Republic of the Philippines ) Application Code: 9NWSS

Municipality of Libona Bukidnon ) S.S.

AFFIDAVIT

I, ANNIE EDRALIN PACANE, Filipino, of legal age, single and a resident of Purok 4, CAMP
9 LATURAN LIBONA BUKIDNON, after having sworn in accordance with law, do hereby depose and
say:

That as such, I was required to submit documents in support of my application for

employment with the Department of Education;

That in compliance with the requirements, I have submitted copies of the following
documents, to wit:
a. Letter of intent
b. CSC Form 212 (revised 2019) in two copies with the latest passport ID
c. Photocopy of PRC professional identification Card
d. Photocopy of ratings obtained in the Licensure Examination for Teachers/
Professional Board Examination for Teachers
e. Photocopy copy of Transcript of Records
f. Photocopies of service record, performance rating and school clearance for those
with teaching experience
g. Photocopy of Certificates of specialized training, if any
h. Photocopy of voter’s ID and/or any proof of residency as demand acceptable by the
school screening committee

That I am executing this affidavit to attest to the truth of the forgoing, the submission of
the above-mentioned documents in support of my application for a teaching position with the
Department of Education and for whatever legal purpose this may serve.

IN WITNESS WHEREOF, I have hereunto set my hand this 3 rd day of November, 2023,
Laturan Libona Bukidnon, Philippines.

ANNIE EDRALIN PACANE

Affiant

SUBSCRIBED AND SWORN TO before me this 3 rd day of November, 2023, Laturan Libona
Bukidnon, Philippines.

ABIGAIL P. EGDAMIN
BARANGAY CAPTAIN
(Person Administering Oath)