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CS Form No.

4
Revised 2018

REPUBLIC OF THE PHILIPPINES


Department of Education
REGION NO. VIII (EASTERN VISAYAS)
Division of Leyte
Government Center, Candahug, Palo, Leyte

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. ______________________ has assumed


the duties and responsibilities as ________________________ of
_____________________________ effective _________________ .

This certification is issued in connection with the issuance of the


appointment of Ms./Mr. ________________________________ as
________________________ .

Done this ____ day of __________ ________ in ______________ .

________________________
Head of Office/Department/Unit

Date: ________________

Attested by:

JOSE MARIANO E. BARRIL JR., PhD JD


ADMINISTRATIVE OFFICER/HRMO II

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

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