Basic Paper for SA

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OSSS Form No. 3


University of the Philippines Diliman, Quezon City

BASIC PAPER FOR GRADUATES/ STUDENT ASSISTANT

[ ] Original [ ] Reappointment [ ] Renewal [ ] Item/ Unit Transfer [ ] Change of designation


1. Name (Surname, First Name, M.I.) : Bithdate  : Citizenship  : 2. College/ Unit/ Office/Div./Dept.

                                                            :                  :                      :
                                                            :                  :                      :
          Employee No.                           :           TIN:                      :

3. Degree Institution Year ( For STFAP SA only: State Bracket Assignment)

4. Previous / present designation  : Unit Code  : PSI No.  : Rate/hour not to exceed 100 hours

:  : a month ot the limits to be imposed
:  : by the chairman

_________________________________________________________________________________ 5, Proposed Designation  : Unit Code  : PSI No.  : Rate/hour not to exceed 100 hours

:  : a month ot the limits to be imposed
:  : by the chairman

_________________________________________________________________________________

6. To replace 7. Conditions of apponiment 8. Effectivity date: From: To: 9. Justification (For SA only – Specify function/duties)

10. Recommended by:  : 11. Endorsed by:  :  : Chairman/Head  : Dean/Director/Head Date Div./Dept/Office  : College/Unit/Office 12. OSSS Clearance:  : 13. Budget Clearance:  : Code/IOB No.  : PSI No.  : Designation  : Rate: Chief Date  : Effectivity Date  :  : Budget Director Date 14. Approval



Vice-Chancellor for Student Affairs Date

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