CS Form No.

4
Revised 2018

Republic of the Philippines

Department of Education
REGION XII
SCHOOLS DIVISION OF SOUTH COTABATO

CERTIFICATION OF ASSUMPTION TO DUTY

This is to certify that Ms./Mr. (FIRST NAME, MIDDLE INITIAL, LAST

NAME) as assumed the duties and responsibilities as (POSITION –
ELEMENTARY / JHS / SHS) of (SCHOOL) effective (LEAVE BLANK) .

This certification is issued in connection with the issuance of the

appointment of Ms./Mr. (FIRST NAME, MIDDLE INITIAL, LAST NAME) as
(POSITION – ELEMENTARY / JHS / SHS).

Done this (LEAVE BLANK) day of (LEAVE BLANK), 2022 in

Department of Education – Schools Division of South Cotabato, Philippines.

LEONARDO M. BALALA, CESE

Schools Division Superintendent

Date: _________________

Attested by:

NERIE H. TRESBE
Administrative Officer IV
OIC to the Office of AOIV (Personnel)

For submission to CSC FO

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