CS Form No.

4
Revised 2018

Republic of the Philippines

Department of Education
CARAGA Administrative Region
Division of Surigao del Sur
Balilahan, Mabua, Tandag City

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:

________________________
HRMO

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