CERTIFICATION

This is to certify that we have received the following documents of

, Teacher-Applicant for Kinder/Elementary/Junior
High School:

a. Application letter addressed to the Schools Division Superintendent stating statement of

purpose/ expression of interest
b. Duly accomplished Applicants’ Individual Sheet (pls. see attached format)
c. Omnibus Certification of authenticity and veracity of all documents submitted signed by
the applicant and notarized (pls. see attached format)
d. CSC Form 212 (Revised 2017) – duly accomplished Personal Data Sheet with latest
passport size ID picture
e. Work Experience Sheet (pls. see attached format)
f. Photocopy of updated PRC ID
g. Photocopy of ratings obtained in the Licensure Examination for Teacher (LET)
/ Professional Board Examination for Teachers (PBET)
h. Certified photocopy of Transcript of Records with at least 15 units of specialization in
relevant strand/specialized subject
h.1 Baccalaureate Degree
h.2 18 Professional Units in Education
h.3 Masters’ Degree
h.4 Doctorate Degree
g. Certification from the School of General Weighted Average (GWA)
g.1 For Education Graduates – GWA of baccalaureate degree
g.2 For Non-Education Graduates – GWA of baccalaureate degree and the eighteen
(18) professional units in education
i. Copies of Service Records or Certificate of Employment with Inclusive Dates or
Performance Rating for those with teaching experience
j. Certificates of relevant Seminars/ Trainings attended after the baccalaureate degree
k. Certified copy of Voter’s ID and/or any proof of residency as deemed acceptable by the
School Screening Committee
l. NBI Clearance

School Head

Date Received:
 OMNIBUS CERTIFICATION

To Whom It May Concern:

I, , a resident of
, an applicant to hereby
affirm the completeness, veracity, accuracy and authenticity of all attached documents
submitted. Furthermore, I understand that any violation committed will automatically disqualify
me to the position I am applying for.

IN WITNESS WHEREOF, I have hereunto set my hand this day of ,

2022 at Ormoc City, Leyte Philippines.

Applicant

SUBSCRIBED AND SWORN TO BEFORE ME this day of , 2022 at Ormoc

City Leyte Philippines. Affiant exhibited to me his/her Residence Certificate No.
issued at on , 2022.
 APPLICANT’S INDIVIDUAL SHEET
Kinder/Elementary and Junior HS Teacher-Applicants
School Year 2022-2023

Name of Applicant Age Sex

Degree: Major:
Complete Address Contact No.
(Applicants shall refer to DepEd Order NO. 7, s. 2015 in accomplishing Items I, II and III but all entries still be verified subject to
availability of documents submitted)
I. EDUCATION (20 points)
Gen. Weighted Ave.
Equivalent Points

II. TEACHING EXPERIENCE (15 points)

III. LET/PBET RATING (15 points)

Rating
Equivalent Points

*******************BELOW THIS PORTION WILL BE ACCOMPLISHED BY THE DSC**********************

IV. SPECIALIZED TRAINING AND SKILLS (10 points)

V. INTERVIEW (10 POINTS)

VI. DEMONSTRATION TEACHING (15 points)

VII. COMMUNICATION TEACHING (15 points)

Score
Percentage
Weighted Points
Rating

GRAND TOTAL

CERTIFIED TRUE and CORRECT:

DVISION SELECTION COMMITTEE

Member Member

Member Chairman Member