Omnibus 2023 t2 MT

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Omnibus Certification for Teaching Positions

Republic of the Philippines


Department of Education
REGION XII
SCHOOLS DIVISION OFFICE OF COTABATO

CHECKLIST OF REQUIREMENTS
Name of Applicant: _________________________________________________ Application Code: _____________________________
Position Applied For: _______________________________________________ Ethnicity: _____________________________________
Office of the Position Applied For: ___________________________________ Person with Disabilty: Yes ( ) No ( )
Contact Number: ___________________________________________________ Solo Parent: Yes ( ) No ( )
Religion: ___________________________________________________________

Verification (To be filled-out by the


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

Checklist of Requirements and Omnibus Sworn Statement on the


1 Certification on the Authenticity and Veracity (CAV) of the
documents submitted

2 Letter of Intent address to the Schools Division Superintendent

Duly Accomplished PDS (CS Form No. 212, Revised 2017) with
3
Work Experience Sheet

4 Official Transcript of records (TOR) with Special Order

Performance Rating for the last three (3) years with at least Very
5
Satisfactory (VS) rating

6 Updated PRC ID

Certificates of Trainings/ Awards/Recognition/ Outstanding


7
Accomplishments

8 Approved Updated Service Record

Attested

__________________________________________
School Head/ Administrative Officer II

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

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.

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