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REPUBLIKA NG PILIPINAS

Kagawaran ng Edukasyon, Kultura at Isports


Pambansang Punong Rehiyon
Sangay ng Valenzuela
Pio Valenzuela St., Marulas
Valenzuela City

REPORT OF THE FIRST DAY OF SERVICE OF TEACHER / EMPLOYEE

1. Name of Teacher / Employee: ________________________________ Employee No: ____________


2. Civil Status: _________________________________ Date of Birth: __________________________
3. City Address: ______________________________________________________________________
4. Place of Birth: __________________________________ T.I.N.: ____________________________
5. Educational Qualification (If BSE, Please Major: __________________________
Give Major/Minor subjects (State if PNU, Minor: __________________________
Private University or College)

Date Graduated: _______________________


No. of Years in Service: _______________________

6. Length of teaching Experience (Public School Only) _______________________________________


Last Station: ________________________________________
7. Civil Service Examination Passed Kind: ____________________________________
Place: ____________________________________
8. Civil Service status ………………………………….. ____________________________________
9. Is Civil Service Eligible or rejected
The Position Offered ………………………………… ____________________________________
10. Prior Annual Salary ………………………………….. ____________________________________
11. Recommended Annual Salary ……………………….. ____________________________________
12 First Day of Actual Service ………………………….. ____________________________________
13. Inclusive Date of Service ……………………………. ____________________________________
14. Name of Previous Incumbent ………………………... ____________________________________
15. Salary of Previous Incumbent ……………………….. ____________________________________
16. Cause of Separation of previous Incumbent ………... _____________________________________
17. Last day of Previous Incumbent …………………….. ____________________________________
18. Permission to transfer ……………………………….. ____________________________________
19. Remarks ……………………………………………... ____________________________________

The appointment is not related by affinity or consanguinity to the recommending or appointing


official or the persons exercising immediate supervision over him / her.

______________________________________
Principal/Head Teacher/ Teacher-In-Charge

______________________________________
School

_____________________________________
Date Submitted

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