OMNIBUS SWORN CERTIFICATION OF AUTHENTICITY AND VERACITY OF

DOCUMENTS

I, ___________________________________, Filipino, of legal age, with

permanent address at ___________________________________. After being sworn in
accordance with law, hereby depose and state that:

1. I am applying for__________________________________.

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 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 Nueva
Ecija, to verify the authenticity of the abovementioned documents.

SUBSCRIBE AND SWORN to before me this ____ day of ____, 20 ____, affiant
exhibiting to me his/her Community Tax Certificate No. __________ issued on
________ at __________Philippines.

_______________________
Signature Over_ Printed Name

__________________
Date

Doc. No. _______________

Page No. _______________
Book No. _______________
Series of