Republic of the Philippines

PHILIPPINE CIVIL SERVICE

OATH OF OFFICE

I, ELIZER MAGLALANG DIMARUCUT of San Vicente, Apalit, Pampanga, having been

appointed to the position of Elementary School Principal IV hereby solemnly swear that I will

well and faithfully discharge to the best of my ability the duties of my present position and of all

others I may hereafter hold under the Republic of the Philippines; that I will support and

depend the constitution of the Philippines; that I will bear true faith and allegiance to the same;

that I 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 obligations upon myself

voluntarily without mental reservation or purpose of evasion.

SO HELP ME GOD.

ELIZER M. DIMARUCUT, Ed. D.

Signature
_________________
Documentary Stamp Community Tax Certificate No.: 04247604
Issued at : Apalit, Pampanga
Issued on : January 03, 2012

SUBSCRIBED AND SWORN to before me this 15th day of November, 2012 at Minalin,

Pampanga, Philippines.

VIOLETA T. LAGMAN
Public Schools District Supervisor
Signature of Officer Administering the Oath
CSC FORM 211 (REVISED AUGUST 1998) PHILIPPINE CIVIL SERVICE
MEDICAL CERTIFICATE
For Employment

INSTRUCTIONS

1. This Medical Certificate should be accomplished by a government physician.

2. Attached this Certificate to original appointments and reinstatement.

FOR THE PROPOSED APPOINTEE

AGENCY/ADDRESS
NAME: Elizer M. Dimarucut, Ed. D.
Department of Education
Region III
ADDRESS: #2389 San Vicente, Apalit, Pampanga Division of Pampanga

PROPOSED POSITION
AGE: 39 SEX: Male CIVIL STATUS: Single
Elementary School Principal IV

Pre-employment Medical-Physical Tests:

1. Blood Test
2. Urinalysis
3. Chest X-Ray
4. Drug Test
5. Neuro-Psychiatric Examination (if necessary)

NOTE: All Results of Examination must be attached to this form.

FOR THE PHYSICIAN

I hereby certify that I have personally examined the above named individual and found
her/him to be physically and medically fit/unfit for employment.

AFFIX
Documentary Stamp
PRINTED NAME/SIGNATURE OF CERTIFICATE NO. OTHER INFORMATION
PHYSICIAN ABOUT THE PROPOSED
APPOINTEE

OFFICIAL DESIGNATION HEIGHT WEIGHT BLOOD

(Bare Feet) (Stripped) TYPE

AGENCY 165 cm. 69 kilos “AB”

Date Examined: Nov. 15, 2012