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Republic of the Philippines
Province of Ilocos Sur
MUNICIPALITY OF SANTA
SERVICE RECORD
NAME:
(Surname)
(Given Name)
(M.I.)
(If married woman, give also full maiden name)
BIRTH :
(Date)
(Place)
(Data herein should be checked from Birth or Baptismal Certificate or some other reliable documents)
This is to certify that the employee name hereinabove actually rendered services in this Office as shown by the service record below:
| SERVICE (Inclusive Dates) |
RECORD OF APPOINTMENT | OFFICE Station |
ENTITY Branch |
LV ABS w/o pay |
SEPARATION | ||||
|---|---|---|---|---|---|---|---|---|---|
| From | To | Designation | Status | Salary/A | Date | Cause | |||
| X - X - X - NOTHING FOLLOWS - X - X - X | |||||||||
CERTIFIED CORRECT:
Municipal HRMO
Date: