Republic of the Philippines

Department of Education
National Capital Region
SCHOOLS DIVISION OFFICE OF QUEZON CITY

Omnibus Certification of Authenticity and Veracity of Documents

I, __________________________________________, Filipino, of legal age, with permanent address at

__________________________________________________________, after being sworn in accordance with law,
hereby depose and state that:

1. I am applying for ___________________________ at _____________________________________,

Position School

_______________________________________________;
Address of School

2. I have submitted the following documents:

2.1 Letter of Intent
2.2 Duly Accomplished Form 212 (Personal Data Sheet)
2.3 Performance Rating for the last three years
2.4 Updated Service Records
2.5 Outstanding Accomplishments
-Innovation
-Research and Development
-Publication/Authorship
-Resource Speaker in Trainings/Seminar
2.6 PRC License
2.7 Transcript of Records (Baccalaureate and Post Degree Graduate)
2.8 Certificates of Relevant Trainings and Seminars attended
2.9 Specialized Trainings (e.g, Scholarship Program/Short Courses)
2.10 Latest CSC Form 33 (Appointment)

3. I am executing this Certification to attest to the authenticity and veracity of all

documents submitted.
4. By executing this Omnibus Certification of Authenticity and Veracity of
Documents, I hereby authorize the Department of Education, Schools Division Office of Quezon
City, through the School Principal, to verify the authenticity of the abovementioned documents.
5.

___________________________________
Signature over Printed Name

_______________________
Date

Subscribed and sworn to before me this _______ day of __________________, 2023 affiant exhibiting to
me his/her PRC ID No. _______________________ issued on ______________________________ at
__________________________________, Philippines.

_________________________________________________________________________________________________________
Nueva Ecija St. Bago Bantay Quezon City (02) 89960640