PRC Form No.

104 (Revised July 2002)

ASSOCIATION OF ZAMBOANGA DEL SUR ELECTRICIANS
NAME OF COMPANY
GOV. VICENTE M. CERILLES ST. SAN FRANCISCO DISTRICT, PAGADIAN CITY/ 09196049803
ADDRESS/E-MAIL/TELEPHONE NO./FAX NO.
CERTIFICATE OF EXPERIENCE
WARNING: All statements are subject to verification and any false statement or misrepresentation made in this CERTIFICATE is a ground for disqualification and
criminal prosecution.

TO THE BOARD OF:

REGISTERED MASTER ELECTRICAN EXAMINER

This is to CERTIFY that

MARY GOLD F. CABRALES
DISTRICT PAGADIAN CITY for the period and performed duties indicated below:
FROM
MAY 5, 2014

is/has been employed with the above-named office/company located at SAN FRANCISCO

TO

POSITION HELD

SPECIFIC WORK/FUNCTIONS

JUNE 29, 2015

ELECTRICIAN VOLUNTEER

Installation and testing of electrical house wiring and commercial buildings.

Assist in the preparation of electrical tools, equipments, materials and supplies.
Enforcement of safety and good housekeeping during the execution of works.
Conduct installation and troubleshoooting of motor controls, magnetic starters and water
pumps in shops and commercial buildings.
Conduct repairs and rewinding of single phase electric motors and airconditioning units.

(Use additional sheet if necessary)

ENGR. ARNEL P. CANTERO, PEE
Affiant (Certifying Officer)
(Signature above printed name)
Certificate of Registration No._______________issued on______________________

IMPORTANT:
1. The Certifying officer should be the Personnel Officer/Manager or Equivalent Position in the office/company.
2. This form is good only for one office/company.
3. Certificates of Employment must accompany this Certificate of Experience.

SUBSCRIBED AND SWORN to before me this ______

day of _______________ 20___ at ____________________________
Affiant exhibited to me his Community Tax Certificate No.
_______________________ issued at
_________________________
on ________________________.
_______________________________________________
__
Notary Public
Doc.. No.
Page No.
Book No.
Series of

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