Republic of the Philippines

Department of Education
Region III
TARLAC CITY SCHOOLS DIVISION
TIBAG HIGH SCHOOL
Tibag, Tarlac City

CHECKLIST OF EMPLOYEE’S 201 FILE

NAME: MARIECHRIS M. DAIVD

SCHOOL: TIBAG HIGH SCHOOL

1. PDS (CSC form 212) s, 2005 ___________________

2. Position Description Forms (PDF) ___________________
3. Transcript of Records ___________________
4. PRC License ___________________
5. Rating Card (LET/PBET) ___________________
6. Copies of Certificates of Eligibilities ___________________
7. Latest 3 years Trainings/Seminars ___________________
8. Service Record ___________________
9. Medical Results (with CSC form 211) ___________________
10. Approved Appointments (CSC form 33) ___________________
11. Contracts of Services (if applicable) ___________________
12. SALN (all applicable years) ___________________
13. Marriage Contract (if married) ___________________
14. Copies of Awards, Commendations/Diplomas ___________________
15. Copies of Disciplinary Actions (if any) ___________________
16. Designations ___________________
17. NBI Clearance ___________________
18. Notices of Salary Adjustment/Step Increments ___________________
19. Oaths of Office (CSC form 32) ___________________
20. Individual Performance Commitment Record ___________________

Prepared by:

MARIECHRIS M. DAVID
Signature over Printed Name

Designation: Teacher II
Employee Number: 4276841

Certified Correct:

_____________________
Teacher-in-Charge

Noted:
RUBY ANA T. PINEDA, PhD
Principal II

Address: Tibag, Tarlac City 2300

Email address: 300971.tarlaccity@deped.gov.ph
Telephone Numbers: (045) 925 - 5095
 Republic of the Philippines
Department of Education
Region III
TARLAC CITY SCHOOLS DIVISION
TIBAG HIGH SCHOOL
Tibag, Tarlac City

SERVICE RECORD
(To be accomplished by Employer)

DAVID MARIECHRIS MIRANDA (if married woman, give also maiden name)
(Surname) (Given name) (Middle name)

July 5, 1994 Tarlac, Tarlac (Date herein should be checked from Birth
(Date of Birth) (Place of Birth) Certificate or other reliable documents)

This is to certify that the employee named herein above actually rendered services in this Office as shown by the
service record below, each line of which is supported by appointment and other papers actually issued by authorities
concerned.

SERVICE ENTITY / OFFICE

RECORD OF APPOINTMENT LEAVE OF
Inclusive Dates STATION / DIVISION
ABSENCE
PLACE OF BRANCH
From To Designation Status Salary W/O PAY
ASSIGNMENT
01/10/2019 TO DATE Tibag High
Teacher II Permanent 278,664 School
TARLAC None
01/01/2019 09/30/2019 Teacher II Permanent 275,256
Tibag High
TARLAC None
School
01/01/2018 12/31/2019 Teacher II Permanent 265,788
Tibag High
TARLAC None
School
01/01/2017 12/31/2016 Teacher II Permanent 256,536
Tibag High
TARLAC None
School
06/13/2014 12/31/2016 Teacher II Permanent 249, 936
Tibag High
TARLAC None
School

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.

Purpose: General
Date: February 17, 2020
Certified Correct:

RUBY ANA T. PINEDA, PhD

Principal II

Address: Tibag, Tarlac City 2300

Email address: 300971.tarlaccity@deped.gov.ph
Telephone Numbers: (045) 925 - 5095