Name of School

Address Tel No.

SERVICE RECORD
(To be accomplished by Employer)

NAME: LAST NAME, FIRST NAME MIDDLE NAME
(Last Name) (Date) (Given Name) (Middle Name) (Place)

(If married woman, give all full maiden name) (Data herein should be checked from the birth or baptismal certificate or some other reliable documents.)

BIRTH: August 15, 1985 Gapan City, Nueva Ecija

This is to certify that the employee named hereinabove actually rendered services in this office as shown by the record below, each line of which is supported by appointment and the other papers actually issued by this Office and approved by the authorities concerned. SERVICE (Inclusive Dates) From June 2009 To March 2010 RECORD OF APPOINTMENT Designation Classroom Teacher Status 1 Prob. Salary 2 OFFICE ENTITY/DIV. Station/Place of assignment Branch 3 L/V ABS W/O PAY SEPARATION 4 Date March 19, 2010

9,000.00 Private Montessori School Gapan City

x-x-x-x-x-x NOTHING FOLLOWS -x-x-x-x-x-x

Issued in compliance with Executive Order No. 54 dated August 10, 1954, and in accordance with Circular No. 58, dated August 10, 1954 of the system.

CERTIFIED CORRECT:
Yolanda V. Espinosa Chief or Head Office Registrar Designation

April15,2009 Date

full maiden

cked from the te or some

PARATION 4 Cause

Resigned

pinosa Office r n

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