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Service Record Form

This document is a service record for an employee that contains their name, birth details, and employment history. It certifies that the employee rendered services for the office as shown in their service record, which details the inclusive dates of service, office/entity assigned to, leave of absence details, and date and cause of separation if applicable. The record was prepared and certified by the administrative officers in compliance with relevant executive orders and circulars.

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hersal fae gerardo
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331 views

Service Record Form

This document is a service record for an employee that contains their name, birth details, and employment history. It certifies that the employee rendered services for the office as shown in their service record, which details the inclusive dates of service, office/entity assigned to, leave of absence details, and date and cause of separation if applicable. The record was prepared and certified by the administrative officers in compliance with relevant executive orders and circulars.

Uploaded by

hersal fae gerardo
Copyright
© © All Rights Reserved
Available Formats
Download as XLSX, PDF, TXT or read online on Scribd
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SERVICE RECORD

(To be accomplished by the Employee)

NAME: (If married woman, give also full Maiden


(Surname) (Given Name) (Maiden Name) name)

BIRTH: (Date herein should be checked from


(Date) (Place) Birth or Baptismal Certificate or
some other reliable documents)

This is to certify that the employee named herein above actually rendered services in this Office as shown by the
Service Record below. Each line of which is supported by appointments and other papers actually issued by this office and
approved by the authorities concerned.
SERVICE OFFICE/
RECORD OF APPOINTMENT SEPARATION
(Inclusive Dates) ENTITY/DIVISION LV ABS
Station/Place W/O
From To Designation Status Salary Branch Date Causes
of Assign. PAY

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 and Certified Correct:
LOU JANE M. NICOLAS
Administrative Officer-IV/HRMO
SUSAN MARIE P. BARTOLOME, Ph.D.
Administrative Officer-V
(If married woman, give also full Maiden

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