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Republic of the Philippines

NATIONAL LABOR RELATIONS COMMISSION
Regional Arbitration Branch No. III
City of San Fernando, Pampanga

___________________________________
___________________________________,
Complainant/s

- Versus - NLRC CASE NO. RAB-III________________________________

___________________________________
___________________________________,
Respondent/s.

Date of Hearing:________________________________
Time : _______________________________

MINUTES
(FOR TERMINATION CASES)
Mandatory Conciliation and Mediation Conference

Respondent/s : (If juridical entities):

□ Corporation: Corporate Name: __________________________________________________________

□ Partnership: Partnership Name:_________________________________________________________
□ Single Proprietorship: Name of Owner (should be impleaded)_________________________________
□ Franchise: Name of Owner (should be impleaded) __________________________________________
□ Business Name: Name of Owner (should be impleaded) ______________________________________

In case of non-appearance of respondent/s, how Summons/es was/were served:

Name of Respondent/s How effected

_______________________________________ _____________________________________
_______________________________________ _______________________________________
_______________________________________ _______________________________________

Employment Status:
□ Admitted by Respondent/s
□ Denied by respondent/s

Evidence of Respondent/s: _____________________________________________

____________________________________________________________________
____________________________________________________________________

Evidence of Complainants: _______________________________________________

_____________________________________________________________________
_____________________________________________________________________

Date of Employment: As to Complainant/s: __________________________________________________

Evidence Presented: __________________________________________________

As to Respondent/s: _________________________________________________
Evidence Presented: __________________________________________________
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Date of Termination: As to Complainant/s: __________________________________________________

Evidence Presented: __________________________________________________

As to Respondent/s: _________________________________________________
Evidence Presented: __________________________________________________

Nature of Termination:
□ Actual □ 1st Notice ________________________________________________
□ 2nd Notice ________________________________________________

□ Constructive

Cause of Termination: As to Complainant/s: ________________________________________________

Evidence Presented: __________________________________________________

As to Respondent/s: _________________________________________________
Evidence Presented: __________________________________________________

Did Respondent/s allege that there was no termination?

□ IF YES, willing to admit complainant back to work?
______________________________________________________________________
□ IF NO, reason/s : _________________________________________________________
_______________________________________________________________________

□ Is complainant willing to return to work?

_______________________________________________________________________
□ If NO, reason/s: __________________________________________________________
_______________________________________________________________________

Abandonment: □ NO
□ YES Date of 1st Notice _________________________________
Date of 2nd Notice

Money Claims/Labor Standard Benefits:

Evidence presented by Respondent/s:
□ Service Incentive Leave Pay _________________________________________
□ 13th month pay _________________________________________
□ Premium Pay for Holiday __________________________________________
□ Wage Differential
□ ECOLA Evidence presented by Complainant/s
□ Night Shift Differential __________________________________________
□ Overtime Pay __________________________________________
□ Rest Day __________________________________________
Other Money Claims:
□ Service Charge/s
□ Separation Pay
□ Retirement Pay
□ Maternity Benefits
□ Moral & Exemplary Damages
□ Attorney’s fees
□ Others: __________________________________________________________________
__________________________________________________________________

Other Stipulations:

As to complainant/s: __________________________________________________________
___________________________________________________________________
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As to respondent/s: __________________________________________________________
___________________________________________________________________

Laws/Jurisprudence relied upon:

By complainant/s: ____________________________________________________________
_____________________________________________________________
_____________________________________________________________

By respondent/s: ____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Other Issues Raised:

_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Relief/s Sought:
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________

Documentary Evidence Presented, if any:

For Complainant/s:
Exhibit “A”:_______________________________________________________________
Exhibit “B”: ______________________________________________________________
Exhibit “C”:_______________________________________________________________

For Respondent/s:
Exhibit “1”:_______________________________________________________________
Exhibit “2”: ______________________________________________________________
Exhibit “3”:_______________________________________________________________

Date of Next Hearing: ________________________________________________________________

__________________________________________ _______________________________________

__________________________________________ _______________________________________

_________________________________________ _______________________________________

_________________________________________ ______________________________________

Complainant/s Respondent/s

HON. LEANDRO M. JOSE

Labor Arbiter