Republic of the Philippines
Department of Education
Region IV
School District of Laguna
OMNIBUS SWORN CERTIFICATION
I, _______________________, of legal age, Filipino, married and presently residing
_______________________, Laguna after having been duly sworn in accordance with law, do
hereby depose and state that:
1. I am a qualified Teacher applicant at the _________________________________;
2. I am executing this Omnibus Sworn Certificate to assure authenticity and veracity of
all documents submitted:
CSC Form 212 (Revised 2005) in two copies with the latest Passport size 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 photocopy of Transcript of records for baccalaureate course;
Copies of Service record, performance rating and school clearance for those
teaching experience;
Certified photocopy of Specialized Training;
Certified photocopy of the Voter’s Certification from the COMELEC; and
NBI Clearance
3. I assure full responsibility and accountability on the authenticity of the documents
submitted and I understand that any violation will automatically disqualify me from the
selection process.
4. Furthermore, I hereby declare under penalties of perjury that the forgoing attestations
are true and correct;
IN WITNESS WHEREOF, I have hereunto set my hand this ____________________
City of Cabuyao, Laguna.
_____________________
Printed Name and Signature of Applicant
Republic of the Philippines )
Province of Laguna ) S.S.
City of Cabuyao )
SUBSCRIBED AND SWORN to before me, on the above stated date at City of Cabuyao,
Laguna, by the Affiant whom I have identified through competent evidence of identity and who
exhibited his/her Identification Card with Number _______________ issued by the
Professional Regulation Commission.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2022
Republic of the Philippines
Department of Education
Region IV
School District of Laguna
OMNIBUS SWORN CERTIFICATION
I, MEDYLYNNE V. PATAJO, of legal age, Filipino, single and presently residing Block 1,
Lot 15, Phase 5, St. Joseph Village 7, Barangay Gulod, City of Cabuyao, Laguna after having
been duly sworn in accordance with law, do hereby depose and state that:
1. I am a qualified Teacher applicant at the _________________________________;
2. I am executing this Omnibus Sworn Certificate to assure authenticity and veracity of
all documents submitted:
CSC Form 212 (Revised 2005) in two copies with the latest Passport size 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 photocopy of Transcript of records for baccalaureate course;
Copies of Service record, performance rating and school clearance for those
teaching experience;
Certified photocopy of Specialized Training;
Certified photocopy of the Voter’s Certification from the COMELEC; and
NBI Clearance
3. I assure full responsibility and accountability on the authenticity of the documents
submitted and I understand that any violation will automatically disqualify me from the
selection process.
4. Furthermore, I hereby declare under penalties of perjury that the forgoing attestations
are true and correct;
IN WITNESS WHEREOF, I have hereunto set my hand this ____________________
City of Cabuyao, Laguna.
MEDYLYNNE V. PATAJO
Printed Name and Signature of Applicant
Republic of the Philippines )
Province of Laguna ) S.S.
City of Cabuyao )
SUBSCRIBED AND SWORN to before me, on the above stated date at City of Cabuyao,
Laguna, by the Affiant whom I have identified through competent evidence of identity and who
exhibited his/her Identification Card with Number 1388967 issued by the Professional
Regulation Commission.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2017
Republic of the Philippines
Department of Education
Region IV
School District of Laguna
OMNIBUS SWORN CERTIFICATION
I, JESSICA MAE M. NOBLEFRANCA, of legal age, Filipino, single and presently
residing Block 19, Lot 43, Southville 1, Brgy. Marinig, City of Cabuyao, Laguna after having
been duly sworn in accordance with law, do hereby depose and state that:
1. I am a qualified Teacher applicant at the Southville Elementary School;
2. I am executing this Omnibus Sworn Certificate to assure authenticity and veracity of
all documents submitted:
CSC Form 212 (Revised 2005) in two copies with the latest Passport size 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 photocopy of Transcript of records for baccalaureate course;
Copies of Service record, performance rating and school clearance for those
teaching experience;
Certified photocopy of Specialized Training;
Certified photocopy of the Voter’s Certification from the COMELEC; and
NBI Clearance
3. I assure full responsibility and accountability on the authenticity of the documents
submitted and I understand that any violation will automatically disqualify me from the
selection process.
4. Furthermore, I hereby declare under penalties of perjury that the forgoing attestations
are true and correct;
IN WITNESS WHEREOF, I have hereunto set my hand this 28th day of November, 2016
at City of Cabuyao, Laguna.
JESSICA MAE M. NOBLEFRANCA
Printed Name and Signature of Applicant
Republic of the Philippines )
Province of Laguna ) S.S.
City of Cabuyao )
SUBSCRIBED AND SWORN to before me, on the above stated date at City of Cabuyao,
Laguna, by the Affiant whom I have identified through competent evidence of identity and who
exhibited his/her Identification Card with Number 1424302 issued by the Professional
Regulation Commission.
Doc. No. __________;
Page No. __________;
Book No. __________;
Series of 2016
