SIKAP PT: FORM B

<<LETTERHEAD OF THE HIGHER EDUCATION INSTITUTION>>

CERTIFICATE OF EMPLOYMENT
Application for the Part-Time Study under the SIKAP Grant

This is to certify that <<Name of Applicant>> is a <<Full-time/Part-time>> <<Status of

Employment1>> <<Teaching/Non-Teaching>> Personnel of the <<Name of Higher
Education Institution>>. He/She was hired on <<date started>> and <<taught/served>>
in the <<Department/Office>> under the <<College/School/Office>>. He/She has been
with the <<Name of Higher Education Institution>> for <<total years of service>>.
His/Her service record for the following terms is as follows:

Term Months Covered No. of Units / No. of Type of Personnel3

(MM/YYYY - MM/YYYY)2 Work hours per week

Term 1, SY 2018-2019

Term 2, SY 2018-2019

Summer, SY 2018-2019

Term 1, SY 2019-2020

Term 2, SY 2019-2020

Summer, SY 2019-2020

Term 1, SY 2020-2021

Term 2, SY 2020-2021

Summer, SY 2020-2021

Term 1, SY 2021-2022
Add rows as necessary

This certificate is issued at the request of <<Name of Applicant>>, and issued this <<Date
of Issuance>> to be used for the Part-Time Study under the Scholarships for Staff and
Instructors’ Knowledge Advancement Program (SIKAP) Grant.

Prepared by: Recommended for Part-Time Study by:

Signature over Printed Name Signature over Printed Name

of the Head of the Human Resource Office of HEI President or its equivalent
<<dry seal, if any>>

1 Regular / Plantilla, Probationary / Temporary, Contractual / Contract of Service, Separated / Unemployed

2 Ensure that all months are covered in the Academic Year
3 Teaching and/or Non-Teaching