RENEWAL FOR SHS PROVISIONAL 2018

NAME_ LANI A. DUMALASA_____ STATUS :_PROVISIONAL

DISTRICT ASSIGNMENT TINAMBAC CAMARINES SUR SALARY: P 20, 179.00 SG

1. Copy of Publication ( CSC bulliten) (1)

2. Approved Recommendation of SDS original (1)
3. CS Form 212 PDS ( Revised 2017) (Personal Data Sheet) Original, latest
picture passport size w/name tag, white background (Original handwritten
or computer encoded) (duly notarized by the lawyer) (4)
4. CS Form No. 1 PDF (Position Description Form) (3)
5. CS Form No 32 (Oath of office) Original,with Documentary stamp (3)
6. CS Form No 4 ( Certificate of assumption to Duty (3)
7. Original Certificate of Performance Rating for the last 3 Ratings period duly
Signed by the Authorities (yr. 2015-2017) (2)

NOTE: USE REVISED 2017 CSC FORMS

ALL PHOTOCOPIED DOCUMENTS SHOULD BE AUNTHENTICATED BY
THE SCHOOL/ UNIVERSITIES/OFFICE ISSUING THE DOCUMENTS
USE HARD BROWN ENVELOPE

PROCESSED/VALIDATED/REVIEWED @ THE HR OFFICE

EDEN B. MACANDOG/ GILBERT E. BELLECA

Validators

VERIFIED BY: REVIEWED BY:

MARIA DIVINA H. CALLEJA GINA A. VALENCIANO

OIC-HRMO Administrative Officer V
 REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION
Division of Camarines Sur

OATH OF OFFICE

I,_____________ LANI A. DUMALASA_________________________________of

Name of Appointee
SAN ROQUE, CALABANGA CAMARINES SUR having been appointed to the
(Address of the Appointee)
position of TEACHER 1 (SHS_____________________ hereby
( position Title)
Solemnly swear; that I faithfully discharge to the best of my ability, the duties of
my present position and and of all others that I may hereafter hold under the
Republic of the Philippines; that I will bear true faith and allegiance to the same;
thai will obey the laws, legal orders, and decrees promulgated by the duly
constituted authorities of the Republic of the Philippines; and that I impose this
obligation upon myself voluntarily, without mental reservation or purpose of
evasion.

SO HELP ME GOD

LANI A DUMALASA
( Signature over Printed Name of the Appointee)

Government ID MTO CALABANGA

ID Number __________ __________
Date Issued 2019

Subscribed and sworn to before me this__________________ day of

_____________________, 2019 in __________________________,

CECILLE BERNADETTE P. RIVERA, CESO V

(Signature Over Printed Name of the Appointing Officer)
Athority/Head of office