Professional Regulation Commission

ONE THOUSAND CASE HOURS

WARNING: All statements are subject to verification and any false statement of misrepresentation made in this CERTIFICATE OF EXPERIENCE is a ground for disqualification and criminal
prosecution for falsification.

TO THE BOARD FOR: SOCIAL WORK

I HEREBY CERTIFY THAT Mr/Mrs. _________________________________ has worked with (Name of Office/Firm) _______________________________________________

Located at __________________________________ as follows:

From To No. of hours AGENCY Specific Nature of Task/ Name of Supervisor Registration No. &
Responsibilities (Reg) Date

This is to certify further that M________________________________ has actually performed the duties enumerated above under my direct supervision I, being a registered
Social Worker with Reg. No._________________- dated May 22, 1995 that my annual registration I.D is still enforce and will expire on November 19, 2025.

Manila, _________________________ 20____

_________________________________________
(Signature above printed Name of Certifying Officer)

APP-03
Rev. 00
Feb 25, 2015
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