Republic of the Philippines

Department of Education
REGION III
SCHOOLS DIVISION OF PAMPANGA
Name of Junior High School Teacher Applicant: ______________________________________________
Unique Applicant Number : ______________________________________________________________
Subject Area : ________________ If TLE Major : Specify specialization: ___________________________
Complete Address : ____________________________________________________________________
Contact Number : ____________________________________________________________________

Documents Submitted :
(As per DepEd Order No. 7, s. 2015) Please Check

1. Written application with the UAN indicated _______

2. CSC Form 212 (Revised 2017) in two copies with the latest 2 x 2 ID picture _______
(application.deped.gov.ph)

3. *Certified photocopy of PRC professional identification card or _______

*PRC certification showing the teachers’ name, LET rating, and other
Information recorded in the PRC office _______

4. Certified photocopy of ratings obtained in the Licensure Examination

For Teachers (LET) / Professional Board Examination for Teachers (PBET) _______

5. Certified copy of transcript of records _______

6. Copies of service records _______

Performance rating _______

School clearance _______

If unavailable, justification citing the reason for unavailability _______

7. Certificate of specialized training _______

8. Certified copy of the Voter’s ID _______

If unavailable, any proof of residency _______

9. NBI Clearance _______

10. Omnibus certification of authenticity and veracity of all documents ______

Submitted, signed by the applicant

__________________________________
School Screening Committee Chairperson

Date: ____________________________
3 copies

1 - Teacher applicant
2 – School file
3 – SDO file (to be attached in the applicant’s folder)

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Address: High School Blvd., Brgy. Lourdes, City of San Fernando (P)
Telephone No.: (045) 435-27-28; Email Address: pampanga@deped.gov.ph