Republic of the Philippines DEPARTMENT OF EDUCATION Region X Northern Min !n!o DI"I#ION OF $ANAO DE$ NORTE %o&' A (uibr!n)!

Pro&*l' %o&*t Co+p' Pigc!r!ng!n , Tubo $!n!o el Norte -To be !cco+plishe b. the e+plo.er/

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shoul be chec; fro+

!te herein

birth or b!ptis+!l certific!te or so+e reli!ble ocu+ents/ T3I# I# TO CERTIF< th!t the e+plo.ee n!+e herein !bo&e !ctu!ll. ren ere ser&ices in this Office sho=n b. the ser&ice recor belo=, e!ch is supporte b. !ppoint+ent !n other p!pers !ctu!ll. issue b. this office !n !ppro&e b. the !uthorities concerne '

#ER"ICE

RECORD OF APPOINTMENT

OFFICE ENTIT<

-inclusi&e !tes/ FROM TO

Design!ti on

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$EA"E OF A2#ENC E ?>o p!.

#EPARATI ON D!te

O@A4BA 66

PRE#E NT

Te!cher 6

Reg'>Per +'

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#ER"ICE FO$$O?#

Issue in co+pli!nce =ith EDecuti&e Or er No' 5B !te August 6C, 679B !n in !ccor !nce =ith Circul!r No' 5@ !te August 6C, 675B of the s.ste+' Purpose E #A$AR< C$AIM "erifie b.E Certifie Correct

HADJA NORMA D. BENITO MACAPOBRE Princip!l III

SILVESTRA

P.

A +inistr!ti&e Officer

October 5, 4C66 D!te