Professional Documents
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ST ND RD TH TH TH TH
ST ND RD TH TH TH TH
1. () NAME OF EMPLOYEE
(Family Name)
(Given Name)
(Middle Name)
3. BUREAU OR OFFICE
2. DEPEARTMENT CORPORATION OR
AGENCY/ LOCAL GOVERNMENT
4. DEPARTMENT/BRANCH/DIVISION
7. () SALARY
AUTHORIZED
7b. OTHER
COMPENSATION
ACTUAL
BOARD
P.I.B/Clothing/Bonus
ACA/PERA
BOARD
RATA
ITEM
8. () OFFICIAL DESIGNATION OF
POSITION
12.FOR LOCAL GOVERNMENT POSITION, CHECK GOVERNMENT UNIT AND UNIT CLASS
MUNICIPALITY [ ]
CITY [ ]
1 st
[ ]
2nd
[ ]
3rd
[ ]
PROVINCE [ ]
4th
[ ]
5th
[ ]
6th
[ ]
7th
[ ]
18.() CONTACTS
[
[
[
FREQUENT
NORMAL WORKING CONDITION [
]
FIELD
WORK
[
GENERAL PUBLIC
[
]
]
[
]
FIELD TRIPS
[
OTHER AGENCIES
[
]
]
]
ESPOSED TO VARIED WEATHER
[
]
SUPERVISORS
[
]
OTHERS (Specify) __________________
]
MANAGEMENT
[
]
]
OTHERS (Specify)_________________________
20.() I CERTIFY THAT THE ABOVE ANSWERS ARE ACCURATE AND COMPLETE
___________________
Date
Employee
______________________
Signature of
T.E./PBET/LET/R.A. 1080
23.I HEREBY CERTIFY THAT THE ABOVE ANSWERS ARE ACCURATE AND COMPLETE
____________________
_______________________________
DATE
IMMEDIATE SUPERVISOR
APPROVED:
_________________
G. MOSTOLES, ED. D.
DATE
Division Superintendent
ZENIA
Acting Schools