CS Form No.

4
Series of 2017

Republic of the Philippines

CIVIL SERVICE COMMISSION
DEPARTMENT OF EDUCATION
Region III
SCHOOLS DIVISION OF ZAMBALES
Iba, Zambales

CERTIFICATION 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:

_______________________________
MARIA NICHOLETTE C. ROJO
Administrative Officer IV / HRMO II

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