Annex C

CHECKLIST OF REQUIREMENTS

APPLICATION CODE:

NAME OF APPLICANT:
POSITION APPLIED FOR:
OFFICE OF THE POSITION APPLIED FOR:
CONTACT NUMBER:
RELIGION:
ETHNICITY:
PERSON WITH DISABILITY : YES ( ) NO ( )
SOLO PARENT : YES ( ) NO ( )

Status of VERIFICATION
Submission
BASIC DOCUMENTARY REQUIREMENT (To be filled-out byt the
(To be filled-out by the HRMO /HR Office / Sub-Committee)
applicant; Check if
Status of Submission
submitted)
(Check if Complied) REMARKS
a. Letter of Intent addressed to the Head of Office or highest Human
Resource Officer
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

e. Photocopy of scholastic / academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of
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. 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 deadline of submission, if
applicable
j. Checklist of Requirements and Omnibus Sworn Statement on the
Certification on the Authenticity and Veracity (CAV) of the documents
sumitted and Data Privacy Consent Form
k. Outstanding Accomplishments ( Outstanding Employee Award,
Innovations, Research and Devt Projects, Consultancy and Speakership to
trainings, seminars and symposia , other awards

l. 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

m. 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 ( 3 rating period)
Attested:

Human Resource Management Officer

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct , and of the 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.

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)lectronic documents shall have the legal effect, validity or enforceability as any other document or leagl 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

APPLICATION CODE:

NAME OF APPLICANT:
POSITION APPLIED FOR:
OFFICE OF THE POSITION APPLIED FOR:
CONTACT NUMBER:
RELIGION:
ETHNICITY:
PERSON WITH DISABILITY : YES ( ) NO ( )
SOLO PARENT : YES ( ) NO ( )

Status of VERIFICATION
Submission
BASIC DOCUMENTARY REQUIREMENT (To be filled-out byt the
(To be filled-out by the HRMO /HR Office / Sub-Committee)
applicant; Check if
Status of Submission
submitted)
(Check if Complied) REMARKS
a. Letter of Intent addressed to the Head of Office or highest Human
Resource Officer
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

e. Photocopy of scholastic / academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of
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. 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 deadline of submission, if
applicable
j. Checklist of Requirements and Omnibus Sworn Statement on the
Certification on the Authenticity and Veracity (CAV) of the documents
sumitted and Data Privacy Consent Form
k. Outstanding Accomplishments ( Outstanding Employee Award,
Innovations, Research and Devt Projects, Consultancy and Speakership to
trainings, seminars and symposia , other awards

l. 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

m. 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 ( 3 rating period)
Attested:

Human Resource Management Officer

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct , and of the 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.

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)lectronic documents shall have the legal effect, validity or enforceability as any other document or leagl 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

APPLICATION CODE:

NAME OF APPLICANT:
POSITION APPLIED FOR:
OFFICE OF THE POSITION APPLIED FOR:
CONTACT NUMBER:
RELIGION:
ETHNICITY:
PERSON WITH DISABILITY : YES ( ) NO ( )
SOLO PARENT : YES ( ) NO ( )

Status of VERIFICATION
Submission
BASIC DOCUMENTARY REQUIREMENT (To be filled-out byt the
(To be filled-out by the HRMO /HR Office / Sub-Committee)
applicant; Check if
Status of Submission
submitted)
(Check if Complied) REMARKS
a. Letter of Intent addressed to the Head of Office or highest Human
Resource Officer
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

e. Photocopy of scholastic / academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of
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. 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 deadline of submission, if
applicable
j. Checklist of Requirements and Omnibus Sworn Statement on the
Certification on the Authenticity and Veracity (CAV) of the documents
sumitted and Data Privacy Consent Form
k. Outstanding Accomplishments ( Outstanding Employee Award,
Innovations, Research and Devt Projects, Consultancy and Speakership to
trainings, seminars and symposia , other awards

l. 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

m. 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 ( 3 rating period)
Attested:

Human Resource Management Officer

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct , and of the 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.

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)lectronic documents shall have the legal effect, validity or enforceability as any other document or leagl 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

APPLICATION CODE:

NAME OF APPLICANT:
POSITION APPLIED FOR:
OFFICE OF THE POSITION APPLIED FOR:
CONTACT NUMBER:
RELIGION:
ETHNICITY:
PERSON WITH DISABILITY : YES ( ) NO ( )
SOLO PARENT : YES ( ) NO ( )

Status of VERIFICATION
Submission
BASIC DOCUMENTARY REQUIREMENT (To be filled-out byt the
(To be filled-out by the HRMO /HR Office / Sub-Committee)
applicant; Check if
Status of Submission
submitted)
(Check if Complied) REMARKS
a. Letter of Intent addressed to the Head of Office or highest Human
Resource Officer
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

e. Photocopy of scholastic / academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of
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. 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 deadline of submission, if
applicable
j. Checklist of Requirements and Omnibus Sworn Statement on the
Certification on the Authenticity and Veracity (CAV) of the documents
sumitted and Data Privacy Consent Form
k. Other documents as may be required for comparative assessment, such
as but not limited to:

l. 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

m. 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
Attested:
ANDREA LOU AMERILA SEVILLA
Human Resource Management Officer

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct , and of the 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.

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)lectronic documents shall have the legal effect, validity or enforceability as any other document or leagl 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.
 Republic of the Philippines
Department of Education
Region VI-Western Visayas
SCHOOLS DIVISION OF ANTIQUE
DISTRICT OF PANDAN

CHECKLIST OF REQUIREMENTS

APPLICATION CODE:

NAME OF APPLICANT:
POSITION APPLIED FOR:
OFFICE OF THE POSITION APPLIED FOR:
CONTACT NUMBER:
RELIGION:
ETHNICITY:
PERSON WITH DISABILITY : YES ( ) NO ( )
SOLO PARENT : YES ( ) NO ( )

Status of VERIFICATION
Submission
BASIC DOCUMENTARY REQUIREMENT (To be filled-out byt the
(To be filled-out by the HRMO /HR Office / Sub-Committee)
applicant; Check if
Status of Submission
submitted)
(Check if Complied) REMARKS
a. Letter of Intent addressed to the Head of Office or highest Human
Resource Officer
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

e. Photocopy of scholastic / academic record such as but not limited to

Transcript of Records (TOR) and Diploma, including completion of
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. 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 deadline of submission, if
applicable
j. Checklist of Requirements and Omnibus Sworn Statement on the
Certification on the Authenticity and Veracity (CAV) of the documents
sumitted and Data Privacy Consent Form
k. Other documents as may be required for comparative assessment, such
as but not limited to:

l. 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

m. 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
Attested:

Human Resource Management Officer

OMNIBUS SWORN STATEMENT

CERTIFICATION OF AUTHENTICITY AND VERACITY

I hereby certify that all information above are true and correct , and of the 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", (e)lectronic documents shall have the legal effect, validity or enforceability as any other document or leagl 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.