CS Form No.

1
Revised 2018 For Use of Regulated Agencies Only
APPOINTMENT TRANSMITTAL AND ACTION FORM

AGENCY
AGENCY:
: DEPARTMENT OF EDUCATION-TANGUB CITY DIVISION CSC FO In-Charge:
SALARY/
JOB/
INSTRUCTIONS: For CSC RO/FO's Use:
(1) Fill-out the data needed in the form completely and accurately. Date Received: A - Approved
(2) Do not abbreviate entries in the form.
(3) Accomplish the Checklist of Common Requirements and sign the certification.
(4) Submit the duly accomplished form in electronic and printed copyPOSITION
(2 copies) TITLE
to the CSC Field Office-In-Charge
together with the original copies of appointments and supporting documents.

NAME OF THE APPOINTEE/S PUBLICATION or CSC ACTION

PERIOD OF
EMPLOYMENT MODE
DATE
DATE OF (CSC Bulletin
Name indicate Agency
EMPLOYMENT (for Temporary, NATURE OF ISSUANCE of Vacant Date of Date of
Extensi period of Receiving
STATUS Casual/ Contractual APPOINTMENT (mm/dd/yyyy publication Positions, Action Release
Last Name First Name on Middle Name Officer
Appointments) ) Agency (mm/dd/yyyy (mm/dd/yyy
(Jr. / (mm/dd/yyyy
(mm/dd/yyyy to Website, ) y)
III) to
mm/dd/yyyy) Newspaper,
No. mm/dd/yyyy)
etc)
1 HERMOSISIMA GIRLIE N/A RECAMADAS TEACHER I (ELEM)
(indicate 11/1 SUBSTITUTE 01/06/2020-04/19/2020 REEMPLOYMENT 1/6/2020 N/A N/A
2 JAICTIN RUBIE N/A LAPIZ parenthetical
TEACHER title, if
I (ELEM) 11/1 SUBSTITUTE 12/26/2019-04/08/2020 REEMPLOYMENT 12/26/2019 N/A N/A
3 MORCILLOS CHERRY MAE N/A applicable)
MACAPOBRE TEACHER I (ELEM) 11/1 SUBSTITUTE 01/02/2020-03/31/2020 ORIGINAL 1/2/2020 N/A N/A
4 PEÑAS ANNIE N/A MALALIS TEACHER I (SEC) 11/1 SUBSTITUTE 01/06/2020-04/19/2020 ORIGINAL 1/6/2020 N/A N/A
D-
5 TROMPETA MARIELLE N/A GUINEA TEACHER I (SEC) 11/1 SUBSTITUTE 01/06/2020-04/19/2020 ORIGINAL 1/6/2020 N/A N/A Disapproved or
6
7 N - Noted
8 PAY
GRADE
9
10
11
12
13
14
15

CERTIFICATION

This is to certify that the information contained in this form are true, correct and complete.

DELMA R. DENAPO
Administrative Officer IV

Date: January 07, 2019

REMARKS/COMMENTS/RECOMMENDATIONS: (e.g. Reasons for Disapproval of Appointment)

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 CHECKLIST OF COMMON REQUIREMENTS HRMO CSC FO
Instructions: Put a check if the requirements are complete. If incomplete, use the space provided to indicate the name of appointee and the lacking requirement/s.

APPOINTMENT FORMS (CS Form No. 33-A, Revised 2018) - Three (3) original
1 copies of appointment form (employee copy, CSC copy and agency copy)

PLANTILLA OF CASUAL APPOINTMENT (CSC Form No. 34-A, C, E or F) - Three

2 (3) original copies (employee copy, CSC copy and agency copy)

3 PERSONAL DATA SHEET (CS Form No. 212, Revised 2017)

ORIGINAL COPY OF AUTHENTICATED CERTIFICATE OF ELIGIBILITY/ RATING/

4 LICENSE - Except if the eligibility has been previously authenticated in 2004 or
onward and recorded by the CSC

5 POSITION DESCRIPTION FORM (DBM-CSC Form No. 1, Revised 2017)

6 OATH OF OFFICE (CS Form No. 32, Revised 2017)

7 CERTIFICATE OF ASSUMPTION TO DUTY (CS Form No. 4)

This is to certify that I have checked the veracity, This is to certify that I have checked all the
authenticity and completeness of all the requirements in requirements in support of the appointments attached
support of the appointments attached herein. herein and found these to be [ ] complete / [ ] lacking.

DELMA R. DENAPO ____________________________________

Administrative Officer IV CSC FO Receiving Officer
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