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Republic of the Philippines

Department of Education
Region X
DIVISION OF EL SALVADOR CITY
Zone 3, Poblacion, El Salvador City
Telefax No: (088) 555-0475| Email Address: elsalvador.city@deped.gov.ph| Website: depedelsalvadorcity.net

APPLICATION FOR PERMISSION TO TEACH OUTSIDE OF OFFICIAL TIME

Name of Applicant: ________________________________Position: _______________


Highest Educational Attainment: ________________________________________________
Official Station: _______________________________________________________________
Performance Ratings for the last 3 Years: __________; ____________; ______________
Length of Service: _________________ Signature _______________
College/University the Applicant Intends to Teach:

School:
Address:
Term: ______ 1st Sem ______ 2nd Sem ______Summer School Year: ____________
___________________________________________________________________________
Subjects to be taught
Subject Time Day Number of Units
________________ ____________ ____________ ______________
________________ ____________ ____________ ______________
________________ ____________ ____________ ______________

_____________________________
Director/Dean

I HEREBY CERTIFY that I have examined Mr/Ms. _____________________________ and found


him/her to be physically fit to carry out additional work beyond the official time of his/her regular function
as shown in the above schedules of work.
________________________________________
DR. GLADYS GRACE CABELTES
Medical officer III
______________________________________________________________________________________

Approved:

JESNAR DEMS S. TORRES, PhD., CESE


Assistant Schools Division Superintendent
OIC- Schools Division Superintendent

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