Lorelie Omnibus

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OMNIBUS CERTIFICATION OF AUTHENTICITY AND VERACITY OF DOCUMENTS

I, Lorelie B. Imaysay, Filipino, of legal age, with permanent address at Sitio


Oregano Lawaan II Talisay City Cebu, after being sworn in accordance with law, hereby
depose and state that:

1. I am applying for _SHS TEACHER 1_______ at BULACAO NATIONAL


Position Name of School

______________________________;
Address of School

2. I have submitted the following documents:

2.1 CSC Form 212 (revised 2005) in two copies with the latest
2x2 ID picture
2.2 Certified photocopy of PRC professional identification card
2.3 Certified photocopy of ratings obtained in the Professional
Board Examination for Teachers
2.4 Certified copy of transcript of records
2.5 Copies of service record / certificate of employment
2.6 Certificates of specialized trainings
2.7 Certified copy of Voter’s ID and /or any proof of residency
2.8 NBI Clearance

3. I am executing this Certification to attest to the authenticity and veracity of all


documents submitted.

4. By executing this Omnibus Certification of Authenticity and Veracity of


Documents, I hereby authorize the Department of Education, Division
_________, to verify the authenticity of the above mentioned documents.

__________________________
Signature over printed name

__________________________
Date

SUBSCRIBED AND SWORN to before me in City / Municipality ________________


this _____ day of __________, 2022, affiant exhibiting to me his/her Community Tax
Certificate No. ________ issued on ______________ at ________________,
Philippines.

__________________________
Notary Public

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