RPSU FORM 103, REVISED 2021

NOTICE OF STATION TRANSFER

Date: _________________________

EMPLOYEE NUMBER: 6287744

EMPLOYEE NAME: CHELION P. LASAGA

SIGNATURE:

OLD STATION:

DIVISION CODE DIVISION NAME STATION CODE STATION NAME

AGUSAN DEL SUR DATU SUBLA ELEMENTARY
SCHOOL

NEW STATION:

DIVISION CODE DIVISION NAME STATION CODE STATION NAME

AGUSAN DEL SUR CEBOLIN ELEMENTARY SCHOOL

First Day of Service in the New Station: 02 12 2024

Month (mm) Day (dd) Year (yyyy)

Last Salary Received from the Previous Station:

Month (mm) Day (dd) Year (yyyy)

Please attach herewith the following supporting documents:

1. Division Order from the Schools Division Superintendent

2. First Day of Service signed by the Principal or District Supervisor of the New Station
3. Latest Payslip

CERTIFIED CORRECT:

MARY ANN Y NUÑEZ

______HRMO____________
Division Administrative Officer
Agency Authorized Officer
(Signature over printed name)