Republic of the Philippines

DEPARTMENT OF EDUCATION
Region III-Central Luzon
Tarlac City School Divission

OMNIBUS SWORN CERTIFICATION

AFFIDAVIT

I, LEO GUSTO BALAGTAS, of legal age, single, Filipino and a resident of Barangay Maruglo,
Capas, Tarlac, after being duly sworn to in accordance with the law, hereby depose and state that.

1. I am qualified applicant for Elementary School Teacher 1 at Department of Education Division Office,
Province of Tarlac.
2. I am executing this omnibus sworn certification to assure the authenticity and veracity of all documents
submitted.
I have submitted the following documents:

 Letter of Intent
 Personal Data Sheet or CSC form 212 (revised 2017) Properly Accomplished
 Certified Photocopy of Professional Identification Card issued by the PRC
 Board Rating for Professional teachers issued by the PRC
 Certified Photocopy of Transcript of Record issued by the TSU
 Certified Photocopy of General Weighted Average. (GWA)
 Certification of Confirmation Issued by National Commission on Indigenous
 People (NCIP)
 National Certificate II issued by TESDA
 Certificate of Incumbency issued by DILG
 Certificate of Service Record issued by Concepcion Modern Child School Inc.
 Certificate of Employment issued by Concepcion Modern Child School Inc.
 Certificate of Appearance issued by United Nations Association of the Philippines
 Certificate of Recognition issued by Tarlac State University (DECAGON)
 Certificate of Completion issued by Tarlac State University (Experiential
 Learning)
 Certificate of Recognition issued by Tarlac State University (TRIPAD)
 Certificate of Participation issued by Presidential Commission for the Urban Poor
 Certification of Participation issued by DILG “Youth Task Force”
 Certification of Participation issued by Department of Education Region III “Regional
Training-Workshop On Indigenous Peoples Education Cultural Standards”
 Certification of Participation issued by Municipality of Capas, DILG, PDEA and PNP
(BADAC)
 Certificate of Employment issued by Public Employment Service Office (PESO)
 Voters Certification issued by
 Diploma
 NBI Clearance

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

Documents submitted.
4. IN WITNESS WHEREOF, I have hereunto set my hand this 29th day of January 2019 at
Municipality of Capas, Province of Tarlac, Philippines.

LEO G. BALAGTAS
Affiant
SUBSCRIBE AND SWORN to before me this January 29, 2019 at the Municipality of Capas,
Province of Tarlac, Philippibnes
 Republic of the Philippines
DEPARTMENT OF EDUCATION
Region III-Central Luzon
Tarlac City School Divission

OMNIBUS SWORN CERTIFICATION

AFFIDAVIT

I, LEO GUSTO BALAGTAS, of legal age, single, Filipino and a resident of Barangay Maruglo,
Capas, Tarlac, after being duly sworn to in accordance with the law, hereby depose and state that.

3. I am qualified applicant for Elementary School Teacher 1 at Department of Education Division Office,
Province of Tarlac.
4. I am executing this omnibus sworn certification to assure the authenticity and veracity of all documents
submitted.
I have submitted the following documents:

 Letter of Intent
 Personal Data Sheet or CSC form 212 (revised 2017) Properly Accomplished
 Certified Photocopy of Professional Identification Card issued by the PRC
 Board Rating for Professional teachers issued by the PRC
 Certified Photocopy of Transcript of Record issued by the TSU
 Certified Photocopy of General Weighted Average. (GWA)
 Certification of Confirmation Issued by National Commission on Indigenous
 People (NCIP)
 National Certificate II issued by TESDA
 Certificate of Incumbency issued by DILG
 Certificate of Appearance issued by United Nations Association of the Philippines
 Certificate of Recognition issued by Tarlac State University (DECAGON)
 Certificate of Completion issued by Tarlac State University (Experiential
 Learning)
 Certificate of Recognition issued by Tarlac State University (TRIPAD)
 Certificate of Participation issued by Presidential Commission for the Urban Poor
 Certification of Participation issued by DILG “Youth Task Force”
 Certification of Participation issued by Department of Education Region III “Regional
Training-Workshop On Indigenous Peoples Education Cultural Standards”
 Certification of Participation issued by Municipality of Capas, DILG, PDEA and PNP
(BADAC)
 Certificate of Employment issued by Public Employment Service Office (PESO)
 Voters Certification issued by Comelec
 Diploma
 NBI Clearance

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

Documents submitted.
4. IN WITNESS WHEREOF, I have hereunto set my hand this 8th day of January 2019 at
Municipality of Capas, Province of Tarlac, Philippines.

LEO G. BALAGTAS
Affiant

SUBSCRIBE AND SWORN to before me this January 08, 2019 at the Municipality of Capas,
Province of Tarlac, Philippibnes