Republika ng Pilipinas

Kagawaran ng Edukasyon
Rehiyon XII
SANGAY NG MGA PAARALANG LUNGSOD
Lungsod ng Heneral Santos

Permit Number: _________

Date: _________________

APPLICATION FOR PERMIT TO TEACH

Name of Applicant: ______________________________________ Position: _____________________

Civil Service Eligibility: _____________________________________ Civil Status: __________________
Name of School where employed: ____________________________ Status of Appointment: _________
Performance Ratings for Past 3 years: _________________________No. of years in service: __________
Total Number of Minutes/ Teaching Loads: ______________________

_____________________________________________________________________________
(Name and Address of School where Applicant intends to teach)

Academic Year: __________________ Quarter/Semester/Summer: ________________

Subjects to be taught this term and the schedule:

SUBJECT/S DAYS OF THE WEEK TIME

_____________________________ ________________________ _____________________
_____________________________ ________________________ _____________________
_____________________________ ________________________ _____________________
_____________________________ ________________________ _____________________

Subjects are under what program? Undergraduate: ________ Graduate: ________

Number of subjects taught this Quarter/Semester/Summer: ___________________

I hereby certify that I have carefully understand the provisions concerning part-time teaching job which I am
bound to observe very strictly. If in the opinion of the Division Superintendent of School this will adversely affect my
efficiency as a teacher this permission to teach shall be revoked.

__________________________
(Signature of Applicant
Date submitted: _____________________

Noted and Endorsed by:

_____________________________
School Head/Immediate Supervisor

APPROVAL RECOMMENDED:

MARIO M. BERMUDEZ, CESO VI

Assistant Schools Division Superintendent
APPROVED:

ALLAN G. FARNAZO
Regional Director
and concurrent Officer-In-Charge
Office of the Schools Division Superintendent
APPLICATION FOR PERMISSION:

_______________________________________________________________
(Name and location of college where application wishes to teach)

CERTIFICATION

TO WHOM IT MAY CONCERN:

This is to certify that ______________________________________ a public school teacher, is seeking

permission to teach in this college (Name of School/College) _____________________________________ with the
following subjects offered this _____________________________________________.

SUBJECT/S DAYS OF THE WEEK TIME

_____________________________ ________________________ _____________________

_____________________________ ________________________ _____________________
_____________________________ ________________________ _____________________
_____________________________ ________________________ _____________________

Signed this _______ day of __________, 201__ at ______________________________________.

___________________________ _____________________________
DEAN REGISTRAR

NOTE:

1. Weekdays classes in a semestral terms should not be earlier than 5:00 p.m.
2. Permit to teach is applied every Semester.