Republic of the Philippines

Department of Education
REGION V
SCHOOLS DIVISION OF MASBATE PROVINCE

OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, JELLYFER D.CORTES, Filipino, of legal age, with permanent address at Poblacion west, Milagros,
Masbate after being sworn in accordance with law, hereby depose and state that:
1. I am applying for Administrative Officer II position in Elementary or Secondary Schools in the
Municipality of Milagros.
2. I have submitted the following documents:
a. Checklist of requirements and Omnibus Sworn Statement on the certification on the
Authenticity and Veracity (CAV) of the documents submitted and Data Privacy Consent Form
Pursuant to RA No. 10173 (Data Privacy Act of 2012) using the attached form;
b. Letter of intent addressed to Raymundo M. Cantonjos, CESO VI- Schools Division
Superintendent;
c. Duly accomplished Personal Data Sheet (CSC Form No. 212, Revised 2017) with Work
Experience Sheet;
d. Photocopy of scholastic/academic record such as but not limited to Transcript of Records
(TOR) and Diploma, including completion of graduate and post-graduate units/degrees if
Available;
e. Photocopy of Certificate/s of Trainings;
f. Photocopy of Certificate of Employment, Contract of Service or duly signed service records
Whichever is/are applicable;
g. Photocopy of valid and updated PRC License/ID and or CSC Eligibility if applicable;
h. Photocopy of the actual Performance Rating in the last rating period (s) covering one year
Performance in the current/latest position prior to the deadline of submission, if applicable.

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 Masbate Province, to verify the authenticity of the
Above mentioned documents.

JELLYFER D.CORTES

Applicant

SUBSCRIBE AND SWORN to before me this ______ day of _________________ 2023 at

_______________________, Philippines. Affiant exhibiting to me his/her CTC No. _________________

Issued on ______________________ at __________________________.

__________________________

Person Administering Oath

Doc. No.: ____________

Book No.: ___________

Page No.: ___________

Series of: ____________