CERTIFICATION

This is to certify that we have received the following documents of ____________________

____________________________ , Teacher-Applicant for Senior High School (SHS):

1. Application letter addressed to the Schools Division Superintendent stating statement of

purpose/ expression of interest; subject/group he intends to teach and the preferred
school, if any
2. Duly accomplished Applicants’ Individual Sheet
3. Omnibus Certification of authenticity and veracity of all documents submitted signed by
the applicant and notarized
4. CSC Form 212 (Revised 2017) – duly accomplished Personal Data Sheet with latest
passport size ID picture
5. Work Experience Sheet
6. Photocopy of updated PRC ID
7. Photocopy of ratings obtained in the Licensure Examination for Teacher(LET)/
Professional Board Examination for Teachers (PBET)
8. Certified photocopy of Transcript of Records with at least 15 units of specialization in
relevant strand/specialized subject
a. Baccalaureate Degree
b. 18 Professional Units in Education
c. Masters’ Degree
d. Doctorate Degree
9. Certification from the School of General Weighted Average (GWA)
a. For Education Graduates – GWA of baccalaureate degree
b. For Non-Education Graduates – GWA of baccalaureate degree and the eighteen
(18) professional units in education
10. Copies of Service Records or Certificate of Employment with Inclusive Dates,
Performance Rating and School Clearance for those with teaching experience. If
unavailable, the applicant must submit a justification citing the reason/s for unavailability
11. Certified photocopy of Certification of Status of Employment/Service Record from
HEI/TVI
12. Certificates of relevant Seminars/ Trainings attended after the baccalaureate degree
13. National Certificate issued by TESDA (NC II, III, TMC, etc), if any
14. Certified photocopy of Certification of Proficiency/ Recognition from recognized and
respectable relevant associations/organizations/guild, if any
15. Certified copy of Voter’s ID and/or any proof of residency as deemed acceptable by the
School Screening Committee
16. NBI Clearance

____________________________
School Head

Date Received: ___________________

 OMNIBUS CERTIFICATION

To Whom It May Concern:

I, _________________________________________, a resident of ________________

_______________________________ , an applicant to _________________________ hereby
affirm the completeness, veracity, accuracy and authenticity of all attached documents
submitted. Furthermore, I understand that any violation committed will automatically disqualify
me to the position I am applying for.

IN WITNESS WHEREOF, I have hereunto set my hand this _______ day of ________ ,
2019 at Ormoc City, Leyte Philippines.

__________________________
Applicant

SUBSCRIBED AND SWORN TO BEFORE ME this ________ day of ______, 2019 at Ormoc
City Leyte Philippines. Affiant exhibited to me his/her Residence Certificate No.
_____________ issued at ____________________ on __________________, 2019.

APPLICANT’S INDIVIDUAL SHEET

 Senior HS Teacher-Applicants
School Year 2019 - 2020

Name of Applicant _________________________________________ Age ____________ Sex __________

Degree: ______________________________________________ Major: ___________________________
Complete Address ____________________________________________ Contact No. _________________
Applied Track and Strand _______________________________________ Group______________________

I. EDUCATION (_______ points)

Gen. Weighted Ave. ________
Equivalent Points __________ ________________

II. TEACHING EXPERIENCE (______ points)

_______________________________
_______________________________ ________________

III. SPECIALIZED TRAINING (________ points)

__________________________________
__________________________________
__________________________________ _________________

IV. INTERVIEW (15 POINTS) _________________

V. ENGLISH COMMUNICATION SKILLS (________ points) _________________

VI. PORTFOLIO/OUTSTANDING ACHIEVEMENTS (________ points) _________________

VII. DEMONSTRATION TEACHING (________ points) _________________

GRAND TOTAL _________________

CERTIFIED TRUE and CORRECT:

SCHOOL SCREENING COMMITTEE

____________________________ __________________________
Member Member

_________________________ ___________________________ ____________________________

Member Chairman Member

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DIVISION SELECTION COMMITTEE

BRENDA P. MAROLEÑA, PIII MA. JEREZA C. MATIGA, P4/ OIC-PSDS

Member Member

ALLAN O. CELEDONIO, Ed.D./ EPS IMELDA A. AMODIA, EPS

Member Member

JOEL A. ZARTIGA, Ph.D./ OIC-ASDS

Chairman