Republic of the Philippines

Department of Education
Caraga Administrative Region
Butuan City Schools Division
Southeast Butuan District II
MAHAY INTEGRATED HIGH SCHOOL
Mahay, Butuan City

INDIVIDUAL PASS SLIP/ TIME ADJUSTMENT SLIP

______ ________________________________ Date: __________________

(Printed Name of Employee & Signature)

Permission is requested to:

 Leave the office premises during office hours  Deviate from my fixed time of arrival
From: ________________ From: ________________ To:
To: __________________ _________________

PURPOSE: REASONS:_________________________________
 Official ___________________________________________
 Personal ___________________________________________
___________________________________________

Approved by:
______PETERSON A. OROPA_______
(Head Office/Authorized Representative)

Actual Time of Departure: _________________ Actual Time of Arrival : _________________

Republic of the Philippines

Department of Education
Caraga Administrative Region
Butuan City Schools Division
Southeast Butuan District II
MAHAY INTEGRATED HIGH SCHOOL
Mahay, Butuan City

INDIVIDUAL PASS SLIP/ TIME ADJUSTMENT SLIP

______ ______________________ __________ Date: __________________

(Printed Name of Employee & Signature)

Permission is requested to:

 Leave the office premises during office hours  Deviate from my fixed time of arrival
From: ________________ From: ________________ To:
To: __________________ _________________

PURPOSE: REASONS:_________________________________
 Official ___________________________________________
 Personal ___________________________________________
___________________________________________

Approved by:
______PETERSON A. OROPA_______
(Head Office/Authorized Representative)

Actual Time of Departure: _________________ Actual Time of Arrival : _________________