Template No.

OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I , Filipino, of legal age, with permanent address

Complete Name
at after being sworn in accordance with law,
hereby
Permanent Address
depose and state that:

1. I am applying for at ,
Position School
__________________________________________________________________ .

2. I have submitted the following documents:

2.1 CSC Form 212 (revised 2017) in two copies with the latest 3.5 x 4.5 ID picture with name tag (signature
over printed name)

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 Copies of service record/ certificate of employment, performance rating, and school clearance for
those with teaching experience

2.6 Certificates of specialized training, if any

2.7 Certified copy of Voter’s ID and/ or any proof of residency as deemed acceptable by the School Screening
Committee

2.8 NBI Clearance

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 City of San Fernando (P) through the School Principal, to verify
the
authenticity of the abovementioned documents.

Signature overPrinted Name

Date

Doc. No.
Page No.
Book No.

Series of