GSIS SMRO PB # 2005012802

Form 01-02

SERVICE RECORDS
(To be accomplished by the employee)

NAME: NOGOLLOS __ GILYN R._______ (If married woman,Give maiden name)

(Surname) (Given) (M.I.)
BIRTH: OCTOBER 16, 1991 Koronadal, South Cotabato______ (Date herein should be checked from
(DATE) (PLACE) Birth of baptismal certificate or some
Other reliable documents)
This is to certify that the employee named herein above actually rendered services in the office as
shown by the service record below each line of which is supported and other papers actually issued by this
office and approved by the authorities concerned.

SERVICE RECORD OF APPOINTMENT OFFICE ENTITY/DIVIS SEPARATION

(INCLUSIVE DATES) DESIGNATION STATUS SALARY STATION BRANCH L/V ABS
FROM TO
01/15/2014 12/31/2014 MUNICIPAL CONTRACTUA 8,000 DepEd MSB MOA
SCHOOL BOARD L Polomolok
TEACHER NHS

1/1/2015 12/31/2015 MUNICIPAL CONTRACTUA 8,000 DepEd MSB MOA

SCHOOL BOARD L Polomolok
TEACHER NHS

1/1/2016 05/15/2016 MUNICIPAL CONTRACTUA 10,000 DepEd MSB MOA

SCHOOL BOARD L Polomolok
TEACHER NHS

05/16/2016 7/7/2016 T-I Permanent 228,924 Nicolas B. National Original

Barreras Nat’l Appointment
HS

8/7/2016 12/31/2016 T-I Permanent 228,924 Reassigned to do still in service

Polomolok
Nat'l Hs

Salary Adjustment
NBC # 568 s17
1/1/2017 12/31/2017 T-I Permanent 235,440 do do
Salary Adjustment
NBC # 572 s2018
Dated 1-3-2018
1/1/2018 T-I Permanent 242,148 do do
still in service

1/1/2018 12/31/2018 T-I Permanent 242,148 do do

 still in service

1/4/2019 Present T-I Permanent do do

IMPORTANT CERTIFIED CORRECT:

PREPARE IN DUPLICATE
PURPOSE: NOSA
DATE: April 11,2018 EVA SOLIS COSEP
CONTENT CONCURRED:_____________________ School Principal IV
GSIS SMRO PB # 2005012802
Form 01-02

SERVICE RECORDS
(To be accomplished by the employee)

NAME: NOGOLLOS __ GILYN R._______ (If married woman,Give maiden name)

(Surname) (Given) (M.I.)
BIRTH: OCTOBER 16, 1991 Koronadal, South Cotabato______ (Date herein should be checked from
(DATE) (PLACE) Birth of baptismal certificate or some
Other reliable documents)
This is to certify that the employee named herein above actually rendered services in the office as
shown by the service record below each line of which is supported and other papers actually issued by this
office and approved by the authorities concerned.

SERVICE RECORD OF APPOINTMENT OFFICE ENTITY/DIVIS SEPARATION

(INCLUSIVE DATES) DESIGNATION STATUS (1) SALARY STATION/PLACE OF BRANCH L/V ABS
ASSIGNMENT LWOP
(2)
FROM TO
01/15/2014 12/31/2014 MUNICIPAL CONTRACTUAL 8,000 DepEd Polomolok MSB NONE MOA
SCHOOL BOARD NHS
TEACHER

1/1/2015 12/31/2015 MUNICIPAL CONTRACTUAL 8,000 DepEd Polomolok MSB NONE MOA
SCHOOL BOARD NHS
TEACHER

1/1/2016 05/15/2016 MUNICIPAL CONTRACTUAL 10,000 DepEd Polomolok MSB NONE MOA
SCHOOL BOARD NHS
TEACHER
05/16/2016 7/7/2016 T-I Permanent 228,924 Nicolas B. Barreras National NONE Original Appointment
Nat’l HS
8/7/2016 12/31/2016 T-I Permanent 228,924 Reassigned to do NONE still in service
Polomolok Nat'l Hs

NONE Salary Adjustment NBC # 568

1/1/2017 12/31/2017 T-I Permanent 235,440 do do s17
NONE Salary Adjustment NBC # 572
s2018 Dated 1-3-2018
2/1/2018 12/31/2018 T-I Permanent 242,148 do do
NONE still in service
1/1/2019 Present T-I Permanent 242,149 do do
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

IMPORTANT CERTIFIED CORRECT:

PREPARE IN DUPLICATE
PURPOSE: NOSA
DATE: April 15,2019 RONALD JIM S. SOMERA
CONTENT CONCURRED:_____________________ Administrative Officer V