Republic of the Philippines

Department of Education

Republic of the Philippines)

City of Malaybalay )S.S.

OMNIBUS SWORN STATEMENT

I, Renalyn C. Lebosada , of legal age, Married , Filipino and residing at

(NAME OF APPLICANT) (STATUS) (CITIZENSHIP)
Barangay 9, Malaybalay City, 8700, Bukidnon , after having been duly sworn in accordance with
(ADDRESS)
law, do hereby depose and state that:

1. Each of the documents submitted in satisfaction of my application for non-teaching /

teaching related / teaching position is an authentic copy of the original, and complete and
all statements and information provided therein are true and correct.

2. Should I qualify for the position I am applying for, the documents I will be submitting in
support of my appointment and for my 201 file are authentic copies of the original
thereof.

3. I am authorizing the selection committee or its duly authorized representative(s) to

verify all documents submitted as to its completeness and authenticity.

IN WITNESS WHEREOF, I have hereunto set my hand this day of _________________,

in the City of Malaybalay, Bukidnon.

Affiant

SUBSCRIBED AND SWORN to before me this day of in the City of

Malaybalay, Bukidnon. Affiant exhibiting to me her CTC No.______________ issued on ___________
at Malaybalay City.

Doc. No. ________

Book No. ________
Page No. ________
Series of _________

Address: Sayre Hi-way, Purok 6, Casisang, Malaybalay City

Telefax No.: 088-314-0094; Telephone No.: 088-813-1246
Email Address: malaybalay.city@deped.gov.ph