OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, CARMILLE LOURANNY FERNANDEZ QUILIOPE, Filipino, of legal age, with permanent address
at Hilaitan,Guihulngan, Negros Oriental, after being sworn in accordance with law, hereby depose and
state that:

1. I am applying for __________Teacher 1______at Matu-og Elementary School,

Position School

Matu-og, Guihulngan, Negros Oriental;

Address of School

2. I have submitted the following documents:

2.1 CSC Form 212 (revised 2005)in two copies with the latest 2x2 ID picture
2.2 Certified photocopy of PRC professional identification card
2.3 Certified photocopy of ratings obtained in the Licensure Examination for
Teachers/ Professional Board Examination for Teachers
2.4 Certified copy of transcript of records
2.5 Certified copy of Certification of QPA
2.6 Certified copy of Certificates of specialized training, if any
2.7 Certified copy of Local Registry of Marriage Contract
2.8 Certified copy of Voter’s ID and /or any proof of residency as deemed
acceptable by the School Screening Committee

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, Division of Guihulngan through the School Principal, to
verify the authenticity of the above mentioned documents.

CARMILLE LOURANNY FERNANDEZ QUILIOPE

Signature over printed name

February 22, 2018

Date
nd
SUBSCRIBED AND SWORN to before me, this 22 day of February, 2018 in the City of
Guihulngan, affiant exhibiting before me his Community Tax Certificate No. 15621503, issued at
Guihulngan City on December 6, 2017.

Doc. No. ______;

Page No. ______;
Book No. ______;
Series of ______;