Republic of the Philippines

Department of Education
Region VIII
Schools Division of Samar
District of Marabut
OSMENA NATIONAL HIGH SCHOOL
Osmena, Marabut, Samar
School ID. 303614

SERVICE RECORD

Name: ANIANO RHEA CHUCA .

(Surname) (Given Name) (Middle Name)

Birth: DECEMBER 24, 1985 OSMENA, MARABUT, SAMAR .

(Date) (Place)

THIS IS TO CERTIFY that the employee named herein actually rendered services in this office as
shown by the service record below, each line which supported by appointments and other papers
actually issued by this office and approved by the authorities concerned.

SERVICE RECORD APPOINTMENT

OFFICE ENTITY/DIVISION Leave of
(Inclusive Dates) absence
SALARY
Status w/o Pay
From To Designation Sg/Step Php Station/Place of Assignment Branch

OSMENA NATIONAL HIGH

11/2022 PRESENT LSA MOA NONE NONE NONE
SCHOOL

Issued in compliance with executive order No. 3 dated August 10, 1954 and in accordance with
Circulate No. 53 dated August 10, 1954 of the system.

JUNE 06, 2023 ROWENA O. ROJAS

DATE Sec. School Principal-1
 TABLE OF CONTENTS

 Letter of intent addressed to the Head of Office or

highest human resource officer

 Duly accomplished Personal Data Sheet (PDS) (CS

…………………………
Form No. 212, Revised 2017) and Work Experience
Sheet- …………………………
… A …………….…….B
 Photocopy of valid and updated PRC License/ID .

…………….……….
 Photocopy of Certificate of Eligibility/Report of Rating- C

 Photocopy of scholastic/academic record Transcript of ……………….….D

Records (TOR) and Diploma-

…………………………
 Photocopy of Certificate/s of Training-
……………………… E
 …………………………
Photocopy of Certificate of Employment, Contract of
Service, or duly signed Service Record, …………...
whichever F
is/are applicable

 Checklist of…………………………
Requirements and Omnibus Sworn
Statement on…………………………
the Certification on the Authenticity and
…………………..
Veracity (CAV) G submitted and Data
of the documents
Privacy Consent Form -

…………………………
…………………………
…. H
 Republic of the Philippines
Department of Education
Region VIII
Schools Division of Samar
District of Marabut
OSMENA NATIONAL HIGH SCHOOL
Osmena, Marabut, Samar
School ID. 303614

SERVICE RECORD

Name: TAMAYO JUDEL DAGA .

(Surname) (Given Name) (Middle Name)

Birth: NOVEMBER 18, 1997 OSMENA, MARABUT, SAMAR____________

(Date) (Place)

THIS IS TO CERTIFY that the employee named herein actually rendered services in this office as
shown by the service record below, each line which supported by appointments and other papers
actually issued by this office and approved by the authorities concerned.

SERVICE RECORD APPOINTMENT

OFFICE ENTITY/DIVISION Leave of
(Inclusive Dates) absence
SALARY
Status w/o Pay
From To Designation Sg/Step Php Station/Place of Assignment Branch

OSMENA NATIONAL HIGH

11/2022 PRESENT LSA MOA NONE NONE NONE
SCHOOL

Issued in compliance with executive order No. 3 dated August 10, 1954 and in accordance with
Circulate No. 53 dated August 10, 1954 of the system.

JUNE 06, 2023 ROWENA O. ROJAS

DATE Sec. School Principal-1