SSC Form for K/Elem/JHS

Republic of the Philippines

Department of Education
Region II – Cagayan Valley
SCHOOLS DIVISION OF SANTIAGO CITY

SCHOOL SCREENING COMMITTEE FORM for TEACHER I

(COMPLETENESS, VERACITY, ACCURACY AND AUTHENTICITY OF DOCUMENTS)

Name of Teacher Applicant: SURNAME:_____________________ FIRST NAME:_________________ MIDDLE NAME:_______________________

Applying as Teacher I in ( ) Kindergarten ( ) SPED ( ) Elementary ( ) Secondary, Major:_______________________

Veracity
IN THIS ORDER/ARRANGEMENT: Completeness Accuracy Authenticity Remarks
A. CSC Form 212 (Revised 2017) in two copies with the latest 2×2 ID picture.
B. Certified photocopy of PRC Professional Identification card
C. Certified photocopy of ratings obtained in the Licensure Examination for
Teachers/ Professional Board Examination for Teachers
D. Certified copy of transcript of records.
Note: A customized MS Excel format to compute the GWA can be downloaded
in the given link: http://bit.ly/2Frn6uy. The applicant must use it to compute the
weighted average. Print and submit a hardcopy. A softcopy must be sent to
records.sdosantiagocity@deped.gov.ph
E. Copies of Service Records, Performance Rating, and School Clearances for
those with Teaching Experiences. (if available)
F. Certificates of specialized training, if any
G. Certified copy of the Voter’s ID and or any proof of residency as deemed
acceptable by the School Screening Committee
H. NBI clearance
I. Certificate of Employment
J. Omnibus certification of authenticity and veracity of all documents submitted,
signed by the applicant
GWA General Weighted Average (do not include the failed, dropped, incomplete grades)

Verified and Certified by: (refer to DO 7, s. 2015 composition for the SSC)

__________________ __________________ __________________ _________________ ___________________

Chairman Member Member Member Member