SERVICE RECORD

(To be Accomplished by Employer)

Employee No.

NAME _ MANANGAN MARY ANN TUVERA (If married woman, give also
(Surname) (Given name) Middle Name full maiden name)

BIRTH June 29,1990 Lupao,N.Ecija______ (Data herein should be checked

Date (Place) from birth or baptismal certificate
or some other reliable documents)

This is to certify that the employee name herein above actually rendered services
in the offices as shown by the service record, each line of which is supposed by
appointment and other papers actually by the office and approved by the
authorities concerned.

SERVICE RECORD OF APPOINTMENT OFFICE/ENTITY/DIV. L/V SEPARATION

Designation Station/Place Branch ABS 4
Status Salary
(Inclusive Dates) of Assignment 3 W/O
Date Cause
From To 1 2 3 PAY
7/16/2015 Present TEACHER I Perm. P222, 588.00 Lupao, N.E. Nat'l None Orig.Appt.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx xxxxxxxxxxxx
xxxxxxxxxxxxxxxxxxxxxxxxxxxxx

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

Prepared by:

DELIA R. DOMINGO Verified Correct:

Principal I
NOEMI C. SAGCAL,Ph.D.
District Supervisor
Certified Correct:

ORLANDO C. DE LEON
Administrative Officer V

16-Mar-16
Date