Republic of the Philippines

CENTRAL LUZON STATE UNIVERSITY

3120 Science City of Muñoz, Nueva Ecija

FACULTY WORKLOAD
Form A

Semester: 1st Semester School Year: 2019-2020

College/Unit: CED Department: USHS

Printed name of Faculty Member:

LAZARO MARC ALLAINE R.
Family Given Name M.I.

E-mail Address: marcallainelazaro@gmail.com Contact Number: 09359225579

Date of Birth (mm/dd/yyyy): 10/03/1999 Gender [(1) Male; (2) Female]: 1
Generic Faculty Rank: Part Time Instructor Own Plantilla (PS) Item [Yes/No]: No
In active duty during the entire semester? [Yes/No]: Yes
On leave with pay? Type of Leave: N/A
Period [indicate date (mm/dd/yyyy)]: N/A
On leave without pay? Type of Leave: N/A
Period [indicate date (mm/dd/yyyy)]: N/A
Academic Degrees Obtained:
Date Completed Wrote Thesis as
Where Obtained
Degree Title/ Major* (mm/dd/yyyy)[OR
(School/Address)
Part of the Degree
Status] (Yes/No)
BS Education Major in CLSU, Science
Baccalaureate 6/28/2019 Yes
Social Studies City of Muñoz
Master’s (2)
Doctoral (2)
*Status: (1) Still being pursued / (2) Not yet started; Please do not indicate “1” if you are (a) NOT enrolled, (b) on
official LOA, or (c) on residency.

Discipline Classification of Primary Teaching Load**:

First Specific Discipline where most teaching is done: 463902
Second Specific Discipline where most teaching is done:

**Please refer to 6-digit discipline codes by CHED from the CLSU website: http://clsu.edu.ph/downloads/Faculty%20and
%20Staff/Faculty%20Files/Discipline%20Codes/index.php

DATA PRIVACY NOTICE: CLSU is committed to ensure that the data privacy rights of its employees, students, clients and
stakeholders are upheld and protected. By signing this form, you give permission to CLSU to store and process your personal data in
adherence to the principles of transparency, legitimate purpose, and proportionality as required by RA 10173 or the Data Privacy Act of
2012.

Prepared by: Certified correct:

MARC ALLAINE R. LAZARO MERCEDITA M. REYES, PhD REGIDOR G. GABOY, PhD

Faculty Member Department Chair Dean
Date: _____________ Date: _____________ Date: _____________

Department Chair Dean

Date: _____________ Date: _____________

Copies for: (1) OVPAA; (2) College/Department; (3) HRMO; (4) Faculty; (5) Faculty Overload In-Charge

ACA.XXX.YYY.F.013 (Revision No. 1; July 26, 2018)