CHECKLIST OF REQUIREMENTS

(Promotion – Master Teacher I & II)

Name of Applicant: _____________________________________________ Application Code: ________________________________________________________

Position Applied for: ____________________________________________ Office of the Position Applied for: _________________________________________
Contact Number: _______________________________________________ Email Address:
___________________________________________________________
Religion: _______________________________________________________ Ethnicity:
________________________________________________________________
Solo Parent: Yes ( ) No ( ) Person with Disability: Yes ( ) No ( ) If yes, please specify:
__________________

Status of Verification
Submission (To be filled out by the School/District Sub-Committee Chair)
(To be filled-out Status of
Basic Documentary Requirement
by the applicant; Submission
Remarks
Check if (Check if
submitted) complied)
a. Letter of intent addressed to the Schools
Division Superintendent stating the specific
school, item number, and position applying for;
b. Duly accomplished and notarized Personal
Data Sheet (CS Form 212, Revised 2017) with
Work Experience Sheet, if applicable;
c. Photocopy of updated and valid eligibility (PRC
License);
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;
e. Photocopy of Certificate/s of Training, if
applicable;
f. Photocopy of Latest Appointment;
g. Updated Service Record or Contract of Service;
h. Last Three (3) Years Performance Evaluation
Rating; and
i. Three (3) Checklist of Requirements and
Omnibus Sworn Statement on the Certification
on the Authority and Veracity (CAV) of the
documents submitted and Data Privacy
Consent Form to be notarized by an authorized
official after the verification of the submitted
documents
Others:
j. Innovations
k. Subject or Grade Chairmanship or School
Organization Advisorship
l. Special Committee Chairmanship
m Educational Research
.
n. Community Project Coordinatorship
o. In-Service Activity
p. Meritorious Achievements
q. Authorship

Attested:

_________________________________________________________
School/District Sub-Committee Chair

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.

_______________________________________
Name and Signature of Applicant

Subscribed and sworn to before me this ______ day of ________________, year ________.

Person Administering Oath