School Selection Committee may refuse acceptance of the
application.