Checklist of Requirements T1 Applicants 1

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Republika ng Pilipinas

Kagawaran ng Edukasyon
REHIYON V (BIKOL)
TANGGAPANG PANSANGAY NG MGA PAARALAN NG LUNGSOD IRIGA
CHECKLIST OF REQUIREMENTS
FOR TEACHER I POSITION

Name of Applicant: VANESSA A. PAMPARO Application Code: E-01-06-02


Religion: BORN AGAIN CHRISIAN
Residence: SAN AGUSTIN, IRIGA CITY, CAMARINES SUR Persons w/ Disability: Yes ( ) No ( 
Contact No: 09468705323 Solo Parent: Yes ( ) No (/)
Email Add: [email protected] Ethnicity: Filipino
Teaching Level/Specialization/Track/Strand
being applied for: GRADE SCHOOL TEACHER

Status of Verification
Submission (To be filled-out by the school)
Basic Documentary Requirements (To be filled out by
Status of Submission Remarks
the applicant; check
(Check if complied)
if submitted)
Original Letter of Intent addressed to the Schools Division
Superintendent, attention: School Head, indicating the position
a.
being applied for and the level/s including the subject area of
specialization/track/strand he/she intends to teach
Original Checklist of Requirements and notarized Omnibus
Sworn Statement on the Certification of Authenticity and
b. Veracity (CAV) of all documents submitted and Data Privacy
Consent Form pursuant to RA 10173 (Data Privacy Act of
2012)
Original notarized Personal Data Sheet (CS Form No. 212,
Revised 2017) completely filled-out with latest passport size
c.
ID picture and with Work Experience Sheet attached, form can
be downloaded at www.csc.gov.ph
Photocopy of Transcript of Records (TOR) and Diploma,
Special Order or Certification of Completed Academic
Requirements (if any) relevant to the position to be filled
d.  Bachelor’s Degree
 18 Professional Units in Education
 Masters’ Degree
 Doctorate Degree
Photocopy of Certificate of Trainings, Seminars or Workshops
e.
relevant to the position to be filled, if any
Photocopy of Service Record or Certificate of Employment
f. with inclusive dates, performance rating and school clearance
for those with teaching experience, if any
g. Photocopy of valid/updated PRC License/ID
h. Photocopy of ratings obtained in PBET/LET/LEPT
For TVL applicants, a Photocopy of the National Certificate
i.
(NC II) issued by TESDA (and TMC I, if any)
Photocopy of Voter’s ID/and or proof of residency as deem
j.
acceptable by the Sub- Committee
For applicants who by ethnicity belongs to an IP Community, a
certificate or any form of attestation from the IP elders/leaders
k.
recognized by the community attesting that the applicant is a
member of the IP Community

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 purpose of compliance with the laws, rules, and regulations being
implemented by the Civil Service Commission

VANESSA A. PAMPARO
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”, electronic documents shall have the legal effect, validity or
enforceability as any other document or legal writing and a) where 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.

------------------------------------------------------------------------
CERTIFICATION

This is to certify that complete application documents of VANESSA A. PAMPAR0


(Applicant’s Name)

with application code no. _ E-01-06-02 has been received by SAN AGUSTIN ELEMENTARY SCHOOL
(Name of School)
on ____________________.

_________________________________
School Head/ HRMPS Sub-Committee

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