Republic of the Philippines

Department of Education
Region III
Schools Division of San Jose del Monte City

OMNIBUS CERTIFICATION AND AUTHETICITY AND VERACITY OF DOCUMENTS

I, ____________ Filipino of legal age, single with residence and postal address at _______________________
after being sworn and accordance with the law, hereby depose and state that;

1. I am applying for teaching position (Teacher I) __________________________ that I understood well

the DepED order No. 028 ,s.2020 (Recruitment,Evaluation and Selection for Teacher I positions for
Kindergarten to Grade 10 for SY 2021-2022.)

2. I have submitted the following documents:

2.1 Letter of Intent to the School head

2.2 Duly Accomplished Personal Data Sheet (PDS) (CS Form No. 212, Revised 2017) in two (2) copies
with the latest 2x2 ID picture.

2.3 Photocopy of Certificate of Eligibility/Report of Rating

2.4 Photocopy of Valid and updated PRC License/ID

2.5 Photocopy of Scholastic/Academic record (Transcript of Record and Diploma)

2.6 Certificate of Employment /Duly signed service record

2.7 Photocopy of Certificates of Trainings

2.8 Photocopy of HOWa Certification

2.9 Photocopy of National Bureau of Investigation (NBI) Clearance

2.10Omnibus Sworn Statement and Certification/Waiver pursuant to Data Privacy Act

3. I am executing this certification to attest the Authenticity and Veracity of all Documents submitted

4. I understand that any violation will automatically disqualify me from the selection process.

5. By executing this Omnibus Certification of Authenticity and Veracity of Documents, I hereby authorize the
Department of Education, Division of Antique through the School Principal to verify the authenticity of the
above mentioned documents.

____________________
Teacher Applicant

PRC ID NO.____________
Valid until: 09/10/2023

SUBSCRIBE AND SWORN to before me this ______day of _____________at ___________________,

_________________________________________________________, Philippines.