Annex C

CHECKLIST OF REQUIREMENTS

Name of Applicant: JESSA MAE C. VERGARA Application Code: 2025-Alc-JHS 0097

Position Applied For: JUNIOR HIGH SCHOOL TEACHER 1
Office of the Position Applied For: MARABURAB INTEGRATED SCHOOL
Contact Number: 0999-966-1836
Religion: IGLESIA NI CRISTO
Ethnicity: ILOCANO
Person with Disability: Yes ( ) No ( / )
Solo Parent: Yes ( ) No ( / )

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

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 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,
h. or duly signed
Photocopy Service
of latest Record, whichever
appointment, is/are applicable
if applicable
i. Photocopy of the Performance Ratings in the last rating
j. period(s)
Checklist covering one (1) year
of Requirements performance
and Omnibus Swornprior to the on
Statement
deadline of submission,
the Certification if applicable and Veracity (CAV) of
k. Other documentson asthe
mayAuthenticity
be required for comparative
the documents
assessment, submitted
such as but and
not Data Privacy
limited Consent Form
to:Outstanding
Means of Verification (MOVs) showing
Accomplishments,
Photocopy Application
of Performance of Education,
Rating and Application
obtained from the relevant
of Learning
work and Development
experience, if performance reckoned
rating infrom
Itemthe
(i) date
is notof last
issuance of the
relevant to appointment
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 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 C. VERGARA

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 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: JESSA MAE C. VERGARA Application Code: 2025-Alc-SHS-ACAD-0068

Position Applied For: SENIOR HIGH SCHOOL TEACHER 1
Office of the Position Applied For: BAYBAYOG NATIONAL HIGH SCHOOL
Contact Number: 0999-966-1836
Religion: IGLESIA NI CRISTO
Ethnicity: ILOCANO
Person with Disability: Yes ( ) No ( / )
Solo Parent: Yes ( ) No ( / )

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

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 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,
h. or duly signed
Photocopy Service
of latest Record, whichever
appointment, is/are applicable
if applicable
i. Photocopy of the Performance Ratings in the last rating
j. period(s)
Checklist covering one (1) year
of Requirements performance
and Omnibus Swornprior to the on
Statement
deadline
the of submission,
Certification if applicable and Veracity (CAV) of
k. Other documentson asthe
mayAuthenticity
be required for comparative
the documents
assessment, submitted
such as but and
not Data Privacy
limited Consent Form
to:Outstanding
Means of Verification (MOVs) showing
Accomplishments, Application
Photocopy of Performance of Education,
Rating obtained fromand Application
the relevant
of Learning
work and Development
experience, if performance reckoned
rating infrom
Itemthe
(i) date
is notof last
issuance of appointment
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 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 C. VERGARA

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 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.