Republic of the Philippines

Department of Education
REGION VI – WESTERN VISAYAS
SCHOOLS DIVISION OFFICE OF SILAY CITY

EMPLOYEE RESIGNATION FORM

_____________________________________ ___________________________________
Name (Print) Employee Number
_____________________________________ ___________________________________
Signature School/Department
_____________________________________ ___________________________________
Position Date

My reason for leaving is:

_____ Relocating out of the area _____ Staying home with children
_____ Personal or family illness _____ Pursuing an advanced degree
_____ For better paying job _____ Transitioning into a new career
_____ Marriage _____ Commuting problems
_____ Spouse/Significant other transferring out of the area
_____ Others: (Please specify)
____________________________________________________________________
____________________________________________________________________

When is your last day with us? ________________________________________

Please rate your experience with DepEd SDO-Silay City. (Please check.)
1 = Poor ; 5 = Great _____1 _____2 _____3 _____4 _____5

What have you learned in your time here?

_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________.
_________________________________
Printed Name over Signature
Noted:

________________________________
School Head/Head of Department

Rizal St., Brgy. III, Silay City, Negros Occidental

Website: www.depedsilaycity.weebly.com
Email Address: deped.silay@deped.gov.ph
Facebook Account: https://www.facebook.com/DepEdSilayCity
Contact Number: Admin 4417153/ 458-4396/ HR 458-4401/ SGOD 458-4402/CID 458-4406/
 Republic of the Philippines
Department of Education
REGION VI – WESTERN VISAYAS
SCHOOLS DIVISION OFFICE OF SILAY CITY

CONTENTS OF SCHOOL – LEVEL EMPLOYEE 201 FILE

(Checklist)

_____ Appointment (Form 33)

_____ Personal Data Sheet (PDS) (CSC Form 212/Updated)

_____ Certificate of Eligibilities/Licenses

_____ Designation Order/Office Order (if applicable)

_____ Statement of Assets, Liabilities and Net Worth (SALN)

_____ Medical Certificate (Form 211)

_____ NBI Clearance

_____ School Diplomas and Transcript of Records

_____ Marriage Contract/Certificate

_____ Updated Commendations/Certificates of Achievements/Awards, etc.

_____ Disciplinary Action Documents (if any)

_____ Individual Performance Commitment and Review

_____ Approved Travel Order

_____ Service Record

______________________________________
Printed Name over Signature

Rizal St., Brgy. III, Silay City, Negros Occidental

Website: www.depedsilaycity.weebly.com
Email Address: deped.silay@deped.gov.ph
Facebook Account: https://www.facebook.com/DepEdSilayCity
Contact Number: Admin 4417153/ 458-4396/ HR 458-4401/ SGOD 458-4402/CID 458-4406/