Annex C

CHECKLIST OF REQUIREMENTS
Name of Applicant: _______________________________ Application Code: ________________________
Position Applied For: ______________________________
Office of the Position Applied For: ____________________ NOTE: IN CASE OF DATA DISCREPANCY/IES, PROVIDE
Contact Number: ________________________________ ANOTHER SHEET CONTAINED THE DETAILS OF THE
Religion: ______________________________________ DISCREPANCY/IES TO BE RETURNED TO THE
Ethnicity: ______________________________________ ORIGINATING GOVERNANCE LEVEL
Person with Disabilty: Yes ( ) No ( )
Solo Parent: Yes ( ) No ( )

Verification (To
Status of Submission be filled-out by the HRMO/HR Office/sub-
(to be filled-out by the committee)
Basic Documentary Requirement
applicant; Check if
submitted) Status of Submission Remarks
(Check if complied)

Letter of intent addressed to the Head of Office or in the highest human

a.
resource officer designated by the head of office.

Duly accomplished Personal Data Sheet (PDS) - CS Form No. 212, Revised
b.
2017) and Work Experience Sheet, if applicable.
Certified photocopy of PRC professional identification card or a PRC
c.
certificatioin showing the teacher's name, if applicable.

Certified photocopy of ratings obtained to the Licensure Examination for

d.
Teachers (LET)/Professional Board Examination for Teachers (PBET(

Photocopy of scholastic/academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of graduate
e.
and post-graduate units/degree, CAV for Bachelor's Degree, Master and
Doctoral Degree.
Certified photocopy of Certificate/s of Training, if applicable. (with original
f.
copy)

Certified photocopy of Certificate of Employment, Contract of Service, or

duly signed Service Record, Contract from Province/Munipal with service
g.
duration and job description; Certification of the SH that the LSB/PSB
teacher is dispensing deliverables contributory to the delivery of curriculum.

h. Certified photocopy of appointment, if applicable

Certified photocopy of Performance Rating in the last rating period(s)
i. covering one (1) year perfromance prior to the deadline of submission, if
applicable

Checklist of Requirments and Omnibus Sworn Statement on the

j. Certification on the Authencity and Veracity (CAV) of the documents
submitted and Data Privacy Consent Form

k. Certified photocopy of Voter's ID and/Barangay Certification

l. National Beaureu of Investigation (NBI) Clearance

m Printout of the automated Application Acknowledgement (via email)

n. other documents as may be required for comparative asseement:

Means of Verification (MOV,s) showing outstanding Accomplishments,

Application of Educatiuon, and Application of Learning and Development
reckoned form the from the date of last issuance of appointment.

Photocopy of performance rating obtained from the relevant work

experience, if performance rating in item (i) is not relevant to the position to
be filled.

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct, and of my personal knowledge and belief, and the documents submitted herewith
are original and/or certified true copies thereof.

DATA PRIVACY CONSENT

I hereby grant the Department of Education the right to collect and process my personal information as stated above, for purposes relevant to
the recruitment, selection, and placement of personnel of the Department and for purposes of compliance with the laws, rules, and regulations
being implemented by the Civil Service Commission.

Subscribed and sworn to before me this _______ day of _____, year ________. Name and Signature of Applicant

Attested:

_________________________________________________________________
School Document Evaluator (SDEC) Signature Over Printed Name Person Administering Oath

__________________________________________________________________
District Document Evaluator (DDEC) Signature Over Printed Name Division Document Evaluator (DivDEC)
Signature over Printed Name

In consonance with Republic Act No. 8792 or the "Electronic Commerce Act of 2000", (electronic documents shall have the legal effect, validity or enforceability as any
other document or legal writing and a) (where the law requires a document to be in writing, that requirement is met by an electronic document if the said electronic
document maintains its integrity and reliability and can be authenticated so as to be usable for subsequent reference.