Republic of the Philippines

Department of
Education
Pagayawan Integrated School
Pagayawan, Bacolod, Lanao del Norte

Enclosure A

CERTIFICATION
This is to acknowledge receipt of the application for________________________________
Elem/Kinder/SPED/JHS/SHS

position SY 2022-2023 of ______________________________________________________, a

First Name Middle Name Surname

local resident of__________________________________________________________, with the

(Purok, Barangay, Municipality/City, Province)

following supporting documents:

Document/s Remarks
a. CSC Form 212 (Revised 2017 in 2 copies with 2x2 ID picture ___________________________________
b. Certified photocopy of PRC professional identification card ___________________________________
c. Certified photocopy of ratings ___________________________________
d. Certified copy of Transfer of Records ___________________________________
e. Copies of service records, performance rating and school ___________________________________
clearance for those with teaching experience.

f. Certificate of specialized training, if any. ___________________________________

g. Certified copy of the Voter’s ID and/or any proof of residency ___________________________________

h. NBI Clearance ___________________________________
i. Omnibus Certification ___________________________________
j. Hiring Applicants Privacy Notice ___________________________________

Received by:
VENUS B. PALANGAN
School Head

_________
Date

Address: Pigcarangan, Tubod, Lanao del Norte

Telephone No.: [063] 341-51-09