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Republic of the Philippines

Department of Education
Region IVA- CALABARZON
SCHOOLS DIVISION OFFICE OF LAGUNA
SCHOOL NAME
DISTRICT OFFICE NAME
Office of the School Principal

SPECIAL ORDER
No. ______ s. 2020

It is made a matter of record that the following Elementary / Secondary


Teacher / Personnel in this Division has RETURNED TO DUTY from
maternity/sick/ vacation leave of absence.

1. Name : XXXXXXX
2. Employee Number : XXXXXXX
3. Station before going on leave : XXXXXXX
4. Monthly Salary : XXXXXXX
5. Date leave was made effective : XXXXXXX
6. Date of Birth of Child : XXXXXXX
7. Date of Return to Duty : XXXXXXX
8. Substitute Teacher Relieved : XXXXXXX
9. Period of leave of absence : XXXXXXX

XXXXXXX
School Head (For Secondary)
PSDS (For Elementary)

Approved:

MARITES A. IBAÑEZ, CESO V


Schools Division Superintendent

School School Name


School Address
Logo School Contact Number

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