OMNIBUS SWORN STATEMENT

REPUBLIC OF THE PHILIPPINES

CITY OF LA CARLOTA

AFFIDAVIT
I, ______Nikkie M. Albay___________ of legal age single/married, and resident of
_Brgy. La Granja____, ____La Carlota City_________ after having been duly sworn in according with law,
do hereby depose and say:

1. I am the owner of the following documents submitted to the Division Screening Committee:

a. CSC Form 212 (Personal Data Sheet) with the latest passport size picture;
b. Civil Service Eligibility (Professional/Sub-Professional);
c. Transcript of Records (TOR);
d. Service Records, Performance Ratings, and School Clearance (for applicants with work
experience);
e. Certificates of Trainings/Seminars;
f. Voter’s ID and
g. Barangay Certification of Residency

2. Each of the documents submitted is in satisfaction and compliance with the requirements for
recruitment set by the Department of Education;

3. Each document is an authentic copy of the original, complete, and all information therein are
true and correct to the best of my knowledge and belief;

4. I assume responsibility and accountability on the validity and authenticity of the documents
submitted; and

5. I am authorizing the Division Screening Committee to verify/validate the documents submitted.

IN WITNESS WHEREOF, I have hereunto affixed my signature this ___ day of

_________________,
in La Carlota City, Philippines.

__________________________
APPLICANT’S SIGNATURE

SUBCRIBED AND SWORN TO before me this ___ day of ___________________________ affiant

exhibiting to me his/her Community Tax Certificate No. __________________________________ issued
on, ____________________ in _____________________________________________ Philippines.