CS Form No.

4
Series of 2017

Republic of the Philippines

Mindanao State University – Iligan Institute of Technology__

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:

________________________
Highest Ranking HRMO

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