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Certificate of Experience Form

This document is a Certificate of Experience form that certifies an individual's employment details. It contains fields for the name and address of the certifying company, the name and employment period of the certified individual, and the positions held and specific work performed. The certifying officer must be a registered professional in the same discipline as the applicant whose registration predates the applicant's employment. The certificate requires notarization and must be accompanied by a Certificate of Employment. It warns that any false statements may result in disqualification and prosecution.

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3K views1 page

Certificate of Experience Form

This document is a Certificate of Experience form that certifies an individual's employment details. It contains fields for the name and address of the certifying company, the name and employment period of the certified individual, and the positions held and specific work performed. The certifying officer must be a registered professional in the same discipline as the applicant whose registration predates the applicant's employment. The certificate requires notarization and must be accompanied by a Certificate of Employment. It warns that any false statements may result in disqualification and prosecution.

Uploaded by

alex050508
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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PRC Form No.

104 (revised March 2003)

__________________________________________________________
NAME OF COMPANY/OFFICE

__________________________________________________________
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 : __________________________________________________________________

This is to CERTIFY that M _________________________________________ is/has been employed with the above-named office/company located at
______________________________________________________ for the period and performed duties indicated below:
FROM

TO

POSITION HELD

_________________________________________
Affiant (Certifying Officer)
(Signature above printed name)

Certificate of Registration No. ___________________ issued on ___________________


IMPORTANT :
1.
2.
3.

The certifying officer should be a registered professional of the same discipline whose date of registration is prior to the date
of employment and PRC ID must be valid.
This form is good only for one office/company.
Certificate of Employment must accompany this Certificate of Experience.

SPECIFIC WORK/FUNCTIONS

SUBSCRIBED AND SWORN to before me this __________day of


__________________, 20_______ at _____________________. Affiant exhibited to
me this Community Tax Certificate No. __________________ issued at
____________________ on ___________________.
_____________________
Notary Public
Doc. No. _________________
Page No. _________________
Book No. ________________
Series of _________________

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