CS Form No.

4
Revised 2018

REPUBLIC OF THE PHILIPPINES

Department of Education
Region X
Division of Misamis Oriental
Laguindingan National High School
Laguindingan, Misamis Oriental

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 TEACHER III.

Done this ____ day of __________ ________ in ______________.

______________________________
School Principal II

Date: ________________

Attested by:

________________________
Administrative Officer

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