Republic of the Philippines

Department of Education
Region III
Schools Division Office of Gapan City
San Vicente, Gapan City, Nueva Ecija

CERTIFICATION
(Certificate of Authenticity and Veracity of All Documents Submitted)

I, ALJHON A. VELAYO, of legal age, SINGLE, Filipino, and residing at Pambuan, Gapan City,
Nueva Ecija, after having been duly sworn in accordance with law, do hereby depose and state
that:

1. I have submitted the following documents

Pertinent Papers (to be submitted on the date set by the Division)
a. Intent Letter
b. PDS (CS Form No. 12, Revised 2017)
c. Photocopy of Certificate of Eligibility / Rating / License
d. Photocopy of Transcript of Record
e. Photocopy of Service Record
f. Photocopy of Certificates of Training
g. Photocopy of Latest Performance covering 0ne year
h. checklist

Papers for Ranking (to be accomplished, presented and submitted on the date
set by the Division and District Ranking Committee)
With None
a. Outstanding Employee Award _____ _____
b. Innovation _____ _____
c. Research and Development Projects _____ _____
d. Publication/Authorship _____ _____
e. Consultant/Resource Speaker in training/
Seminars/Workshop/Symposia _____ _____
f. Education _____ _____

2. All documents submitted in satisfaction of the requirements for Ranking of Master Teacher I
position is an authentic copy of the original, complete, and all statements and information
provided therein are true and correct;

3. I am authorizing the Division Personnel Selection Board or its duly authorized

representative(s) to verify all the documents submitted;

4. I understand that any violation will automatically disqualify me from selection process: and

5. Acknowledge and understand all conditions in Guidelines stated in DepEd Order No. 42, s.
2007 on Head Teacher position;

IN WITNESS WHEREOF, I have hereunto set my hand this _____day of ____________at

______________________________________, Philippines.

ALJHON A. VELAYO
_____________________________________
Signature Over Printed Name of the Applicant

SWORN AND SUBSCRIBED before me this ______ day of ______________, affiant exhibiting
to me his/her Community Tax Certificate No. _________________ issued on ____________
issued at ____________________________, Philippines.
 Republic of the Philippines
Department of Education
Region III
Schools Division Office of Gapan City
San Vicente, Gapan City, Nueva Ecija

Checklist of Requirements
a. Intent Letter
b. PDS
(CS Form No. 12, Revised 2017)
c. Photocopy of Certificate of Eligibility / Rating / License
d. Photocopy of Transcript of Record
e. Photocopy of Service Record
f. Photocopy of Certificates of Training
g. Photocopy of Latest Performance covering one year
(2021-2022)

Prepared by:

ALJHON A. VELAYO
Teacher III, JRLMHS