OMNIBUS SWORN STATEMENT

Republic of the Philippines

Province of _______
Municipality of _________

AFFIDAVIT

I, _________________________of legal age, single/married/widow/widower. Filipino

Name of Applicant/Affiant

and residing at__________________________, after having been duly sworn in accordance

Address of Affiant

with law, do hereby depose and state that:

1. I am bonafide applicant for__________ in the_________________________________,

Position Name of School

Division of Biliran;

2. I am submitting the following documents together with a written application, to wit:

 CSC Form 212 (Revised 2017) in two copies with the latest 2x2 ID picture
 Certified photocopy of PRC Certificate of Registration/License
 Certified photocopy of ratings obtained in the Licensure Examination for
Teachers/Professional Board Examination for Teachers.
 Certified copies of transcript of records for baccalaureate course
 Certificates of specialized training, if any
 Certified copy of Voter’s ID or Voter’s Certification
 General weighted average for baccalaureate course
 Technical Education and Skills Development Authority (TESDA) National
Certificate II, if any
 NBI Clearance

3. I am certifying that each of the documents submitted in satisfaction of the

requirements for application is an authentic copy of the original , complete, and all
statements and information provided therein are true and correct;
4. I am authorizing the Chairman and Members of the School Selection Committee to
verify all the documents which I have submitted.

IN WITNESS WHEREOF, I have set my hand this day of 2019 at

________________________.

__________________
Applicant Signature
 PRC ID No. _________
Issued on ____________
Issued at ____________

SUBSCRIBED AND SWORN to before me this ____ day of ________, 2019 at

______________________, affiants exhibited to me his/her PRC ID Number.

__________________
Notary Public

Doc. No. _____

Book No._____
Page No. _____
Series of 20____