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R epublic of the Philippines

Professional Regulation Commission Manila

PRC OPTForm No. 101-2 (Rev. 04-2011)

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PASSPORT SIZE PHOTO with COMPLETE Name Tag in plain white background (taken within 3 mos.) Scanned/Photocopied picture not acceptable

TEACHERS APPLICATION FORM (TAF)

CHECK MAJOR:
MATHEMATICS VALUES EDUCATION

SECONDARY
ENGLISH FILIPINO MAPEH AGRICULTURE & FISHERY ARTS BIOLOGICAL SCIENCES PHYSICAL SCIENCES TLE/TECHNOLOGY EDUCATION

PERRC NO. _________

(Permanent Examination and Registration Record Card)

SOCIAL STUDIES

1ST TIMER (NEW) REPEATER

WARNING: This application must be filled out personally by the applicant. All documents submitted shall form part of the records of this Commission and are subject to verification. Any false statement or misrepresentation made in this application is a ground for disqualification and criminal prosecution/administrative sanction for falsification. PERSONAL APPEARANCE SHALL BE REQUIRED IN THE FILING OF THIS APPLICATION.

Part I PERSONAL INFORMATION

LAST NAME FIRST NAME MIDDLE NAME

PERMANENT MAILING ADDRESS (House No., Street, Town Prov./City)

ZIP CODE

PRC RURBAN CODE (Town/City/Prov.)

Gender MALE Civil Status SINGLE MARRIED WIDOW/ER FEMALE

CITIZENSHIP DATE OF BIRTH

CONTACT NUMBERS (LANDLINE & MOBILE) / E-MAIL ADDRESS PLACE OF BIRTH (City, Town Province) PRC RURBAN CODE (Town/City/Prov.)

SPOUSE NAME & CITIZENSHIP

FATHERS NAME & CITIZENSHIP

MOTHERS MAIDEN NAME & CITIZENSHIP

HAVE YOU EVER BEEN CONVICTED IN A FINAL JUDGMENT BY ANY COURT, MILITARY TRIBUNAL OR ADMINISTRATIVE BODY? YES NO (If yes, attach hereto a copy of the decision)

Part II EDUCATIONAL INFORMATION

COURSE COMPLETED BACHELORS DEGREE FOR Equivalent Non-BSED Graduates GRADUATE DEGREE No. of units in Prof. Ed. MAJOR FIELD OF STUDY COURSE CODE DATE GRADUATED (mm/yyyy) NAME OF SCHOOL SCHOOL CODE LOCATION

Part III PREVIOUS LICENSURE EXAMINATION FOR TEACHERS (LET) TAKEN

LAST EXAMINATION TAKEN MONTH & YEAR PLACE OF EXAMINATION STATUS CODES EX CODE: _______ (REFER AT THE BACK) NX CODE: _______

Manila

Others:__________________

I HEREBY CERTIFY that the information and/or statements in this application including the exhibits submitted in support thereof are all true and correct of my own knowledge, and that I am fully aware that any false information or statement in this application or in its attachments shall render me liable for criminal prosecution and /or administrative sanction. I AM WILLING TO BE SUBJECTED TO A VALIDATING EXAMINATION IN CASE THE TEST RESULTS IN MY PLACE OF EXAMINATION ARE STATISTICALLY IMPROBABLE.
RIGHT THUMBMARK

ACTION TAKEN BY THE APPLICATION PROCESSOR

ACTION TAKEN BY THE BOARD DISAPPROVED APPROVED

Remarks: ___________________________ Remarks: ___________________________ ____________________________________ ____________________________________ Processed by: ________________________ Chairman: _______________ Date________ Date: _______________________________ Member: ________________ Date________ ACTION TAKEN ACTION TAKEN BY THE CASH SECTION BY THE ISSUING OFFICER Amount: ____________________________ Remarks: ___________________________ ____________________________________ Issued by: ___________________________ Date: _______________________________

____________________________ O.R. No: ____________________________ Signature of Applicant ____________________________ Cashier: ___________________________ Date Accomplished
Date: ______________________________

Subscribed and sworn to before me this ____ day of _______________ 20____ at ______________. Affiant applicant exhibited to me his/her Community Tax Certificate No. _______________ issued at _________________ on _________________.
PRC Administering Officer Administration of Oath is FREE (Office Order No.2009-377 & 2009-379 both dated September 3, 2009
Republic of the Philippines PROFESSIONAL REGULATION COMMISSION Manila Documentary Stamp

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PASSPORT SIZE PHOTO with COMPLETE Name Tag in plain white background (taken within 3 mos.) Scanned/Photocopied picture not acceptable

APPLICATION STUB (This also serves as your Notice of Admission)

