CS Form No.

4
Series of 2018

Republic of the Philippines

DEPARTMENT OF EDUCATION
DIVISION OF NORTHERN SAMAR

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that _________________________has assumed the duties

and responsibilities as ______________________ of
____________________________ effective _______________

This certification is issued in connection with the issuance of the appointment

of ________________ as ___________________,

Done this ______ day of __________________, in Catarman, Northern

Samar

__________________________
Supervising Officer

Attested by:

CARMENCITA L. MARTIRES
HRMO

For submission to CSCFO

within 30 days from the
201 file date of assumption of the
Admin appointee
COA
CSC