CS Form No.

4
Revised 2018

Republic of the Philippines

_DEPARTMENT OF EDUCATION__
DIVISION OF BACOLOD CITY

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. YNICKHO L. GENSOLI has assumed the

duties and responsibilities as SPECIAL SCIENCE TEACHER 1 of DOMINGO
LACSON NATIONAL HIGH SCHOOL effective _________________.

This certification is issued in connection with the issuance of the

appointment of Ms./Mr. YNICKHO L. GENSOLI as SPECIAL SCIENCE
TEACHER 1.

Done this ____ day of __________ ________ in ______________.

CHERYL J. TONDO
PRINCIPAL IV

Date: ________________

Attested by:

ESTHER P. ALFARAS
Administrative Officer V

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