CS Form No.

4
Series of 2017
Republic of the Philippines
Department of Education
SAMAR SCHOOLS DIVISION OFFICE
Catbalogan City

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms/Mr. JELOME KAIROS A. TAN has assumed the duties and responsibilities

as TEACHER I of BAQUIW NATIONAL HIGH SCHOOL effective __________________.

This certification is issued in connection with the issuance of the appointment of Ms/Mr JELOME
KAIROS A. TAN as JHS TEACHER I.

Done this ______ day of _______________________ in _____________________.

MARIZA S. MAGAN. Ed.D..CESO V

Head of Office/Department/Unit
Date: ___________________

Attested by:

_______________________________
Highest Ranking HRMO

201 file
Admin
COA For submission to CSCFO
CSC within 30 days from the
date of assumption of the
appointee