Republic of the Philippines

Region I

SCHOOLS DIVISION OFFICE URDANETA CITY

Urdaneta City, Pangasinan

NAME: ABEGAIL O. NEDUASA

DATE OF BIRTH: NOVEMBER 18, 1997
PLACE OF BIRTH: MALASIQUI, PANGASINAN
RESIDENTIAL ADDRESS: 192 BRGY. SAN JOSE, URADANETA CITY, PANGASINAN
PERMANENT ADDRESS: 283 BRGY. CAWAYAN BOGTONG MALASIQUI,
PANGASINAN
TELEPHONE NUMBER:-
LANDLINE NO.: -
CELLPHONE NO.: 09957757658

EDUCATIONAL BACKGROUND
College Degree: BACHELOR OF ELEMENTARY EDUCATION - MAJOR IN ENHANCED
GENERAL EDUCATION
Where Obtained: PANGASINA STATE UNIVERSITY, SAN CARLOS CAMPUS
Year Obtained: 2018GWA: 86%

DOCUMENTS SUBMITTED\

A. Letter of Intent addressed to the Schools Division Superintendent

B. Duly Accomplished Personal Data Sheet (CSC Form 212, Revised 2017) with Work
Experience Sheet
C. Photocopy of valid and updated PRC Certificate of registration/License
D. Photocopy of Certificate of Eligibility/ Rating
E. Photocopy of scholastic/ academic record such as but not limited to Transcript of Records
(TOR) and Diploma, including completion of graduate and post graduate unit/ degrees
F. Photocopy of Certificates/s of Training, if applicable
G. Photocopy of Certificate of Employment, Contract of Service, or duly signed Service Record
H. Photocopy of latest appointment
I. Photocopy of the Performance Rating in the last rating periods covering one (1) year performance
in the current /latest position prior to the deadline of submission, if applicable
J. Checklist of Requirements and Omnibus Sworn Statement (Annex C)
K. Other documents as may be required by the HRMPSB for comparative assessment

I hereby certify to the authenticity & veracity of the information contained in this form and all
documents submitted herewith.
   _____________________________________
    (NAME AND SIGNATURE OF APPLICANT)
    CTC No.: __________________
    Issued on: __________________
    Issued at: __________________

SUBSCRIBED AND SWORN to before me this 10th of May 2023, at San Carlos City Pangasinan,
applicant exhibiting to me his/her Community Tax Certificate bearing the numbers 03229714
as proof of his/her identity.