Sg . Life-ScrQn Diagnostic Laboraiyy & 4 00H Leaner caesar q y Inn oT compound be Sven bey aod Ke eer SS tot cmon eee ere br ae MEDICAL CERTIFICATE TO WHOM IT MAY CONCERN ‘This isto certify that we have on our records of laboratory examination / consultation the following data to with Name + De Jesus, Rhandell ‘Age/Gender + 26/M Purpose + Requirement Nationality : Filipino Date of Examination : July 29, 2021 Examinations Xray, CBC, U/A, DST & Physical Examination Remarks This certification is being issued this 7/29/2021 12:36:02 PMfor whatever purpose it may serve.o oO TARLAC STATE UNIVERSITY HUMAN RESOURCE DEVELOPMENT & MANAGEMENT OFFICE COMMITMENT (For Contractual/Substitute/Lecturer Faculty) TO WHOM IT MAY CONCERN: In consideration of my appointment as temporary/substitute/lecturer faculty member of the TARLAC STATE UNIVERSITY, I do hereby bind myself morally and professionally to serve the TARLAC STATE UNIVERSITY until the close of classes of the _Ist Semester of the School Year_2021-2022 _; and to accomplish all required documents appertaining to my academic assignment, and subject myself to clearance. | further bind myself not to place my class assignments and the TSU under disadvantageous circumstances by voluntary leaving the service without giving prior notice of my leave/separation at least thirty (30) days before leaving the service; and that to answer for any breach of contract of this commitment, I hereby authorize the TSU to withhold my salary due me without prejudice to a cause of action against me. 1 sign this commitment voluntarily. RHANI 6 ‘Name & Signature of Faculty Dean/Director REPUBLIC OF THE PHILIPPINES) crTy or SANI@UI_ TARLAD ss ACKNOWLEDGEMENT BEFORE ME, a Notary Public, this Personally appeared EVANGELISTA, JR. Pb, NP 2020-05, PTR NO. 4117254 » 0404/2021 - PANIQUI, TA 'BP LIFETIME NO. 08372 » ROLL NO, ‘un MCLE COMPLIANCE NO, Vi-eo1a064 __Efectivity Date: July 2017 [Page 1 of“re you related by consanguinty o affinity (othe. _Jnng or recommending authoiy, oF the chief of bureau or office ort the person who has immediate supenision over you inthe Ofice, ‘Bureau or Department where you willbe apppointed, a. within the third degree? »b wthin the fourth degree (for Local Govemment Unit - Career Employees)? Ors O ves YES, give details: ‘a Have you ever been found gaily of any administrative offense? b, Have you been criminally charged before any court? O vs IKYES, give deta O vs YES, give deals: Dale Filed: Status of Cass: Tlave you eve’ been conviced of any cima or volaton of any lw decree, ordnance or regulation by any court or buna? O ves YES, give detais: Have you ever teen separated fom the service in any ofthe folowing modes: resignation, retirement, dropped fom the ros, dismissal, termination, end of tem, fished contractor phased cut (abolion) in the pubic or private sector? Oves Bn TFYES, give details ‘a Have you ever been a candidate na nabonal or local lectin held win he lst year (except ‘Barangay election)? 'b Have you resignd from the goverment service during the thee (3}rnonth period before the lat lection to promota/acvely campaign fora national or iocl candidate? Ove a YES, ge deta Ove a YES, ge deta No. No “ave you acquired te satus ofan immigrant or permanent resident of enother country? O ves No. IFYES, gve deta (country) Pursuant to: @) Indigenous People's Act (RA 6371); (b) Magna Gata for Disabled Persons (RA 7277); and (¢) Solo Parents Weller Ac of 2000 (RA 8972), please answer the flowing tems: ‘Ae you @ member of any indigenous group? ‘Ae you a person wih dsabity? ‘Are you a solo parent? REFERENCES Peen tte by casanguntyo any appear pee) TaN ADDRESS ves IVES, please speci: Ores I YES, please speciy ID No: Ors If YES, please speci ID No: TELNO, ‘Arturo Areliano J. Moncada Tarlac 09178363469 eric Villanueva Panigu, Tarac 09129061167 ‘Anthony Bautista Panigu, Trac (09099718752 T declare under cath fat | have personaly aocompished tis Personal Data Sheet which & a ve, comet and ‘complete statement pursuant to the provisions of pertinent laws, rues and reguiatons of the Republic of the Philippines. | authorize the agency headiauthorized representative to vetiyvabdae the contents stated herein, | agree that any misropresentaton made in this document and its attachments shall cause the fing of adminisiratvelciminal casels against me. 3 Tosved jan Gs S55 PAC One em EASE INDICATE ID Number aed Dat of ssuanco mapign 0. DBLA cay TOR. HOMO NO Wo Noraphe DesignPLAGE OF ExMANATION CONFERVENT ‘CAREER SERVICE PROFESSIONAL City of San Femendo, Pempanga NSE DATES ed) Te (DEPARTMENT AGEN OFFICE COMPANY (Win ort ati) ‘OMS Cybernet ‘BE Rose Collage Educational Foundation In.15 Form Wo FE oO —@ PERSONAL DATA SHEET 2 su DE JESUS ERT = RSM RHANDELL MARTINEZ ‘42711995 [ic czenser| faa Cowes Coven by nature Burgos, Moncada, Teac holt ete, Ps. inate court. enenscan reds Nile C Femate TH Sale i weriet | cRESCENTA CORES Tear frm or se meas mene = Pear fs come ha — Toe Lo reams fa pavennne ‘asians mocre a8 fa oano eanerea fe aenono ™ ferme eascn ven = [escncremonte ne SO dhelzenivan gral cam > sasrsame Wa a mere WA ieiaatal we ma woos we wa WA mA cron Wa WA A noenmesrmae Wa WA wh es | 1 WA wa Taw a ry va rivera [Oe venus ry wm reste RNAPIE aaa Wa va woe eAGUING WA wa |r tenersucone —RAMIENTO WA wt omoe be vesus WA wa nore bovern WA me — WARTINED i suewexrane Monca Soth Cota Caen Seto rate2- one mom | 207 |wa for secon Ploboan Academy eter For Yau oor | ro few f2or1 [Honorable TOOATERLT TRADE COURS CIT Colleges cant Progamming am 3am Cane Eaten cour en ot 15. camptr See a ‘Guoware STUDIES we wa wa SRT RTT ae TT