Fillable DEPARTMENT OF LABOR AND EMPLOYMENT APPLICATION FOR CERTIFICATION (gov)

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DEPARTMENT OF LABOR AND EMPLOYMENT APPLICATION FOR CERTIFICATION (gov)

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STATE FORMER NAME, IF APPLICABLE:
APPLICATION FOR CERTIFICATION THAT COMPANY HAS/HAS NO PENDING CASES
Republic of the Philippines
DEPARTMENT OF LABOR AND EMPLOYMENT
Regional Office No. IV-A (CALABARZON)
Printed Name and Signature of Applicant
(Please supply all required information. Misrepresentation, false statement or fraud in this application or in any supporting
document is ground for denial/cancellation of certification.)
NAME OF COMPANY:
ADDRESS OF COMPANY:
REASON FOR REQUEST:
TEL. NO.: FAX NO.:
NATURE OF BUSINESS:
NAME OF OWNER: Mr./Mrs./Ms.
E-MAIL:
Mark ✓ if company has pending case and if company has no pending case.
TO BE FILLED UP BY THE EVALUATOR
Documents submitted:
Letter Request Others, please specify
Copy of Business Permit
Position in the Company Date Filed
If company has pending case:
Case Number Office where company has pending case
Evaluated by:
Printed Name and Signature Date
MALSUQPO TSSD LR/LS EXECUTIONCPO LPO BPO RPO
FM-LR-012 Effective 2018-03-01
THIS FORM IS NOT FOR SALE
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DEPARTMENT OF LABOR AND EMPLOYMENT APPLICATION FOR CERTIFICATION (gov)

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Completed 16 March 2022

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