Department of Education

Region V
Division of Camarines Sur
V.BAGASINA SR. MEMORIAL HIGH SCHOOL
HIMAAO, PILI, CAMARINES SUR

DR. LOIDA N. NIDEA, CESO V

Schools Division Superintendent
DepEd, Division of Camarines Sur
San Jose, Pili, Camarines Sur

Madam:

Good Day!

I have the honor to request for reinstatement from maternity leave of absence effective on JULY 5, 2021

I was on leave from MARCH 22, 2021 to JULY 4, 2021.

Herewith enclosed are my C.S.C. form 211 and/or the Certificate of Live Birth of my Child.

Thank you very much and Godspeed!

Very truly yours,

JANET O. VASQUEZ
Teacher I
V.Bagasina Sr. Memorial High School

Station Code: 557

Division Code: 013
Employee No: 5820243
Contact No: 09460264540

Recommending Approval:

JIMMY P. SERTAN
Principal I
CS Form No. 211
Revised 2017

MEDICAL CERTIFICATE
(For Employment)

                 

INSTRUCTIONS
a. This medical certificate should be accomplished by a licensed government physician.
b. Attach this certificate to original appointment, transfer and reemployment.
c. The results of the following pre-employment medical/physical/mental examinations

Blood Test
Urinalysi
s
Chest X-Ray
Drug
Test
Psychological Test
Neuro-Psychiatric Examination (if applicable)
                 

FOR THE PROPOSED APPOINTEE

NAME (Last Name, First Name, Name Extension (if any) and Middle Name) AGENCY / ADDRESS

DEPARTMENT OF EDUCATION
VASQUEZ, JANET OTILLA
ADDRESS         Division Of Camarines Sur

San Jose, Pili, Camarines Sur

ZONE 4, SAGURONG, PILI, CAMARINES SUR
AGE   SEX   CIVIL STATUS PROPOSED POSITION

26 FEMALE MARRIED TEACHER 1

                 

FOR THE LICENSED GOVERNMENT PHYSICIAN

I hereby certify that I have reviewed and evaluated the attached examination results, personally examined the
above named individual and found him/her to be physically and medically FIT / UNFIT for employment.
OTHER INFORMATION ABOUT THE
SIGNATURE over PRINTED NAME OF LICENSED GOVERNMENT PHYSICIAN:
PROPOSED APPOINTEE
 

 
AGENCY/Affiliation of Licensed Government Physician:  

 
LICENSE
HEIGHT (M) WEIGHT (KG) BLOOD
NO.        
Bare Foot Stripped TYPE
       

OFFICIAL DESIGNATION       DATE

   
EXAMINED