INSTITUTE OF INTEGRATED ELECTRICAL ENGINEERS OF THE PHILIPPINES, INC.

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

Part I. Employer Information

Name of Company/Office:
Name of Employer:
Position or Title Held:
Address/E-mail/Telephone No./Fax No.:
This is to CERTIFY that Mr./Ms. ________________________________ is/has been employed with the above-named office/company located at
_____________________________________ for the period and performed duties indicated below.

Part II. Applicant Employment Information

Type of Employment: Full-time Part-time

Dates of Employment:
From: __/__/____ to: __/__/____
Month Day Year Month Day Year

Applicant Position or Title Held:

Give specific work/function performed by the applicant:

Part III. Applicant Certificate or Affidavit on specific record of practice to include, but NOT limited to the following:
SUPPORTNG DOCUMENTS
A. TESDA
NC II – Electrical Installation and Maintenance NC III –Electrical Installation and Maintenance
NC II – Electrical Power Distribution Line Construction NC III – Electrical Power Distribution, Operation and Maintenance

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 INSTITUTE OF INTEGRATED ELECTRICAL ENGINEERS OF THE PHILIPPINES, INC.

CERTIFICATE OF EXPERIENCE
B. Apprenticeship Affidavit issued by instructors, trainors/supervisors who are registered electrical practitioners themselves, as validated
and concurred by the AIPO (Accredited Integrated Professional Organization).
Note: All necessary supporting documents checked above should be attached to this form.
I do hereby declare that the information recorded hereon is true and, that I am authorized to verify and release the above recorded employee information.

IMPORTANT:
_______________________________
1. The certifying officer should be a registered professional of the same
Affiant (Certifying Officer) discipline whose date of registration is prior to the date of employment and
(Signature over printed name) PRC ID must be valid.
Certificate of Registration No. _______ issued on _______. 2. This form is good only for one office/company.
3. Certificate of Employment must accompany this Certificate of Experience.

SUBSCRIBED AND SWORN to before me this _______ day of _______, 2023. Affiant exhibiting to me his evidence of identity ___________________.

NOTARY PUBLIC
Doc. No. ____;
Page No. ____;
Book No. ____;
Series of 2023.

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