Annex C

CHECKLIST OF REQUIREMENTS

Name of Applicant: JESSA MAE E. PALACA Application Code: ______________________________________

Position Applied For: Teacher I
Office of the Position Applied For: Tuganay Elementary School
Contact Number: 09505342646
Religion: Roman Catholic
Ethnicity: Cebuano
Person with Disability: Yes ( ) No (/)
Solo Parent: Yes ( ) No (/)
Verification
Status of (To be filled-out by the HRMO/HR
Office/sub-committee)
Basic Documentary Requirement Submission
(To be filled-out Status of
by the applicant. Submission Remarks
Check if submitted) (Check if complied)

a.
Letter of intent addressed to the Head of Office, or to the highest human resource /
officer designated by the Head of Office

b.
Duly accomplished Personal Data Sheet (PDS) /
(CS Form No. 212, Revised 2017) and Work Experience Sheet, if applicable
c. Photocopy of valid and updated PRC License/ID, if applicable /
d. Photocopy of Certificate of Eligibility/Report of Rating, if applicable /
Photocopy of scholastic/academic record such as but not limited to Transcript of
e. Records (TOR) and Diploma, including completion of graduate and post-graduate
units/degrees, if available /
f. Photocopy of Certificate/s of Training, if applicable /
g. Photocopy of Certificate of Employment, Contract of Service, or duly signed
Service Record, whichever is/are applicable
h. h. Photocopy of latest appointment, if applicable
Photocopy of the Performance Ratings in the last rating period(s) covering one (1) /
i. year performance prior to the assessment, if applicable
C he ck lis t o f Re quirements and Omnibus Sworn Statement on the Certificati on on /
j. the Authe nticity and Vera city (CAV) of the documents submitted and Data Privacy
Consent Form (Annex C)
k. Other documents as may be required for comparative assessment: /
Me ans o f V e rification (MOVs ) showing Outstanding Acco mplishments ,
Application o f Education , and Application of Learni ng and Development
reckoned from the date of last issuance of appointm ent
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

Received by: Attested:

School Sub-Commitee/HT Personnel School Principal/HRMO

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.
____________________________________________________

JESSA MAE E. PALACA

Name and Signature of Applicant

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

Person Administering Oath

In consonance with Republic Act No. 8792 or the "Electronic Commerce Act of 2000", (e)electronic documents shall have the legal effect, validity or enforceability as any other document
or legal writing and a) (w)here 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.
 Annex C
CHECKLIST OF REQUIREMENTS

Name of Applicant: MERIAM B. ALQUIZAR Application Code: ______________________________________

Position Applied For: Teacher I
Office of the Position Applied For: Tuganay Elementary School
Contact Number: 09564068230
Religion: Roman Catholic
Ethnicity: Cebuano
Person with Disability: Yes ( ) No (/)
Solo Parent: Yes ( ) No (/)
Verification
Status of (To be filled-out by the HRMO/HR
Office/sub-committee)
Basic Documentary Requirement Submission
(To be filled-out Status of
by the applicant. Submission Remarks
Check if submitted) (Check if complied)

a.
Letter of intent addressed to the Head of Office, or to the highest human resource /
officer designated by the Head of Office

b.
Duly accomplished Personal Data Sheet (PDS) /
(CS Form No. 212, Revised 2017) and Work Experience Sheet, if applicable
c. Photocopy of valid and updated PRC License/ID, if applicable /
d. Photocopy of Certificate of Eligibility/Report of Rating, if applicable /
Photocopy of scholastic/academic record such as but not limited to Transcript of
e. Records (TOR) and Diploma, including completion of graduate and post-graduate
units/degrees, if available /
f. Photocopy of Certificate/s of Training, if applicable /
g. Photocopy of Certificate of Employment, Contract of Service, or duly signed
Service Record, whichever is/are applicable
h. h. Photocopy of latest appointment, if applicable
Photocopy of the Performance Ratings in the last rating period(s) covering one (1) /
i. year performance prior to the assessment, if applicable
C he ck lis t o f Re quirements and Omnibus Sworn Statement on the Certificati on on /
j. the Authe nticity and Vera city (CAV) of the documents submitted and Data Privacy
Consent Form (Annex C)
k. Other documents as may be required for comparative assessment: /
Me ans o f V e rification (MOVs ) showing Outstanding Acco mplishments ,
Application o f Education , and Application of Learni ng and Development
reckoned from the date of last issuance of appointm ent
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

Received by: Attested:

School Sub-Commitee/HT Personnel School Principal/HRMO

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.
____________________________________________________

MERIAM B. ALQUIZAR
Name and Signature of Applicant

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

Person Administering Oath

In consonance with Republic Act No. 8792 or the "Electronic Commerce Act of 2000", (e)electronic documents shall have the legal effect, validity or enforceability as any other document
or legal writing and a) (w)here 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.