Republic of the Philippines

Department of Education
Region V
SCHOOLS DIVISION OFFICE OF CAMARINES SUR

April 16, 2021

SHERRYL A. MILLENA
Zone 2, Bahay, Pasacao, Camarines Sur

Sir/Madam:

This is to certify receipt of the following documents relative to your application for Teacher
1 in SDO Camarines Sur:
Document (Check or X)
1. Handwritten Application Letter
2. CSC Form 212 (Revised 2017) Personal Data Sheet completely filled up
with latest 2X2 ID picture
3. Photocopy of PRC ID (if expired please include claim stub)
4. PRC Certificate of Ratings obtained in the Licensure Exam for Teachers
(LET)/Professional Board Examination for Teachers (PBET)
5. Transcript of Records (TOR) Baccalaureate Degree/Post Graduate
Studies
6. Certificate of General Weighted Average (Baccalaureate Degree)
7. Copies of previous appointments, Service Records/Employment
Certificate, Performance Ratings and School Clearance (for those with
teaching experience. If unavailable, the applicant must submit a
justification citing the reason/s for unavailability)
8. Certificates of specialized trainings, if any
9. Certified copy of the Voter’s ID and/or latest Barangay Certification
which states that the applicant is a bonafide resident of the barangay for
the last 6 months as of her/his application
10. NBI Clearance
11. PSA issued Birth Certificate
12. PSA issued Marriage Contract, if applicable
13. Omnibus certification of authenticity and veracity of all documents
submitted
 /(check) if document is submitted
 X if document is not submitted

Certified by: School Screening Committee

(Name) MARIA THESSA T. FABRICANTE

(Designation) Teacher III
(School) Bahay Elementary School

Conforme: Teacher Applicant

(Printed Name) SHERRYL A. MILLENA

(Signature) _____________________________