Republic of the Philippines Republic of the Philippines

DEPARTMENT OF HEALTH DEPARTMENT OF HEALTH

CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT CENTRAL LUZON CENTER FOR HEALTH DEVELOPMENT
REQUISITION SLIP REQUISITION SLIP
Personnel Section Personnel Section
Kenneth S. Santos
Name:________________________ NDP - Nurse II
Designation:______________________ Kenneth S. Santos
Name:________________________ NDP - Nurse II
Designation:______________________
Mabalacat City
Division / Place of Assignment:__________________________ Date:____________________________ Mabalacat City
Division / Place of Assignment:__________________________ Date:____________________________

x CERTIFICATE OF EMPLOYMENT PAYSLIP (for permanent employees only) x CERTIFICATE OF EMPLOYMENT PAYSLIP (for permanent employees only)
x Active Inactive x Active Inactive
For PCW Training
Purpose:_________________ Month:_________________ For PCW Training
Purpose:_________________ Month:_________________
(except for reference purposes) (except for reference purposes)
Feb. 07, 22
Entrance to Duty (Original):_________________ Feb. 07, 22
Entrance to Duty (Original):_________________
PRESENT
End Date:___________________________ PRESENT
End Date:___________________________
NDP - Nurse II
Position: ___________________________ DTR NDP - Nurse II
Position: ___________________________ DTR
Mabalacat City
Place of Assignment: __________________ Permanent Job Order Place of Assignment: __________________
Mabalacat City Permanent Job Order

with compensation Month:______________ with compensation Month:______________

x without compensation Purpose:_________________ x without compensation Purpose:_________________

Others: _________________ Others: _________________

SERVICE RECORD SERVICE RECORD

Date of Birth:_________________ OTHERS:_____________________ Date of Birth:_________________ OTHERS:_____________________
Place of Birth: ________________ Place of Birth: ________________

Requested by: Verified by: Requested by: Verified by:

Kenneth S. Santos
____________________________ ____________________________ Kenneth S. Santos
____________________________ ____________________________
Signature over printed name Signature over printed name/Date Signature over printed name Signature over printed name/Date

09089456802
Contact Number: ____________________ Contact Number: ____________________
09089456802
santoskenneth034@gmail.com
Email Address: ____________________ santoskenneth034@gmail.com
Email Address: ____________________