Teacher's Service Record

Name of School Address Tel No.

SERVICE RECORD (To be accomplished by Employer)

NAME: LAST NAME, FIRST NAME MIDDLE NAME (Last Name)

(Given Name)

(If married woman, give all full maiden name)

(Middle Name)

BIRTH: August 15, 1985 Gapan City, Nueva Ecija (Date)

(Data herein should be checked from the birth or baptismal certificate or some other reliable documents.)

(Place)

This is to certify that the employee named hereinabove actually rendered services in this office as shown by the record below, each line of which is supported by appointment and the other papers actually issued by this Office and approved by the authorities concerned. SERVICE (Inclusive Dates)

RECORD OF APPOINTMENT

From

To

Designation

June 2009

March 2010

Classroom Teacher

Status 1 Prob.

Salary 2

OFFICE ENTITY/DIV. Station/Place of assignment

9,000.00 Private Montessori School Gapan City

x-x-x-x-x-x NOTHING FOLLOWS -x-x-x-x-x-x

Branch 3

L/V ABS W/O PAY

SEPARATION 4 Date March 19, 2010

Issued in compliance with Executive Order No. 54 dated August 10, 1954, and in accordance with Circular No. 58, dated August 10, 1954 of the system.

CERTIFIED CORRECT:

April15,2009 Date

Yolanda V. Espinosa Chief or Head Office Registrar Designation

full maiden

cked from the te or some

PARATION 4 Cause

Resigned

pinosa Office r n