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Republic of the Philippines

Department of Education
Region 02
DIVISION OF SANTIAGO CITY
DepEd Building, Calaocan, Santiago City
Philippines. Tel. No. (078)305-2016/305-2137

Name: _________________________________________Date of Birth: _____________ Sex: ________


(Surname) (Given Name) (MI)
Authorized Position Title:___________________ Item No.____________________________
Range:__________ Authorized Salary:___________________________

I. EDUCATIONAL ATTAINMENT AND CIVIL SERVICE ELIGIBILITY

Title degree of Institution Year Received Civil Service Rating Date


Highest Grade Eligibility
Attainment

II. SERVICE RECORD ATTACHED DULY CERTIFIED SERVICE RECORD

III. EQUIVALENT UNITS


a. Total No. of years in teaching: Public only:____________Equivalent ____________
b. Degree or Degree Equivalent Present Degree__________Equivalent ____________
c. Areas of Equivalent
1. Professional Study
2. Teaching Experience
in Public Schools
3. Adm. Supervisory
Experience
4. Others (Seminar, Workshops, etc)

PERFORMANCE RATING : __________________________________


CERTIFIED CORRECT:
_____________________________________ ____________________________
School In-Charge Signature of Teacher

Note: Teachers, DO NOT WRITE BELOW


Classification Date Range Salary Scheduled Remarks
Processed Assignment Range Salary

RECOMMENDING APPROVAL: Processed by:

FLORANTE E. VERGARA, CESO VI JIE D. BAUTISTA


OIC-Schools Division Superintendent HRMO

DEPED REGIONAL OFFICE STATION


EVALUATED/PROCESSED:

Classification:___________________________
Post Audited at Range:____________________

APPROVED:

LORNA DIG-DINO, PhD., CESO IV


Officer In-Charge, Office of the Regional Director
Republic of the Philippines
Department of Education
Region 02
DIVISION OF SANTIAGO CITY
DepEd Building, Calaocan, Santiago City
Philippines. Tel. No. (078)305-2016/305-2137

CERTIFICATE OF AUTHENTICITY

TO WHOM IT MAY CONCERN:

I HEREBY CERTIFY under oath that I have been actually enrolled in the school listed in the
accompanying transcript of records and that I have actually earned units indicated therein is required, the
Chief of Higher Education, Department of Education has been furnished with authentic copies of the sworn
statement and its enclosures.

__________________________
Affiant

SUBSCRIBED AND SWORN to before me this ______ day of ______________, 2017 at


Santiago City. Affiant having exhibited to me her/his Community Tax Certificate Number
_____________________ issued at Bannawag Norte, Santiago City on ____________________.

WILHELMINA B. ANGELES
Administrative Officer V

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