Annex A

(FOR RECOMMENDATORY PURPOSES ONLY)

CERTIFIED LIST OF PUBLIC SCHOOL TEACHERS WHO ARE WILLING, AVAILABLE AND QUALIFIED TO SERVE AS MEMBERS OF THE ELECTORAL BOARDS
FOR THE 13 MAY 2019 NATIONAL AND LOCAL ELECTIONS

WILLING, SERVED IN THE

SIGNATURE OF THE
AVAILABLE AND PREVIOUS ELECTIONS
APPLICANT
QUALIFIED TO REGISTERED AS MEMBER OF THE
(The signature is an
POSITION/ SCHOOL OF BECOME A MEMBER VOTER WITH ELECTORAL BOARDS
NAME attestation to the
DESIGATION ASSIGMENT OF THE ACTIVE STATUS (if applicable, indicate the
truthfulness of all facts
ELECTRORAL (YES/NO) position held and election
indicated in this
BOARD year’s)
Certification)
(YES/NO) (YES/NO)

I hereby certify that the foregoing public school teachers are qualified, willing and available to serve as Member of the Electoral Boards for the 13 May 2019 National and Local Elections.

Date of the Request of the CEO: ___________________

Date of the Submission of the OEO: ___________________

__________________________________________
Deped Office in the District, City or Municipal

________________________
*Must be of good moral character and irreproachable reputation; Has never been convicted of any election offense or any of the crime punishable by more than (6) months if imprisonment; Has no pending information against election offense;
Able to speak and Write English, Filipino or Local dialect; and of know integrity and competence.