Republic of the Philippines

Department of Education
Region 1
SCHOOLS DIVISION OFFICE 1 PANGASINAN
Alvear St. Lingayen, Pangasinan
Tel.no.: (075)522-2202 (OSDS) (75) 632-8365(ASDS)
Email:pangasinan@deped.gov.ph: officeofthesdspangasinani@gmail.com

CHECKLIST OF DOCUMENTS TO BE SUBMITTED BY APPLICANT TEACHER

SY 2022-2023

Name of Applicant: PAUL DANIELLE M. FERRER

Address: 72 PADILLA STREET WEST POBLACION, LINGAYEN, PANGASINAN
Contact No.: 09266558157

1. Letter of Intent

2. CSC Form 212 (revised 2017) in three copies with the latest passport ID picture

3. Certified photocopy of Diploma in Bachelor’s Degree

4. Certified and authenticated copy of transcript of records for baccalaureate course with

a certification from the school graduated indicating General Weighted Average (GWA)

5. Certified photocopy of PRC ID Card/Certificate of Registration/License

6. Certified photocopy of ratings obtained in the Licensure Examination (LET)

7. Copies of Service Record

8. Certified photocopy of certificates of relevant specialized trainings, if any

9. Certified Copy of Voter’s ID or any proof of residency

10. Certified Copy of NBI Clearance

11. Omnibus Certification of Authenticity & Veracity of all documents submitted,

signed by the applicant.

School Screening Committee

Certified True & Correct:

___________________ _____________________
Member Member

___________________ __ ______________________
Member Member

__________________________
 Republic of the Philippines
Department of Education
Region 1
SCHOOLS DIVISION OFFICE 1 PANGASINAN
Alvear St. Lingayen, Pangasinan
Tel.no.: (075)522-2202 (OSDS) (75) 632-8365(ASDS)
Email:pangasinan@deped.gov.ph: officeofthesdspangasinani@gmail.com

Chairman