Checklist Enclosure 2

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Republic of the Philippines

Department of Education
CARAGA REGION XIII
SCHOOLS DIVISION OF SURIGAO DEL SUR
(Enclosure 2)
CHECKLIST OF REQUIREMENTS

Name of Applicant: ________________________________________________________________________


Last Name First Name Middle Name Suffix
Education level Applied for: Elementary ( ) Junior High School ( ) Senior High School ( )
If Elementary, for which school/district? ___________________________________________________________
If JHS, indicate subject area of specialization: _______________________________________________________
If SHS, indicate track: ________________________________________________________________________
College Degree: ________________________________________________________________________
Graduate Studies:
(Indicate number of units earned)________________________________________________________________________
Contact Number(s): ___________________________________________________________________________
E-mail Address: ___________________________________________________________________________
Ethnicity: ___________________________________________________________________________
Person with disability? Yes ( ) No ( )
Solo parent? Yes ( ) No ( )
RQA 2021-2022 applicant? Yes (✓) No ( )
With Provisional Appointment for 2021-2022? Yes ( ) No ( )

Status of Verification
Submission Status of Remarks
(to be filled out by the Submission (to be filled out by the
Basic Documentary Requirements applicant: check if HRMO)
(to be filled out by the
submitted) School Head; check if
complied)
1 Checklist of Requirements with Omnibus
Certification and Waiver (Enclosure 2)
2 Written application addressed to the
Schools Division Superintendent
3 Duly accomplished Personal Data Sheet
(CSC Form 212, Revised 2017 with
passport size ID picture and Work
Experience Sheet
4 Photocopy of LET/PBET Rating and
Photocopy of Valid and Updated PRC
License/ID and if expired, proof of
renewal
5 Photocopy of Performance Evaluation for
those with teaching experience
6 Photocopy of School Clearance for those
with teaching experience
7 Duly signed Service Record or Certificate
of Employment if any
8 Certified true copy of Transcript of
Records (TOR) with computed average
rating
9 Certified true copy of Certificate(s) of
Training attended (10 day or more), if any
10 Photocopy of Certification of
Proficiency/Recognition from recognized
and respectable relevant
associations/organizations/guild, if any
11 Photocopy of Voter’s ID and / or proof of
residency

Checked by:

_________________________________________
Name and Signature of School Head
-----------------------------------------------------------------------------------------------------------------------------------------

OMNIBUS CERTIFICATION AND WAIVER

This is to certify that all information above are true and correct; and documents submitted are authentic.
This is also to authorize the Department of Education – Schools Division of Surigao del Sur to use my
personal information for purpose of recruitment, selection, and hiring.

________________________________________
Name and Signature of Applicant

JUNE C. GUERRA, AO IV
HRMO

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