CS Form No.

4
Series of 2017
REPUBLIC OF THE PHILIPPINES
DEPARTMENT OF EDUCATION
REGION VII (Central Visayas)
DIVISION OF BAIS CITY
Bais City

CERTIFICATE OF ASSUMPTION TO DUTY

This is to certify that Ms/Mr. ________________________________________________

has assumed the duties and responsibilities as _______________________________________
of ____________________________________ effective _______________________________.

This certification is issued in connection with the issuance of the

appointment of Ms/Mr _________________________________________________ as
_________________________________.

Done this ______ day of ___________________ in _______________________.

___________________________
Head of office/Department/Unit
Date: ______________

Attested by:

BRENDA V. CHIU
Teacher II/ OIC- HRMO
Highest Ranking HRMO

201 file
Admin
COA For submission to CSCFO
CSC within 30 days from the date
of assumption of the
appointee