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Annex C Checklist and Omnibus

Evelyn Arro Esaga has applied for the position of Teacher I at Tandag City Division and has submitted a checklist of requirements for her application. The document includes a list of necessary documents such as a letter of intent, personal data sheet, and various certificates, along with a sworn statement certifying the authenticity of the information provided. It also includes a data privacy consent allowing the Department of Education to process her personal information for recruitment purposes.

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4 views

Annex C Checklist and Omnibus

Evelyn Arro Esaga has applied for the position of Teacher I at Tandag City Division and has submitted a checklist of requirements for her application. The document includes a list of necessary documents such as a letter of intent, personal data sheet, and various certificates, along with a sworn statement certifying the authenticity of the information provided. It also includes a data privacy consent allowing the Department of Education to process her personal information for recruitment purposes.

Uploaded by

maribellcaro007
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Annex C

Name of Applicant: EVELYN ARRO ESAGA Religion: Born Again Christian


Position Applied For: TEACHER I Ethnicity:
Office: Tandag City Division Person with Disability: Yes ( ) No ( )
Contact Number: 09398082731 Solo Parent: Yes ( ) No ( )

CHECKLIST OF REQUIREMENTS
Basic Documentary Requirement Status of Verification
Submission (To be filled-out by the HR Office/Subcommittee)
(To be filled-
out by the Status of Remarks
applicant; Submission
Check if
(Check if
submitted)
complied)

a. Letter of intent addressed to the Head of Office, or to PETER J.


the highest human resource officer designated by GALIMBA
the Head of Office Assistant
Schools
Division
Superintenden
t
OIC, Schools
Division
Superintenden
t

b. Duly accomplished Personal Data Sheet (PDS) / ORIGINAL


(CS Form No. 212, Revised 2017) and Work
Experience Sheet, if applicable

c. Photocopy of valid and updated PRC License/ID, if Authenticated


applicable photocopy of
prc license
(photo copy)

d. Photocopy of Certificate of Eligibility/Report of Rating, Authenticated


if applicable photocopy of
rating in the
LET(photo
copy)

e. Photocopy of scholastic/academic record such as but Transcript


not limited to Transcript of Records (TOR) and record /
Diploma, including completion of graduate and post- diploma( duly
graduate units/degrees, if available certified copy
from the
original by the
registrar with
certification
GWA )(PHOTO
COPY)

f. Photocopy of Certificate/s of Training, if applicable PHOTO COPY

g. Photocopy of Certificate of Employment, Contract of


Service, or duly signed Service Record, whichever is/are
applicable

h. Photocopy of latest appointment, if applicable

i. Photocopy of the Performance Ratings in the last


rating period(s) covering one (1) year performance
prior to the assessment, if applicable

j. Photocopy of Performance Rating obtained from the


relevant work experience, if performance rating in Item
No. 9 is not relevant to the position to be filled

k. Means of Verification (MOVs) showing Outstanding /


Accomplishments, Application of Education, and
Application of Learning and Development reckoned
from the date of last issuance of appointment

l. Checklist of Requirements and Omnibus /


Certification/Waiver (Annex C)

m Other relevant documents


.

OMNIBUS SWORN STATEMENT


CERTIFICATION ON 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.

EVELYN ARRO ESAGA


Name and Signature of
Applicant

______________________________________________________
Person Administering Oath

Reviewed:_____________________________
Administrative Officer
Attested:________________________________
School Head

In consonance with Republic Act No. 8792 or the "Electronic Commerce Act of 2000", (e)lectronic 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.

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