CS Form No.

4
Revised 2018

Republic of the Philippines

__(Name of Agency)__

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. _EDELBERTO B. COLLANO JR. has

assumed the duties and responsibilities as _TEACHER III of _LONOY
ELEMENTARY SCHOOL_ effective _________________.

This certification is issued in connection with the issuance of the

appointment of Ms./Mr. _EDELBERTO B. COLLANO JR._ as TEACHER III.

Done this ____ day of __________ ________ in ______________.

_ELIZABETH B. COLLANO_
Head of Office/Department/Unit

Date: ________________

Attested by:

_JOSE MARIANO E. BARRIL, JR._

Administrative Officer IV/HRMO II
Highest Ranking HRMO

201 file
Admin
COA
CSC For submission to CSC FO
within 30 days from the
date of assumption of the
appointee