MAJOR: Mr./Ms. ______________________________________________ This is to inform you that your application for the SECONDARY (FOR PRC USE ONLY) Teacher Licensure Examination to be given on SEPTEMBER 25, 2011 ACKNOWLEDGEMENT ON THE RECEIPT OF has been CONDITIONALLY APPROVED PENDING FINAL REVIEW TEST BOOKLETS & ANSWER SHEETS AND VERIFICATION of your credentials. I acknowledge receipt of the test booklets Very truly yours, & answer sheets of the above-named _________________________ examinee on the subjects indicated below: PRC Issuing Officer / Date Room Watchers Signature Date General Ed.
FAILURE TO SUBMIT THE EVALUATED APPLICATION FORM TO THE ISSUING OFFICER WILL EXCLUDE THE APPLICANT FROM THE LIST OF EXAMINEES AND FORFEITURE OF THE AMOUNT PAID.

______________

________ ________

Professional Ed. ______________

PERRC NO. __________

NOTE:

Major

______________ ________

REQUIREMENTS Original and photocopy of Birth Certificate issued by the National Statistics Office (NSO) in security paper Original and photocopy of Marriage Certificate issued by NSO in security paper (for married female applicants) For NON-AVAILABILITY OF RECORDS - Negative Certification issued by NSO and Certificate of Live Birth/Marriage from the Local Civil Registrar (LCR) duly authenticated by authorized NSO Statistician For NON-READABLE entries in NSO Birth/Marriage Certificate - A clear copy of LCR Form 102 or Form 1A duly signed/certified by the Local Civil Registrar FOR EDUCATION GRADUATES: Original and photocopy of the Official Transcript of Records with SCANNED PICTURE, remarks FOR BOARD EXAMINATION PURPOSES ONLY, bearing the exact date of graduation and Special Order Number FOR NON-EDUCATION GRADUATES: Original and photocopy of the Official Transcript of Records for degree earned bearing the exact date of graduation and Special Order Number and Official Transcript of Records for 18 units in Professional Education courses with SCANNED PICTURE, remarks FOR BOARD EXAMINATION PURPOSES ONLY Original and photocopy of College Diploma if exact date of graduation is not indicated on the Official Transcript of Records CHED recognition or permit to operate for graduates of new schools/programs Three (3) recent identical copies of passport size pictures in plain white background with complete name tag One (1) piece window envelope with metered postage stamp for ordinary mail (for Report of Rating) Examination fee of PhP900.00 Current Community Tax Certificate (Cedula) INSTRUCTION IN APPLYING FOR EXAMINATION 1. Secure Teachers Application Form (TAF) from the PRC Public Assistance Unit (PAU) at the ground floor. 2. Present duly accomplished TAF and required documents to processor at OPT-Application Windows for evaluation and issuance of Permanent Examination and Registration Record Card (PERRC). 3. Proceed to PRC Customer Service Center for documentary stamp and window envelope with metered postage stamps. 4. Pay examination fee at the Cashier. Get Official Receipt. 5. Submit ALL DOCUMENTS to Issuing Officer at OPT-Application Windows or other designated windows for issuance of Application Stub and Program of Examination. 6. Keep Application Stub and Official Receipt and present them to proctors on examination day. 7. Verify from the PRC Website at www.prc.gov.ph or Masterlist posted at the various filing centers two to three days before the examination day, for the Room Assignments. INSTRUCTION IN FILLING-UP THE CODES 1. Refer to the MASTERLIST OF ADDRESS /RURBAN CODES posted at the premises of the filing center for the CODES of the Town, City or Province of your Residence and Postal Address and Place of Birth (This is different from the ZIP CODE) Refer to the MASTERLIST OF SCHOOL CODES also posted at the filing center for the School/College/University and Location Refer to the MASTERLIST OF COURSE CODES for the Course Code For STATUS CODES, use the following: a. EX CODE - Examination Type Code Print 1 for Complete/First Timer and 2 for Repeaters NX CODE - Number of Times Taken Print 0 for None Print 1 for Once Print 2 for Twice...and so on

2. 3. 4.

b.

IMPORTANT
1. Keep this stub with you. Application Number will be used when you fill out the Identification Sheet on the day of examination (present this stub when you verify your test results/apply for registration). 2. Verify from the PRC Website at www.prc.gov.ph or Masterlist posted at the various filing centers two to three days before the examination day, for the Room Assignments. 3. Bring pencits (No. 1 or 2), ballpen ( with black ink only), one piece long brown envelope, one long transparent plastic envelope, this stub and Official Receipt with you in the examination room. 4. Report to your school assignment before 6:30 am on examination day. Late examinees will not be admitted. Failure to come on your scheduled examination will mean forfeiture of examination fee.
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